HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

question-icon

Suggest Treatment For Thyroid Nodules

default
Posted on Mon, 23 Feb 2015
Question: Here is my story. I had a CT with contrast to evaluate my heart for upcoming Aortic Valve replacement. This past Sunday I was reviewing my medical records for the surgeon appointment and noticed they found nodules on my Thyroid. Never was I told by the cardiologist and the test was ran a month earlier. When I went into the surgeon he said that he would not perform the surgery until we know the thyroid concenrs because it can affect the functions of the heart. I then saw my internal medicine primary and had labs ran and for TSH T1 T2 T3 T4 and all were normal. He sent me to the hospital for an ultrasound. They found a nodule on my Ithsmus and on my left lobe. I saw an endocrinologist yesterday. She was referred to me but I found out she has only been in practice a year. She did an ultrasound and said the one on my Ithsmus is an Echoic Primarily solid nodule and it measured 2 cm. the one on my left lobe was also Echoic but not as solid. I asked her risk of cancer and she said the left was not a concern but the ithsmus was suspicious for cancer and she gave it double the odds that it was. She said it is very treatable but she also said that I had several other nodules under 1cm throughout my thyroid. She said either way she would recommend that I remove my thyroid due to future risks even if not cancer. I fought the hospital and she supported me in getting a stat biopsy knowing I have open heart surgery scheduled. They are getting me on Monday and I should have results by Wednesday afternoon. My questions...Should I do heart surgery first or the thyroid surgery if cancer? If not cancer I would think do heart surgery first. She did an ultrasound of my lymph nodes and said she didn't see anything which is good. I also have a second opinion Endocrinologist appointment on Monday so I need to know what to ask. What scares me is we would have never known I had them if my CT was not done. They said they are slow growing by 2cm is big which means they have been there for awhile right? What are odds if they are cancer that they spread to something else if there for awhile? Based on description of what I gave you - she said solid had a halo appearance around it would you suspect it is cancer? Next questions....can you have an aortic mechanical valve with no thyroid? What would the affects be on the heart especially if I have it removed after heart surgery and its newly functioning? Please let me know and also do you recommend removal of the thyroid even if benign? Also will idione radiation affect my heart valve either now or when I have it in the future and will idione attack the heart? ALso can you take Coumadin with Thyroid meds and what are the contradictions for long term use a it woud be 40 years if I lived a full life and what is full life expectency with both of these? Can you ask a specialist for Endo and Cardiologist? Thanks!
doctor
Answered by Dr. Lilit Baghdasaryan (4 hours later)
Brief Answer:
Nodule seems bening

Detailed Answer:
Dear Mrs,

From your description nodules seem benign. If lymph nodes are intact, it is good sign. Anyway biopsy is obligatory. If you were my patient at first I would perform thyroid biopsy and check serum TG and anti-TPO antibodies. If the answer is bad, which is less probable, I would go for thyroid surgery, If the answer is good, I wouldn't do surgery now. I will try start treatment unless there are other indications for surgery. Nodules more than 3.0cm are indication for surgery, smaller nodules can be managed conservatively, but it depends also on the case.
If thyroid surgery is done, there will be a need for hormone therapy. And you can go safely with hormone therapy for surgery of valve replacement. Also there is no contraindications for using warfarin and thyroid hormone together. There will be a need to monitor INR closely.

Hope I could help you

Wishing you good health

Regards,
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Lilit Baghdasaryan (15 minutes later)
Also need to add I am Coumadin sensitive from a genetic test and also one nodule is 2cm and solid ectopic? Still think cancer free? Would you as cardiologist recommend thyroid surgery first or after valve replacement and will thyroid removal affect heart functions? Do you know anyone who has mechanical valve I am doing on x valve and no thyroid? Also have you heard of any complications with on x valve,
doctor
Answered by Dr. Lilit Baghdasaryan (22 minutes later)
Brief Answer:
Please, find the answer below

Detailed Answer:
Dear Mrs,

Nodules more seem to be benign from the description, but the definite answer will give biopsy.
In case of cancer I would first recommend thyroid surgery.
After thyroid removal patients receive hormone replacement therapy, and usually it doesn't affect heart function.
There are good data on On-X valve, it is not inferior from other valves from the point of efficacy and superior from the point of side effects; it has lower probability of throboembolic events , thus a need for lower dose of warfarin
Complications are always the same as other mechanical valves, thromboembolic events and bleeding events. In the case of on-x valve they are less

Regards,
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
Dr.
Dr. Lilit Baghdasaryan

Cardiologist

Practicing since :2007

Answered : 1536 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

159 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
Suggest Treatment For Thyroid Nodules

Brief Answer: Nodule seems bening Detailed Answer: Dear Mrs, From your description nodules seem benign. If lymph nodes are intact, it is good sign. Anyway biopsy is obligatory. If you were my patient at first I would perform thyroid biopsy and check serum TG and anti-TPO antibodies. If the answer is bad, which is less probable, I would go for thyroid surgery, If the answer is good, I wouldn't do surgery now. I will try start treatment unless there are other indications for surgery. Nodules more than 3.0cm are indication for surgery, smaller nodules can be managed conservatively, but it depends also on the case. If thyroid surgery is done, there will be a need for hormone therapy. And you can go safely with hormone therapy for surgery of valve replacement. Also there is no contraindications for using warfarin and thyroid hormone together. There will be a need to monitor INR closely. Hope I could help you Wishing you good health Regards,