Thyroid Incidentaloma

Incidentalomas are more common than we would like to think. They can be found most anywhere incidentally. As medical scanning tests have become more sophisticated, they have been able to detect more things. These incidental findings are known as incidentalomas. What do you do when a test your doctor has ordered detects an incidentaloma or multiple incidentalomas?

A thyroid nodule was innocently detected on a stress thallium heart test I had done four years ago. When I discussed this with my cardiologist, I was told no further testing was needed. Fortunately my primary care doctor felt otherwise (like I did) and ordered more tests. The thyroid uptake scan detected a cold nodule which can be consistent with cancer. An ultrasound guided needle biopsy was negative for cancer. My thyroid blood tests have remained normal over the years. In addition, the nodule cannot be seen or felt. Yearly sonograms have been stable and unchanged until this year.

I am waiting for the official report from my doctor for this year's sonogram done this week. The technician that did the ultrasound of the thyroid confirmed what I saw as I lay on the table and watched the screen. There were changes showing up. After four years of following this incidental finding, it turns out it is not so incidental.

Many physicians feel that incidentalomas should be left alone. There is much controversy over what to do about them because it is feared that unnecessary procedures, surgeries, and treatments may lead to increase morbidity and mortality. They are becoming more frequent as tests get better. As you can see ignoring them is far from the answer. It gave me a "free" ticket for a thyroid biopsy then kept showing up normal for a few years.

At least yearly surveillance is warranted for incidental findings. Depending on what is found, medical invasive intervention such as biopsy or surgery may be necessary. Additional testing as it relates to the incidentaloma is also indicated. Each person's case must be individualized. The more you know about it helps you and your doctors decide what is best for you.

It turns out that I found out about my incidentaloma incidentally - when I requested a copy of my stress test report.


by J.L. Richardson, M.D., family medicine doctor and author of Patient Handbook to Medical Care: Your Personal Health Guide.

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