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Suggest Treatment For Cysts On The Right Thyroid
Question: Hi there. Just received a report for my recent US Carotid Duplex Scan, Bilat and while my artery is AOK, they found, incidentally, a well-defined oval, 16mm greatest dimension right thyroid CYST with focal macrocalcification and obviously, I am very concerned. The reports indicates that is a CYST and not a Nodule, so i am wondering if that makes a difference since I've red a good number of Nodules with macro calcification are indeed malignant. Any advice on next step would be most appreciated. TSH results from Dec 2014 (last time I was tested) were normal. Thank you for your time and assistance.
Brief Answer:
Thyroid
Detailed Answer:
Cysts are extremely unlikely to be malignant. In fact, pure cysts typically are not cancer because they do not have a solid component.
However, a thorough evaluation is warranted by an in-person examination preferably by an endocrinologist.
Even though your TSH was done couple years ago, it would be a good idea to get a current value.
When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting and can be done at any time of the day
Thyroid
Detailed Answer:
Cysts are extremely unlikely to be malignant. In fact, pure cysts typically are not cancer because they do not have a solid component.
However, a thorough evaluation is warranted by an in-person examination preferably by an endocrinologist.
Even though your TSH was done couple years ago, it would be a good idea to get a current value.
When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting and can be done at any time of the day
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks so much for the quick and detailed reply, Dr. Topiwala! That is very helpful info, however, I do have a few follow up questions:
*Is it common for Nodules to be mistaken for Cysts or vice versa?
*The studies I have read regarding thyroid nodules of *any* size with focal macrocalcification incidentally discovered via an ultrasound is that that they are almost always (+/- 95%) malignant. Is this not also true for Cysts? Based on your reply above, it sounds as though it isn't, but I want ask the question to be sure.
*By their very nature, can Cysts actually be macrocalcified? And if so, can you also please advise what focal macrocalcification is relative to a Cyst as opposed to other classifications of Cyst calcification?
*And finally, would a well-defined oval, 16mm greatest dimension, right thyroid CYST with focal macrocalcification indicate something that may actually be malignant or would those indicators point to something more benign in nature?
Although I know that further testing is most definitely warranted, am in curious if, in your experience, the characteristics of my specific cyst listed above would appear to indicate a malignancy or instead point to something more benign?
Thanks again for your time, assistance and expertise. I look forward to your reply.
Kind regards.
*Is it common for Nodules to be mistaken for Cysts or vice versa?
*The studies I have read regarding thyroid nodules of *any* size with focal macrocalcification incidentally discovered via an ultrasound is that that they are almost always (+/- 95%) malignant. Is this not also true for Cysts? Based on your reply above, it sounds as though it isn't, but I want ask the question to be sure.
*By their very nature, can Cysts actually be macrocalcified? And if so, can you also please advise what focal macrocalcification is relative to a Cyst as opposed to other classifications of Cyst calcification?
*And finally, would a well-defined oval, 16mm greatest dimension, right thyroid CYST with focal macrocalcification indicate something that may actually be malignant or would those indicators point to something more benign in nature?
Although I know that further testing is most definitely warranted, am in curious if, in your experience, the characteristics of my specific cyst listed above would appear to indicate a malignancy or instead point to something more benign?
Thanks again for your time, assistance and expertise. I look forward to your reply.
Kind regards.
Brief Answer:
Follow up
Detailed Answer:
Is it common for Nodules to be mistaken for Cysts or vice versa?
Unlikely. Ultrasound generally can differentiate between these two separate entities quite well, although cystic nodules do exist which have some solid elements.
*The studies I have read regarding thyroid nodules of *any* size with focal macrocalcification incidentally discovered via an ultrasound is that that they are almost always (+/- 95%) malignant. Is this not also true for Cysts? Based on your reply above, it sounds as though it isn't, but I want ask the question to be sure.
First of all you dont seem to have a nodule. So whatever you read does not apply to you. However it is best to see an expert in-person to be sure of a thorough assessment.
*By their very nature, can Cysts actually be macrocalcified? And if so, can you also please advise what focal macrocalcification is relative to a Cyst as opposed to other classifications of Cyst calcification?
By definition a cyst contains only fluid. So there cannot be calcification in it. So that should resolve your other concerns embedded within this question.
*And finally, would a well-defined oval, 16mm greatest dimension, right thyroid CYST with focal macrocalcification indicate something that may actually be malignant or would those indicators point to something more benign in nature?
There are several other characteristics on ultrasound of a nodule/cystic nodule such as margins, height, width and growth rate in addition to only calcification, vascularity and size, that need to be taken into consideration before making a prediction regarding it's malignant potential. So the information we have is inadequate.
Although I know that further testing is most definitely warranted, am in curious if, in your experience, the characteristics of my specific cyst listed above would appear to indicate a malignancy or instead point to something more benign?
Again, a pure cyst is extremely unlikely to harbor malignancy
Follow up
Detailed Answer:
Is it common for Nodules to be mistaken for Cysts or vice versa?
Unlikely. Ultrasound generally can differentiate between these two separate entities quite well, although cystic nodules do exist which have some solid elements.
*The studies I have read regarding thyroid nodules of *any* size with focal macrocalcification incidentally discovered via an ultrasound is that that they are almost always (+/- 95%) malignant. Is this not also true for Cysts? Based on your reply above, it sounds as though it isn't, but I want ask the question to be sure.
First of all you dont seem to have a nodule. So whatever you read does not apply to you. However it is best to see an expert in-person to be sure of a thorough assessment.
*By their very nature, can Cysts actually be macrocalcified? And if so, can you also please advise what focal macrocalcification is relative to a Cyst as opposed to other classifications of Cyst calcification?
By definition a cyst contains only fluid. So there cannot be calcification in it. So that should resolve your other concerns embedded within this question.
*And finally, would a well-defined oval, 16mm greatest dimension, right thyroid CYST with focal macrocalcification indicate something that may actually be malignant or would those indicators point to something more benign in nature?
There are several other characteristics on ultrasound of a nodule/cystic nodule such as margins, height, width and growth rate in addition to only calcification, vascularity and size, that need to be taken into consideration before making a prediction regarding it's malignant potential. So the information we have is inadequate.
Although I know that further testing is most definitely warranted, am in curious if, in your experience, the characteristics of my specific cyst listed above would appear to indicate a malignancy or instead point to something more benign?
Again, a pure cyst is extremely unlikely to harbor malignancy
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks again for your quick and thorough reply, Dr. Topiwala, as well as for your time and your expertise.
My final questions is this:
The report I received indicates that I have a:
'Well-defined oval, 16mm greatest dimension, right thyroid CYST with focal macrocalcification'
But given your comments, CYSTS cannot be calcified, correct?
And if that is the case, then it is more likely that the *terminology* in the report is incorrect and that I instead have either a Cystic Nodule with focal macrocalcification or simply a Nodule (not of a cystic nature) with focal macrocalcification since by definition it is impossible to have a Cyst with calcification of *any* type, macro or otherwise, correct?
My final questions is this:
The report I received indicates that I have a:
'Well-defined oval, 16mm greatest dimension, right thyroid CYST with focal macrocalcification'
But given your comments, CYSTS cannot be calcified, correct?
And if that is the case, then it is more likely that the *terminology* in the report is incorrect and that I instead have either a Cystic Nodule with focal macrocalcification or simply a Nodule (not of a cystic nature) with focal macrocalcification since by definition it is impossible to have a Cyst with calcification of *any* type, macro or otherwise, correct?
Brief Answer:
Second follow up
Detailed Answer:
I see your point. There is ambiguity in the report. A repeat scan can be considered in order to better characterize the lesion
Second follow up
Detailed Answer:
I see your point. There is ambiguity in the report. A repeat scan can be considered in order to better characterize the lesion
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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