thyroid mass

I went to the ER last February. Very early in the morning. It was a rare slow day at the hospital, so they gave me every test my insurance would pay for. About $38,000 worth in all. I had a broken neck, so that was front and center. When I was discharged, I noted it said I had a 2.5cm mass on my thyroid and I needed to follow up with my PCP. The doctors at the hospital never mentioned it to me. It sounded serious. My father in law recently passed from thyroid cancer. The CT and MRIs I had revealed the mass. None the less, I had to have an ultra sound of the thyroid. The results were posted to my on line medical chart. (2.5cm mass on thyroid). Then I got a consult to Ear Nose Throat specialists. The PA there asked if he could touch my neck. I said sure. He asked me to swallow. I did. Then he said I was finished and I could schedule a biopsy on my way out the door. He wrote on my chart that he informed me I had a 2.5cm mass, which I was unaware of. Nothing could have been farther from the truth. He just wanted to add the consult to the cost of the biopsy. I researched it and decided not to have the biopsy. 50% of people over 50 years of age have a mass on their thyroid. If it is 1-1.6 cm, you have a 5% chance of malignancy. If it is larger, you have a smaller chance of a more malignant form of cancer. I discussed my decision with my PCP, and he said it was a reasonable decision. The ENT got his consult, but the biopsy got away.

I'm sorry you're having to deal with this. Sounds stressful.

More to the story. My PCP said they did FNA (fine needle aspiration)/biopsy at the local hospital. I had him make me an appointment. I just didn't want to patronize the other ENT people because they had settled with the DOJ for $10 million in 2020. Of course, I had to have another ultra sound with the hospital. Then they do the FNA during another ultrasound. They get their $$ one way or another. I had a big copay because my insurance wasn't going to pay for all those ultrasounds. And this was on top of the thousands I paid for MRIs and CT scans with my neck. OK, the results come back not so good. Endocrinologists or ENTs do their own cancers. They use a Bethesda scale to rate you 1-6. 2 is benign, 6 is cancer, 3 & 4 are suspicious. I got a 4. I have yet to have my consult, but they are likely going to advise I have at least half of my thyroid removed. My age and size of the thyroid mass work against me. It's easy for them. It's what they do. However, after having reviewed studies from Sloan Kettering and MD Anderson, I see where 70-80% of surgeries were revealed to be not cancerous. As far as I'm concerned, they can leave it alone and monitor it with additional FNAs until they are sure it is cancerous, and then I'll submit to surgery. Sadly, their is diagnostic controversy in this area and isn't it shameful they can't determine if a mass is cancerous or not until it has been removed? On the bright side, I did expand my vocabulary. Cytology, follicle, neoplasm, lesion, adenoma, histology, Hurthle cell carcinoma, are now all part of my repertoire.

Wait i thought glp1s are contraindicated if you have thyroid issues?

Yes, and thank you. I think that is true if you have been diagnosed with thyroid cancer. My Bethesada rating of 4 puts me in a category of risk for thyroid cancer. (23-30% depending on who you believe). However, my thyroid is functioning just fine. Patients taking GLP-1 agonists should be monitored for thyroid function regularly. If thyroid dysfunction is detected, it may be necessary to adjust the medication or discontinue its use. It is important to note that the risk of thyroid issues with GLP-1 agonists is low. Most patients who take these medications do not experience any thyroid problems. I'm rolling the dice for 4 months. I don't think I will agree to even a partial thyroidectomy. Even if my mass is trending towards malignancy, the vast majority of thyroid cancers are not aggressive and I think monitoring the mass for malignancy and thyroid for functionality is the proper course of action.
Though I'm sure they would be just as happy to remove it. That's their specialty!

Frankly, ozempic has been such a game-changer, such a miracle-implementer, such an earth-mover - could i be any more emphatic? - that i would recommend its use under pretty much any circumstances. It is indeed alchemy. Its like drivin a Cadillac!

I agree. The term "game changer" is greatly over used, but it may be appropriate for these weight loss drugs. Our nation is in a metabolic crisis. Obesity, Diabetes, Hypertension, Atherosclerosis, Heart attack and Stroke.
They should be adding these GLP-1 drugs to hamburger buns.

I investigated the costs of my FNA biopsy and pathology procedure. The national average is less than $2k. I was charged over $5k.
I asked for a detailed billing statement because I was asked for a $300 copay during phone registration and never received any paperwork.
I actually think they billed me for a 2nd ultrasound because they think the two procedures are related, (ulatrasound then FNA) and that's the way
it usually goes down. However, the ENT I went to wanted to charge me for a consult before he did the FNA which was unnecessary. I had just paid
for MRIs, CT Scans, etc, which clearly identified the issue. I had the ultrasound which further identified the issue. He wanted his consult fee prior to
doing the FNA. I didn't make the appointment. 7 Months later I had the FNA scheduled at the hospital and they're thinking "we've bee cheated! we didn't get to charge him
for an ultrasound!" And the beauty of it all is I have to go back to the first guy for a consult on the findings and he is going to recommend a partial or total thyroid removal.
I need to talk to someone at my med advantage plan to see if there isn't a better option for me. Sheesh! The ultrasound in conjunction with the FNA is just to guide the needle.
If they had analyzed my thyroid with a 2nd ultrasound, a comparison might have been helpful. They don't care. Just remove the damn thing. It's what we do and we're good at it.