Doc: Growing goiter precipitates thyroid biopsy
Dear Dr. Roach: In February, my doctor had me get a neck ultrasound because she said one side of my neck felt larger. The results came back that the right lobe of my thyroid gland did measure larger. I had a blood test, which was OK. Another ultrasound was done last month. The doctor’s nurse called and said they had made me an appointment with an oncologist because the measurements had increased. The appointment isn’t until the middle of next month. Do you think it is safe to wait? Should I try to find another oncologist? I feel healthy. Are there any symptoms I should be aware of?
Dear J.C.: Enlargement in the thyroid gland (“goiter”’ is a term for any kind of enlargement of the thyroid) can come from benign causes and from thyroid cancer. Benign causes are much more likely.
Checking the thyroid function with blood tests helps to narrow down the possibilities. I am guessing that because they told you the blood test result was OK, it was a normal thyroid function test. This also goes along with your lack of symptoms. Often, a physician will then order thyroid antibody tests, since autoimmune thyroid disease (specifically, Hashimoto’s) is a common cause.
Since your thyroid gland is increasing in size, a biopsy is a very reasonable next step. In my institution, this is usually performed by an endocrinologist, but it can be done by an interventional radiologist or any other trained professional. The biopsy is a fairly simple procedure. An oncologist normally is consulted after a pathologic diagnosis of cancer is made.
If your doctor is very worried about the change in the size of the thyroid, I would think a biopsy done sooner rather than weeks from now is likely to reassure both of you. In the unlikely event that it is thyroid cancer, doing so will allow you to get treated faster.
Dear Dr. Roach: Recently a member of our church was bitten by a rabid bat and, along with his wife, is now undergoing treatment. This is the second person I know in this area who has been bitten by a bat that was confirmed to be rabid. Our barn has a bat colony, so I explored getting a vaccination as a precaution. I was told that it would require multiple shots and cost more than $2,000. Why is it so expensive for humans when our animals receive rabies vaccinations for about $25?
Dear G.I.: I spent a long time researching the answer to this, but I still can’t provide a good one. Vaccines are expensive to research and produce, but the wholesale cost of the same vaccine has dramatically increased in the past several years. Outside the U.S., the wholesale cost is about $15 per dose (three doses are required). Given that your barn has a bat colony and there is rabies in your area, I can understand why you would want the vaccine, but I can say only that I am shocked and dismayed at the cost. In the U.S., some insurance companies will cover it, so I think it is worth asking your physician and finding out.
Email questions to ToYourGoodHealth@med.cornell.edu.