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How Often Should One Have Nuclear Scan For Goiter?
Question: a male 14 yr old had nuclear scan and uptake, earlier had goiter, in scan found 2witin the isthmus .5x.3x.4 cm hypoechoid nodule in inferior aspect of rt lobe is a .4x.2x.3 c, cyst and .2x.1x.2cm hypoechoic nodule.in superior left lobe .2x..1.x1 c, hypoechoid nodule. in mid medial aspect of left lobe .3x.2x.2 cm heterogeneous solid nodule . the thyroid parachymal echogencity is otherwise remarkable..... How often should this be scanned? and he is on Syntrix(is that the right word?) I worry that it could turn cancerous. This male has just started his puberty at 17... He had been on NUMEROUS phychotropic drugs since the age of 9..... TOO MANY.... He has numerous phycological problems, but I worry about thte underlying problem, that the thyroid could mas many of the other problems.. How do I advocate for getting Nuclear scans? or how often should there be a scan or ? to keep this in control???
Is there something where they would report: his IGFB is normal??? I cannot find this IGFB... Please let me know what it is and what does it do??
thirdly, he is getting violent, and exhibiting schizophrenic tendencies.. How can we discern if the thyroid can have any influence on that, or his mental state at all...??
4.. how do I find which drugs can give gynocomastia? They are laughing since I ask about this, but I feel there have been so many drugs in his system, and I understand Gynocomastia does not go away even with weightloss. Please advise...
I am an advocate for this male ( hypothetical of course.....) so I would like to find the answers, since I do not get any from others involved.....
Thank you .
Is there something where they would report: his IGFB is normal??? I cannot find this IGFB... Please let me know what it is and what does it do??
thirdly, he is getting violent, and exhibiting schizophrenic tendencies.. How can we discern if the thyroid can have any influence on that, or his mental state at all...??
4.. how do I find which drugs can give gynocomastia? They are laughing since I ask about this, but I feel there have been so many drugs in his system, and I understand Gynocomastia does not go away even with weightloss. Please advise...
I am an advocate for this male ( hypothetical of course.....) so I would like to find the answers, since I do not get any from others involved.....
Thank you .
Brief Answer:
Hello
Detailed Answer:
Good day.
Noted your concern.
Hypoechogenecity is a term used in ultrasound scan, not in nuclear scan. I wonder if he had an ultrasound scan. Nuclear scan shows if the nodules are hot or cold and about the uptake. The size of the nodules are too small. All less than 0.5 cm. Noted that he is on Synthroid. We need to keep his Synthroid dose optimum to keep TSH in normal age. This may help to prevent increase in size of these nodules.
A repeat nulcear scan is ot necessary ( from your decription), but a ultrasoud follow up ater six month is reuired to compare the size of nodules. Psychotropic drugs and uldelying psychiatric conditions can affect thyroid functions and abnormal thyroid function can affect mental health sometimes. The option is to keep his thyroid medicines optimum and keep TSH in normal range.
Regarding IGFB, it is not clear what do you mean. DO you have a report which mention this? Could you please scan and attach that report to this question?
Male gynecomastoa is caused by many drugs which interfere with testosterone/estrogen ratio. Common drugs that cuase this include Spironolactone, Cimetedine, Fluconazole, Digoxin , few psychiatry medicines like tricyclic anti depressants etc
Regards
Binu
Hello
Detailed Answer:
Good day.
Noted your concern.
Hypoechogenecity is a term used in ultrasound scan, not in nuclear scan. I wonder if he had an ultrasound scan. Nuclear scan shows if the nodules are hot or cold and about the uptake. The size of the nodules are too small. All less than 0.5 cm. Noted that he is on Synthroid. We need to keep his Synthroid dose optimum to keep TSH in normal age. This may help to prevent increase in size of these nodules.
A repeat nulcear scan is ot necessary ( from your decription), but a ultrasoud follow up ater six month is reuired to compare the size of nodules. Psychotropic drugs and uldelying psychiatric conditions can affect thyroid functions and abnormal thyroid function can affect mental health sometimes. The option is to keep his thyroid medicines optimum and keep TSH in normal range.
Regarding IGFB, it is not clear what do you mean. DO you have a report which mention this? Could you please scan and attach that report to this question?
Male gynecomastoa is caused by many drugs which interfere with testosterone/estrogen ratio. Common drugs that cuase this include Spironolactone, Cimetedine, Fluconazole, Digoxin , few psychiatry medicines like tricyclic anti depressants etc
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
the IGFB is from a report which mention that his IGFB was normal. I believe they talked about growth hormone... since he did not get into puberty stage till the age of 17, the endrocolologist notes that his IGFB was normal... What is that??
I understand that the nodules are small, but I remember that more nodules had appeared in 6 months. Now I want to find out how often these should be checked ( for growth and possible cancer developments????) ??If they have not growm in 6 months,, it would not be certain, that they will not grow later..would it????
So my question on that, how often do you do scan of the thyroid and nodules to keep status of the size??? and what else would you do??
Does the Gynocomastia reverse easily, when medicine is stopped???
Would Syntroid, Abilify, Prozac, Clonidine, be of concern for developing gynocomastia??
Thanks so much,
I understand that the nodules are small, but I remember that more nodules had appeared in 6 months. Now I want to find out how often these should be checked ( for growth and possible cancer developments????) ??If they have not growm in 6 months,, it would not be certain, that they will not grow later..would it????
So my question on that, how often do you do scan of the thyroid and nodules to keep status of the size??? and what else would you do??
Does the Gynocomastia reverse easily, when medicine is stopped???
Would Syntroid, Abilify, Prozac, Clonidine, be of concern for developing gynocomastia??
Thanks so much,
Brief Answer:
Growth hormone activity indicators
Detailed Answer:
Okay,now i got it. I thought you mentioned about the scan report.
IGF-1 is insulin like growth factor 1. This is representative of growth hormone activity. Another marker is IGF-BP3 ( insulin like growth factor binding protein 3 ). If these are normal, his growth hormone axis is likely to be normal.
Noted your concerns regarding thyroid nodules. First approach would be to keep his thyroid hormone status normal by optimizing the synthroid dose. Second thing is to
do a repeat ultrasound scan of thyroid after 6 months to compare the size. If they are stable and no growth, then after one year. However, if any nodule is more than 1 cm or of there are suspicious features in ultrasound, then a needle test is required.
A repeat nuclear scan for this purpose is not warranted.
the drugs which you mentioned do no cause gynecomastia.
Regards
Binu
Growth hormone activity indicators
Detailed Answer:
Okay,now i got it. I thought you mentioned about the scan report.
IGF-1 is insulin like growth factor 1. This is representative of growth hormone activity. Another marker is IGF-BP3 ( insulin like growth factor binding protein 3 ). If these are normal, his growth hormone axis is likely to be normal.
Noted your concerns regarding thyroid nodules. First approach would be to keep his thyroid hormone status normal by optimizing the synthroid dose. Second thing is to
do a repeat ultrasound scan of thyroid after 6 months to compare the size. If they are stable and no growth, then after one year. However, if any nodule is more than 1 cm or of there are suspicious features in ultrasound, then a needle test is required.
A repeat nuclear scan for this purpose is not warranted.
the drugs which you mentioned do no cause gynecomastia.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, I am almost there, but I want to be very sure of my answers, as I will state them to professionals later....
Would you as an Endocrinologist tell a patient that his : IGFB was normal???
I see you explained about the IGF-1 and IGF-BP3. So I am wondering if this is how it is reported as: IGFB???? Or is it a mistake how they reported it???
Last question. He was requested to have an Adenoidectomy...
He has had a lot of sinus problems, has hearing los and allergic rhinitis... Is the Adenoidectomy still warranted, since also enuresis is getting better...
I think this is the last question Doctor , thank you
Would you as an Endocrinologist tell a patient that his : IGFB was normal???
I see you explained about the IGF-1 and IGF-BP3. So I am wondering if this is how it is reported as: IGFB???? Or is it a mistake how they reported it???
Last question. He was requested to have an Adenoidectomy...
He has had a lot of sinus problems, has hearing los and allergic rhinitis... Is the Adenoidectomy still warranted, since also enuresis is getting better...
I think this is the last question Doctor , thank you
Brief Answer:
Hi
Detailed Answer:
It will be reported as IGF-1 and IGF-BP3 ( not IGFB). It must have been a typing error.
Unfortunately, I don't have expertise to comment on necessity of an adenoidectomy. It is beyond my expertise. You may need to do meet an ENT ( otolaryngology) doctor to get advice on this
Regards
Binu
Hi
Detailed Answer:
It will be reported as IGF-1 and IGF-BP3 ( not IGFB). It must have been a typing error.
Unfortunately, I don't have expertise to comment on necessity of an adenoidectomy. It is beyond my expertise. You may need to do meet an ENT ( otolaryngology) doctor to get advice on this
Regards
Binu
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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