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Questions for Dr. Kennedy
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hot or cold nodule
Posted by: Barb Weeden
Date: March 16, 2002 6:48 PM

I am scheduled for a FNA next Friday. My doctor told me that my Uptake Scan stated that this is "not definitely a hot nodule," so they are going to do an FNA it as if it was cold. Can you explain how a goiter can be neither hot or cold? I am wondering if this is not a common occurrence?



Edited 1 time(s). Last edit at September 8, 2008 3:25 AM by Dr. Kennedy.

RE: hot or cold nodule
Posted by: Ron Kennedy, M.D.
Date: March 16, 2002 10:17 PM

A hot nodule takes up large amounts of radioactive iodine, and is visualized as a "hot spot" on the thyroid scan. The majority of hot nodules have lost their normal ability to be regulated by TSH and produce excess amounts of thyroid hormone, and result in hyperthyroidism. A hot nodule may not produce sufficient amounts of thyroid hormone to suppress TSH. therefore TSH may be normal. As the nodule enlarges, TSH will fall, and if hyperthyroidism follows, TSH will be fully suppressed. The FNA, or Fine Needle Aspiration (biopsy), is an attempt to distinguish these and arrive at a correct diagnosis. A "not definitely hot nodule" is on the borderline, clearly hot or cold. The nodule would be assumed to be cold and the FNA would be done so an not to miss thyroid cancer. You may want a second opinion. I question the wisdom of piercing the capsule of a tumor which could conceivably be malignant with a needle in that puncture of the capsule might present an escape route for malignant cells which might not otherwise occur until some time in the future. If I had a cold nodule, I would insist on having it completely removed.



Edited 1 time(s). Last edit at September 8, 2008 3:33 AM by Dr. Kennedy.



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