Concerns Regarding My Enlarged Thyroid: Should I Be Worried?
I’m a 26-year-old female grappling with thyroid issues, specifically Hashimoto’s disease and a goiter. I weigh 120 pounds and stand at 5 feet 5 inches. Currently, the only medication I take for my thyroid is a high dose of vitamin D (ergocalciferol), while I also use Pristiq for managing depression, PTSD, and anxiety. Recently, I came across a discussion thread that highlighted some key warnings for individuals in their twenties, and it caught my attention. One significant statement was, "There is no safe way to strangle someone." Research indicates that even minimal pressure that restricts oxygen flow can lead to brain injury. It's alarming to note that a person may lose consciousness within just 10 seconds of being choked, and brain damage could occur in a mere 17 seconds. In some cases, death can happen as quickly as 150 seconds after losing consciousness. Studies have revealed that women who endure sexual strangulation report neurological changes, including a nearly two and a half times higher likelihood of experiencing depressive symptoms. From a medical perspective, strangulation can result in serious issues such as dissection of major neck arteries, obstructed blood circulation to and from the brain, swelling of the brain, cardiac arrest, miscarriages, and even strokes that might not manifest symptoms for weeks. Neurological effects of this trauma range from loss of consciousness—indicative of at least mild brain injury—to paralysis, speech impairments, and seizures. Cognitive issues can include amnesia and struggles with executive functioning, which encompasses decision-making and planning. On the psychological side, individuals may face PTSD, feelings of dissociation, suicidal thoughts, anxiety, and changes in personality. Research suggests that repeated experiences of sexual strangulation can lead to neural activation imbalances in the brain, affecting various functions related to consciousness and emotion. Additional comprehensive studies are necessary to understand both the immediate and long-lasting impacts of such trauma more fully. Regarding my health, my thyroid tends to fluctuate in size, often becoming larger. The most recent imaging I received in January showed changes, which led to a biopsy that fortunately did not indicate cancer. However, the nodules noticed in my ultrasound have varied in size since that time. The report detailed the thyroid gland's heterogeneous echogenicity and hyperemia. Measurements include: the right lobe at 5.1 cm x 1.6 cm x 2.3 cm, the left lobe at 5.0 cm x 1.7 cm x 1.7 cm, and the isthmus at 0.4 cm. I have also identified three nodules: 1) a solid hypoechoic nodule measuring 1.4 cm x 0.9 cm x 1.5 cm, if thyroid-related this scores 7 total points; 2) a solid hyperechoic nodule measuring 2.6 cm x 1.1 cm x 2.6 cm, scoring 6 points; 3) another solid hyperechoic nodule, 1.1 cm x 0.7 cm x 1.1 cm, also scoring 6 points. Considering this information, should I be concerned about the risks associated with my enlarged thyroid? I’m wrestling with the decision of whether to have my thyroid surgically removed, as I'm reluctant to depend on medication for a prolonged period. Given the pain and the potential for choking or other effects resembling those stated above, I am seriously reconsidering my options for surgery.
Answers (1)
7/12/2025, 3:30:54 AM
OpenHealth AI
Main Points: Your concerns about your enlarged thyroid and associated symptoms are valid. Following a recent biopsy showing no cancer, it's essential to focus on monitoring your thyroid health while considering your treatment options. You should prioritize open communication with your healthcare provider about your symptoms, the need for surgery, and your long-term management plan.
Explanation: Hashimoto’s disease can cause fluctuations in thyroid size and could lead to goiter formation and nodules. The fact that your recent biopsy was negative for cancer is reassuring. However, it’s understandable that you're worried about the size of your thyroid and potential complications, especially considering the pain and discomfort you mentioned. It's good that you are informed about the risks associated with thyroid conditions, but the likelihood of severe complications in your case seems reduced, especially since malignancy has been ruled out.
Nodules in the thyroid, particularly when benign, can sometimes be monitored instead of immediately treated with surgery. However, if you are experiencing difficulty breathing, swallowing, or significant discomfort, discussing surgical options might be necessary.
Next Steps:
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Document Your Symptoms: Keep a detailed record of any symptoms related to your thyroid, such as changes in size, pain levels, swallowing difficulties, or signs of depression and anxiety that may be exacerbated by your thyroid condition.
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Schedule a Follow-Up Appointment: Contact your healthcare provider to discuss your concerns about the goiter, the nodules, and your overall thyroid function. It’s essential to have a candid conversation about whether surgery is the right route for you, considering the potential benefits and risks.
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Monitor Thyroid Function Tests: Ensure regular monitoring of your thyroid hormone levels and any new imaging, as recommended by your healthcare provider, to keep a closer eye on any changes.
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Explore Treatment Adjustments: Discuss with your doctor whether adjusting your current thyroid medication or treatment plan could improve your symptoms without the need for surgery.
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Attend to Mental Health: Continue managing your mental health actively with your current treatment for depression, PTSD, and anxiety. Consider discussing any heightened anxiety regarding your thyroid health with your mental health professional.
Remember, it's crucial to feel comfortable and informed about your treatment options, so gathering all necessary information will empower your decision-making process. I'm here to help you understand your options better or provide more information if you need it.
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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.