I would appreciate the advice of your experts on one of my patients. She is a 70 yo woman with a hot nodule which increased from 3 to 3.8 cm between 2000 and 2002. It has recently increased over the past year to 5 cm. I saw her first a year ago. She has no compressive symptoms. She also has no symptoms of hyperthyroidism. PMH: S/P aortic defect repair in 1999 with moderate Mitral regurg., HTN, chronic renal insuff
DATA : TSH 0.24, FT4: 0.8, T3: 138. I-123 scan: MNG with autonomous nodule on left Thyroid u/s: left nodule now 5cm Rt 1 cm nodule.
I was planning to recommend treatment with I-131, but was wondering with the size increase if you would recommend anything else.? Thank you, Lisa Wisniewski, MD email@example.com
Add - I did recommend I-131, but patient preferred not to get that yet.
The patient has a large, growing, mildly hyperfunctioning, nodule in a gland with other nodules, in the setting of several health problems. One approach would be surgical resection and if carefully performed might be very satisfactory. 131-I certainly would be suggested my many thyroidologists. Probably this would best be proceeded by FNA to rule out ma l ignancy, but the results may be indeterminate. The choice of dose should be carefu l ly considered, since it might be best to treat with a moderate dose rather than a huge ablative dose, which in this case would be quite large and give the adjacent area a high radiation dose. In Europe such patients are sometimes treated by direct ethanol injection into the nodule, but I believe experience with that technique is limited in USA. L De Groot, MD