Question about Father's High TSH and Large Nodule

Posted by zent100 @zent100, Mar 2 11:35am

Hello,

Thank you for reading my message about my father.

Father is 87, lives in India. Primary care Physician did a routine physical and found a very high TSH of 9.82 (0.34 - 4.25) and normal values of T3 and T4. TSH was previously measured in July 2021, and it was 4.5 and since it was borderline, no further testing was done. Un ornately the thyroid testing was not done in physicals until now.

A neck ultrasound found a 6 cm x 3.4 isthmus nodule with a calcified focus. Cystic nodules in both lobes. Right lobe was atrophic and showed coarse echotexture: Chronic thyroiditis. Benign Nodule with a TIRADS 1/2. The submandibular glands are normal. No obvious lymphadenopathy.

Was referred to a cancer surgeon as the nodule is very large. He tested for Thyroglobulin. It came out as 21.2 (1.7 - 55.6). He advised against biopsy for now. Prescribed daily 50 mcg of Thyroxin. Asked to see him in two months.

Questions:
1) If father's nodule is cancerous, will waiting two more months make it spread beyond the thyroid? Better to do the biopsy now?

2) Is it better to see an Endocrinologist at this point and do additional tests like thyroid antibodies, Free T3 and T4 etc. to look for signs of cancer?

Thank you,

Zent

Interested in more discussions like this? Go to the Thyroid Cancer Support Group.

I appreciate all your concerns for your father. It might be helpful to know that a biopsy is not always definitive. I suspect the Dr believes it is related to the thyroiditis more then an active or aggressive cancer. He is prescribed medication that would slow any thyroid cancer if it was but may also resolve another issue causing the problems. The high levels could even reflect a thyroid trying to work overtime. If the levels drop after two months and the growth is slowed and or even shrinks that would be a really positive outcome, especially at his age. Major surgery would be difficult for him.
Since he only is waiting 8 weeks most thyroid cancers wouldn't advance much in that time beyond the current situation. My surgeons opted not to do a biopsy and simply removed the growth after a brief 6 wk period. It did turn out to be cancerous and I had a followup surgery 6 wks later to remove the remainder of my thyroid.
You are being a great advocate for your father. You might call and ask to speak to his doctor , or email them, and ask him those questions you have. He'll need your fathers permission to discuss with you, but hearing his reasoning may help you with your concerns.

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Hello,
Thank you so much for your helpful reply!
Spoke to the surgeon who thinks it's unlikely the module is cancerous. For the last 6 months, his voice has become softer at times and normal at other times. So, I am not sure if that is related to the thyroid issue. Did you experience that prior to the surgery?

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Actually I did have voice fluctuations afterwards more then before. I have seen in family and experience, that as individuals age, modulations in speech begin to change. It's simply the ability at times to control speech levels. So I am wondering if perhaps it is more age related , then the thyroid growth.
I'm glad you were able to speak with the doctor and hopefully that reassured you some. I understand it's hard to watch our parent age and have issues arise that we can't change. That concern is a normal reaction. You are a great advocate for your father. I am hoping you can spend some joy filled times with him . Praying the medication helps him and in 8 weeks you'll get better news!

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Thank you so much for your kind reply and prayers! I hope you don't mind if I ask you questions in the future.

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I personally think that he should do the biopsy! I had a partial thyroidectomy two days ago, and my cancerous nodule stayed right in the thyroid ..encased in cystic fluid, and it is all gone!
It’s a somewhat painful recovery, but I’m glad the cancerous nodule is out of me and I have peace of mind!

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@zent100

Thank you so much for your kind reply and prayers! I hope you don't mind if I ask you questions in the future.

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However I can support you. Happy to help .

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@trosborn21

I personally think that he should do the biopsy! I had a partial thyroidectomy two days ago, and my cancerous nodule stayed right in the thyroid ..encased in cystic fluid, and it is all gone!
It’s a somewhat painful recovery, but I’m glad the cancerous nodule is out of me and I have peace of mind!

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Glad you are doing well. Thank you for the response.

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