21-Year-Old Female with Multiple Thyroid Nodules: Biopsy or Observation?
Age/Sex: 21-year-old female - TSH levels: within normal range - Thyroid gland: normal dimensions (Right lobe 5.4 × 1.6 × 1.5 cm; Left lobe 4.9 × 1.7 × 1.1 cm; total volume: 10 mL), with a uniform texture and no signs of abnormal lymph nodes. - Nodules identified: - Right lower lobe: 2 × 2 mm TR5 (marked hypoechogenicity with echogenic foci) - Right lower lobe: 4 × 4 mm TR5 (similar characteristics) - Left upper lobe: 3 mm TR5 (same findings) - Left upper lobe: another 3 mm TR5 (identical) - Left lower lobe: 7 × 5 × 4 mm TR5 (same criteria) - Left lower lobe: 4 × 4 × 4 mm TR1 (spongiform appearance) - Remarks: "Unclear if cystic or solid in nature." Radiology recommends annual ultrasound for the next five years. Inquiries: 1. Considering my report, what percentage of malignancy risk would you attribute to me, both as an individual and per nodule? 2. Would you choose to perform a biopsy on the 7 mm TR5 nodule at this time, or would you recommend surveillance? What is your reasoning? 3. Does being 21 years old or having several TR5 nodules influence the typical recommendation for fine needle aspiration (FNA) thresholds for nodules under 1 cm? 4. Should monitoring be preferred, what would be the suitable follow-up interval specifically for the 7 mm TR5 nodule? 5. Would you initiate a referral to an endocrinologist now, and how would delaying treatment by 6 to 9 months impact prognosis in the event of cancer? 6. If this were your patient, what specific action plan (including next steps and timelines) would you implement, along with any pertinent insights you might have? I find myself quite anxious and overwhelmed by this situation, so I truly value any thoughtful guidance and suggestions. Thank you kindly.
Answers (1)
9/12/2025, 11:40:43 AM
OpenHealth AI
Thank you for sharing your detailed concerns regarding the thyroid nodules. It's completely understandable to feel anxious about this situation, especially with the complexity involved. I’ll address your inquiries step by step to clarify your options and help you feel more informed and supported.
Summary of Main Points:
- The overall risk of malignancy in your case is low, especially given your age and the characteristics of the nodules.
- Current guidelines suggest surveillance rather than immediate biopsy for small nodules, especially under 1 cm, unless there are specific concerning features.
- Being 21 and having multiple TR5 nodules can affect recommendations, leaning towards observation.
- Regular follow-up is essential for monitoring any changes over time.
Detailed Explanation:
-
Malignancy Risk: For nodules classified as TR5 (suspicious features), the malignancy risk might range from 5-20% depending on various factors. Given that you're young and most of your nodules are small, the overall risk for you as an individual is likely on the lower end of this spectrum.
-
Biopsy vs. Surveillance: Since the 7 mm TR5 nodule has suspicious features but is also relatively small, many guidelines would recommend surveillance via ultrasound rather than biopsy at this time, especially since you are younger and don’t have abnormal thyroid function tests.
-
Age and FNA Thresholds: Yes, younger patients and those with multiple nodules typically follow more conservative approaches regarding fine needle aspiration (FNA) thresholds. It’s important to balance the risks and benefits, particularly when the nodules are under 1 cm.
-
Monitoring Interval: For the 7 mm TR5 nodule, follow-up with ultrasound every 6-12 months is generally appropriate, especially in the first couple of years when monitoring for changes is crucial.
-
Referral to Endocrinologist: Referring to an endocrinologist can provide you with specialized care and a comprehensive assessment of your situation. Delaying treatment for 6-9 months in the event of a malignancy could lead to possible progressing disease, but given the current findings and the low risk, this is likely manageable.
-
Action Plan: Here’s a proposed next step:
- Immediate: Schedule an ultrasound with a follow-up appointment in 6 months specifically for the 7 mm TR5 nodule.
- Referral: Consider a referral to an endocrinologist now for a tailored management plan.
- Monitoring: Keep a record of any symptoms you might experience, like changes in weight, mood, or neck discomfort.
- Follow-Up: Reassess the nodules in 6 months and prepare for yearly monitoring thereafter.
Final Thoughts:
Your feelings of anxiety are valid, but it's important to remember that many thyroid nodules are benign and can be safely monitored over time. Continue to communicate openly with your healthcare team, and ensure that you have all your questions answered during your appointments. I’m here to support you, and please reach out if you need further clarification or guidance.
Related Questions
Understanding Tuberculosis Exposure Risk
A 26-year-old male, who neither drinks alcohol nor smokes, seeks to understand the implications of exposure to tuberculosis (TB). As an anesthesia technician, I became concerned after I encountered a TB-positive patient about a month ago. I had to enter the patient’s room several times to perform blood gas tests. On my first entry, I mistakenly wore my N95 mask incorrectly due to the hectic nature of attending to multiple rooms. From my research, it appears that TB is quite transmissible; direct exposure can pose a serious risk of infection. Transmission usually requires prolonged contact with an infected individual, particularly in a close or face-to-face setting. In this case, the patient was lying face down and appeared to be sleeping when I entered. I have already undergone testing for TB, but I am eager to deepen my understanding of the risks involved in these situations.
24M | Unexplained Fainting Incident
**Note:** I previously shared this story, but it was inexplicably removed. I’m a 24-year-old male without any medical diagnosis or prescription medications. While I do consume alcohol occasionally, I hadn’t been drinking before this happened. Around 3 a.m., I got up from bed to use the restroom. As soon as I began to urinate, I suddenly felt a wave of dizziness. The next moment I was aware of was regaining consciousness in the bathtub, startled awake by the sensation of something dripping on me—only to discover it was my own blood. This was my first experience with fainting. When I came to, confusion set in. I was disoriented and couldn’t comprehend why I was being dripped on while in what I thought was my “bed.” Strangely, I also imagined that I was lying on a collection of marbles (which I actually don’t own)—this turned out to be the shattered glass of my shower door lying around me. I’m uncertain whether I lost consciousness first and then fell, or if the fall caused my brief blackout. It took me a few moments to understand why I was in the bathroom at all. I’m not sure how long I was out; I only remember it was around 3 in the morning when I initially got up, and about the same time when I regained consciousness. I dialed 911, and the ambulance arrived promptly. They checked my vitals, performed an EKG and measured my blood sugar, finding nothing unusual. At the emergency room, they repeated the vital checks, conducted a CT scan, drew blood, and took x-rays—yet still no abnormalities were detected. I had several cuts on my face and left arm (curiously, this is the arm that would have been turned away from the door), along with bruising around my ribs. Since the incident, I’ve been suffering from headaches and pain in my ribs. I received stitches on both my face and arm. The nurse suggested I could have stronger pain relief, but I opted for just Toradol. They eventually discharged me, stating, "We’re unsure what caused this, but return if it happens again." What might have triggered such an incident? How can I safeguard against it reoccurring if they remain uncertain about the cause?
Healing Progress Post-GBS: Toe Concerns
I am a 28-year-old male, measuring 5 feet 10 inches and weighing 131 pounds. My current medications include Fomadatine and Zyrtec, prescribed due to my ongoing battle with Chronic Gastritis and SIBO. I maintain a healthy lifestyle, abstaining from both smoking and alcohol. My health concern revolves around the toe adjacent to my pinky toe on my left foot, as well as my pinky toe on the right foot. Since August of last year, I have been on the mend from Guillain Barre Syndrome. Recently, I've noticed that at night, the skin on my feet tends to turn a reddish pink, although this usually improves after I walk around. However, two of my toes have remained red, with one appearing slightly swollen. Generally, my pinky toes are quite thick, but the condition of my left foot's toe is worrisome for me. It seems that I'm unable to upload an image to illustrate my issue.
Challenges with Appetite and Discomfort While Eating — Difficulty in Gaining Weight
As an 18-year-old male, I find that I become satisfied after consuming rather minimal amounts of food. This situation presents a considerable challenge, particularly since I only need to have a standard breakfast, lunch, or dinner to feel completely satiated for the remainder of the day. My goal of increasing my weight has made this issue even more complicated. When I limit myself to one meal per day, I often face weight loss or an uncomfortable sensation of fullness that leaves me feeling sluggish. Opting for two meals makes me feel excessively bloated, distracting me from my daily responsibilities. Moreover, I suffer from an unusual issue with my throat, where almost any food I consume causes discomfort, as detailed in the list below. I have contemplated focusing on having just lunch while continuing my weightlifting regimen to maintain my current weight and gradually build muscle. What advice could you offer? Could there be an underlying cause for these symptoms? Lastly, would it be wise for me to consult a healthcare professional? Foods That Cause Discomfort: Bread, flour, pizza, fruits, sugary or starchy items, seed oils, chips, and essentially everything else. Foods That Are Tolerable: Rice, salads, chicken, fish, and vegetables. Overall Symptoms Include: * Quick satiety after normal meals * Challenges in gaining weight * Bloated and lethargic sensations when consuming more than one meal * Persistent throat sensitivity to a wide variety of foods
Seeking Insights: My Journey with Undiagnosed Neurological Symptoms
Hello everyone, I'm a 34-year-old female grappling with neurological symptoms that first appeared in October, and I’m eager to hear from anyone who might have faced similar challenges. My journey began with unexpected migraines, blurred vision, and an ongoing sensation of being off-balance or intoxicated. Gradually, I began experiencing mainly sensory-related symptoms, such as tingling and burning sensations, feelings of extreme heat and cold, sharp pains radiating in my arms and back, as well as discomfort in my hands and toes, alongside intermittent numbness. I also endure varying degrees of weakness and heaviness in my right side, specifically my arm and leg, although I haven’t suffered complete functional loss. The nature of my symptoms is erratic; they fluctuate rather than consistently deteriorate. An MRI revealed mild, scattered lesions in the white matter, which were deemed nonspecific. Further tests from a lumbar puncture returned normal results, showing no markers of inflammation, and the oligoclonal bands were not present. A thorough range of lab tests yielded no significant findings. After evaluating my case, the neurology team suggested a possible diagnosis of MS and administered a three-day course of intravenous steroids. While I noticed a slight improvement in some sensory pain, my symptoms persist and continue to vary day by day. I still experience headaches and pressure in my head along with episodes of blurred vision, but there have been no new deficits since treatment. I am reaching out to connect with others who have had similar experiences. I would like to learn about the insights or diagnoses you encountered and what treatments proved beneficial (such as those related to migraine disorders, dysautonomia, or sensory neuropathy, for example). If you have navigated a similar path, I would greatly appreciate your sharing your story. Thank you!