Last year, I went with my son to his allergist appointment. When we were called back, the doctor took us into his office and had us sit down on a bench in his exam room. He started chatting with us about my son’s allergies, medications, and so forth when he looked at me, paused, and told me to “look up.” I was a little taken aback, but I did as he asked. Before I knew it, my son’s allergist was palpating the middle of my neck and examining me! After a few moments of this, he said, “You need to see an endocrinologist. I think you have a large thyroid nodule.”
While it was a little bit of an unconventional exam, low and behold, I followed up, and he was right! I went to a local endocrinologist who agreed with my son’s allergist. She said that I probably do have a large thyroid nodule and need to get it checked out. She instructed me to have a thyroid function blood test and go to a radiology facility to have a thyroid ultrasound.
I’m ashamed to say this, but I’ve worked in the medical field for over 15 years yet knew nothing about the thyroid gland. I knew it existed… but that’s about it. After I scheduled my tests, I spoke with a physician friend of mine who gave me the rundown about the thyroid and all that could potentially happen with it.
The thyroid gland is a small, butterfly shaped gland situated in the front of the neck, just below the laryngeal prominence of the thyroid cartilage (the “Adam’s apple”). In most people, you can’t see it with the naked eye. In my case and in the case of some people with thyroid disease, the thyroid gland, or a portion of it, becomes enlarged and can be seen as “protruding” or an asymmetrical mass in the anterior neck.
Though small in size, the thyroid gland is an extremely important part of our hormonal ecosystem. While there are multiple hormones that the thyroid is responsible for, the main one is thyroxine. Thyroxine stimulates the consumption of oxygen and therefore influences the metabolism of all cells and tissues in the body. Thyroid hormones are responsible for a gamut of functions including the regulation of body temperature, brain and bone development, growth, energy levels, and even our moods.
My lab test was fairly easy and came back within 48 hours. I was tested for: 1) Free thyroxine in the blood and 2) TSH levels (thyroid stimulating hormone). These are the most frequently affected blood levels when the thyroid gland is functioning abnormally due to a growth or disease. The most common dysfunctions are hyperthyroidism (too much thyroxine) and hypothyroidism (too little thyroxine). These would be indicated by an excess or deficiency in the free T4 test. Thyroid stimulating hormone is actually produced by the pituitary and stimulates the thyroid to produce T4. Thankfully, both were normal
My next step was scheduling the thyroid ultrasound. As a medical professional myself, I knew that choosing the right radiology facility was extremely important. Specifically, in Ultrasound, the ability of the technologist and the experience of the radiologist can drastically alter the diagnostic efficacy of the exam as well as the quality of the reporting.
My provider recommended The Radiology Clinic, located in Rockville, Maryland. I called the center, provided some basic information, and within 5 minutes I had an appointment. They provided me with login credentials for their patient portal, and I was able to fill out the required forms online to expedite the in-office experience.
When I arrived at The Radiology Clinic, I immediately noticed that the office had been redesigned to facilitate social distancing due to the COVID-19 pandemic. The staff was diligent in spacing out chairs and cleaning surfaces. I was quickly escorted to a private room to wait before my exam.
When I was called back for my appointment, the Ultrasound Technologist was very thorough in her explanation of the exam. I was asked to lie on an exam table. She then put some warm gel on my neck. She explained that the ultrasonic gel helps transmit the ultrasound waves more efficiently.
To document the experience, I asked a friend who accompanied me to take a couple of photos. As you can see, the technologist performing the procedure is using an Ultrasound probe to send the ultrasonic waves to my thyroid. She made measurements and documented the procedure as she imaged. The entire experience was painless and efficient.
The following are actual images of my thyroid that I was able to view from my patient portal.
The thyroid wraps around the front aspect of the trachea. The entire thyroid gland is circled below in red. Unfortunately, I do in fact have thyroid nodules; three of them. The second picture shows my nodules which appear as black/grey circular structures within my right thyroid; I circled two of the nodules in blue.
Now the question… what do I do now? The answer wasn’t straightforward, but there were some established guidelines I could cling to. The Radiology Clinic uses “TI-RADS” thyroid reporting to classify thyroid nodules and offer guidance based on data driven norms. TI-RADS stands for Thyroid Imaging Reporting and Data System and was established by the American College of Radiology. While this method of thyroid reporting takes longer for the radiologist, it provides clear guidance based on years of data collection and information. Most providers prefer radiology facilities who report using TI-RADS.
Based on TI-RADS guidelines, my nodules were too small to be concerned about. With this information, along with the fact that my thyroid function tests came back normal, my provider said a follow up thyroid ultrasound would be the most appropriate course of action. She said that biopsying the largest of my nodules could definitively rule out thyroid cancer but based on the information we had, we would put that to the side for now.
I scheduled my thyroid Ultrasound for 12 months from the initial visit. While I’m not concerned, I’ll be happy when the report comes back with little to no growth in my nodules’ sizes!
The Radiology Clinic performs thyroid ultrasounds daily and has the experience and knowledge to help guide providers in their decision making. For questions or appointments, they can be contacted at 301-217-0500 or by email at email@example.com.