Suggest Treatment For Difficulty Breathing Inspite Of Suffering From Hypothyroidism

Posted on Thu, 15 Jan 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 15 Jan 2015 Answered on

Sat, 31 Jan 2015 Last reviewed on

Question : I have hypo thyroid for 30 years. Neck pain ultersound showed nodule very heterogeneous one biopsy said follical cell with possible hurtle cells. Thyroditis suspect. Hard to swallow. Second afirma biopsy said benign. Symptoms are very much hypo. Right side of neck hurts. Breathing laying down harder. Surgens p a called today and said may not be able to to help me.because of past heart problems. Waited six weeks for app. He will see me three hours away. Do I go or look for someone else? App is this Friday

Answered by Dr. Ajish TP (37 minutes later)

Brief Answer:
Please upload the reports

Detailed Answer:
Hi,

Welcome to HCM. I have gone through your question and understand your concerns.

Please upload the ultrasound and FNAC (biopsy) reports, so that we can answer better.

We do surgical removal of thyroid when any of the following is there:

1. Size of nodule more than 4 cm
2. Pressure symptoms
3. Growth extending down the chest cage
4. Biopsy - cancerous or follicular neoplasm

If the swelling is big, causing pressure symptoms ( swallowing problems) and the initial reports says follicular neoplasm, it is better to do surgery. If you are having cardiac problems, do it in a centre where cardiology back up is there. First consult your surgeon and get his opinion.

Hope I have answered your questions. If you have any further queries I will be happy to help you.

Regards,

Dr Ajish TP [MD,DM]
Consultant Endocrinologist

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Ajish TP (6 hours later)

What I really want to know in your opinion do I need surgery or to at least see surgeon?My endocrinologist sent me to this Surgeon He is at University of Md Hospital Thank you for your help XXXXXXX

Answered by Dr. Ajish TP (49 minutes later)

Brief Answer:
Needs surgery

Detailed Answer:
Hi XXXXXXX

Welcome back.

I have gone through your reports. You should meet a surgeon and go ahead with surgical removal of thyroid.

One of your biopsy report say - "follicular neoplasm". In follicular neoplasm we cannot say whether it is benign (non cancerous) or malignant (cancerous). Though only 20% of these reports turn out to be cancerous after surgery, the current recommendation is to do surgery for all cases reported as "follicular neoplasm".

Second biopsy says normal - but this report cannot be relied 100%, as we are needling a large nodule and looking at the cells caught in a needle. So whenever there are 2 reports : one benign and another cancerous/ follicular we will take the abnormal one and go ahead with surgery.

So the best option for you is to go ahead with surgery.
If you are not going for surgical removal, you needs close follow up with ultrasounds and needle biopsies every 6-12 months.

No need to get worried about thyroid cancer as the chance of you having that with these reports is less than 20%. Even if it is cancer, it is the safest cancer. Surgical treatment will result in complete cure in more than 95% cases.

Hope this will clear your doubts.
Wishing you good health.

Regards
Dr Ajish TP

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Ajish TP (1 hour later)

Thank you very much for your help and explanation. It has helped me greatly. I appreciate your advice. I will go to appointment on Friday at the University Hospital but if the surgon does not feel confortable dong surgery I will find another. Again thank you. XXXXXXX

Answered by Dr. Ajish TP (2 minutes later)

Brief Answer:
Wishing you good health

Detailed Answer:
Hi XXXXXXX

Great to know the information provided was useful to you.

Wishing you good health.

Regards
Dr Ajish TP

Above answer was peer-reviewed by : Dr. Shanthi.E