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How can a thyroid nodule be treated?

Q: I am a 31 years old man detected with a heterogeneous thyroid nodule in the right lobe of size 4.0 x 1.9 cm. Increased vascularity noted within the nodule with no calcification/cystic changes. My left lobe is normal in size, shape and texture but a small hypoechoic nodule measuring 0.7 cm has been noted in the posterior aspect of the left lobe. The isthmus is normal too. The thyroid function test report showed - T3 - 1.15 ng/mL (normal range is 0.8-2.0), T4 - 9.25 ug/dL (normal range is 5.1-14.1), TSH - 4.10 uIU/mL (normal range is 0.27-4.2). The doctor suggested surgery to get the nodule removed. I consulted another doctor for a second opinion. He did the FNAC test, which stated - paucicellular aspirate, ultrasound guided FNA from nodule in right lobe of thyroid. My Anti TPO test showed 0.6 U/mL (less than 9.0). So, he suggested waiting for 6 months to see if the nodule increased in size and after that the FNAC would be repeated. Right now no medication/surgery is required. What do these test results mean? I don't have any thyroid related symptoms except severe neck pain. I have a congenital vertebral block in C6-7. The doctor opined that the thyroid nodule might have triggered the neck pain. Please advise.

A:As per information given by you, its clear that you have thyroid nodule which is quite good size. Now your worry (anybody will have) is whether this nodule is benign or malignant (cancer). Best way to know this is to get FNAC. In your case FNAC was not adequate, therefore first step is to go for a repeat FNAC. Or the test, which may be useful to give this information, is thyroid nuclear scan. Based upon these reports one has to take a decision. Most likely it will be benign and then you have three options; surgery, medications (thyroxine), which can keep it under check or just observation. Its good to follow up with a endocrinologist. Surgeons usually tend to go for surgery more often than physicians and endocrinologists. Final decision should be yours - if you have worry in your mind all the time then it is good to go for surgery.

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