What Do Nodules On Thyroid Indicate?
THYROID SURGERY
Detailed Answer:
Good day,
Noted your concerns. There are several issues to discuss.
1. Post Aortic valve repair, you will be on blood thinners ( Warfarin/Coumadin) and it has to be stopped before any future surgeries, procedures. So that has to be considered.
2. To assess the chances of thyroid malignancy. This will need a needle test. Thyroid cancer risk assessment can only be done after a needle test.HALO around nodule is a good sign and malignant nodules usually will lack it.
However, as your endocriologist has pointed out , there are several nodules on both sides which will grow in future and it is impossible to do a needle test from each nodule. These nodules will eventually grow and hence the best option would be surgery.
If the needle test is negative, and if you choose to observe, then thyroid surgery can wait and a repeat scan after 6 months will be recommended. Even if the needle test is benign, if the nodules grow in future surgery will be indicated. So it is a tricky situation and if i were you, i would opt for surgery.
If the Aortic stenosis is severe, you will need an early surgery for that. If needle test is negative thyroid surgery can be done later. However, the other argument is that, you will be on blood thinners after valve repair and for any future surgeries, that will have to be stopped and you will need heparin during that time. So some surgeons will prefer to do a thyroid surgery first and do valve repair later. Thyroid surgery is not complex and is easier compared to valve repair.
There is no problem taking Coumadin and thyroxine together. If there is cancer in thyroid, you may ( based on type of cancer) need radio iodine later. This also will not affect heart valve.
YOU WILL NEED TO SIT TOGETHER AND TALK TO ANAESTHESIST and HEART SURGEON and ENDOCRINOLOGIST ( after needle test) regarding all the above factors.
I realize that it is a complex situation. But this is the best advice i can give you with out examining you. Please feel free to ask further.
Regards
Binu
Please wait for needle test report
Detailed Answer:
Solid and hypoechoic lesions can rarely harbour cancer. If you have a tight aortic stenosis, that has to be repaired anyway. Your thyroid nodule must have been there for a while which was incidentally noted in a CT scan. This is called as an incidentaloma. There is only around 1 to 5% chance of malignancy. Even if it is malignant, most thyroid cancers are very slow growing. It can take several years for them to grow unlike cancers in other parts if the body.
There is no issues taking coumadin and thyroxine together.
There is minimal or no chance that the thyroid nodules can spontaneously reduce in size. There are no drugs which can reduce the growth of nodules. However if you have hypothyroidism( TSH high and Free T4 low ) then thyroxine treatment can occasionally shrink the nodules. But a 2 cm module is very unlikely to regress even with thyroxine.
At this stage I feel that you should wait for the thyroid nodule needle test. Decisions can change based on this and please be patient for few days.