Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
34 year old male - stage 1 minimally invasive follicular carcinoma
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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34 year old male - stage 1 minimally invasive follicular carcinoma

Hello Dr Lupo,

I am wondering what your thought is on my case. I have just been diagnosed after my first surgery last week upon removal of my left thyroid lobe measuring about 4 and 2.5 cm. The pathologist on email mentioned to the surgeon that it looked benign but 1 or 2 spot where there has been an invasion into a small vessel. He gave me two options. One is to wait and the other is to treat aggressively and have the right lobe removed which what I have decided. Surgery will be done this Friday.

All my lab previously was normal. I am 34 y/o male 5'7 125 lbs (just recently lost a few pounds after 1st surgery) and a med student. I have always had problem gaining weight in the past.

What's your thought about the diagnosis and prognosis in this condition? I probably will go for the RAI as well in few weeks time.

Any advice on supplements to take after total thyroidectomy. I plan to workout very hard in the gym after reading all the weight gain stories on the internet. Any thoughts on Rx with regards to T3 and T4?

Thank you
Jon
97953_tn?1193367871
Minimally invasive follicular thyroid cancer is not aggressive and the prognosis is generally excellent..  Completion thyroidectomy is the norm and I-131 would not likely be needed in most cases.  Levothyroxine alone is standard of care w/ a small subgroup of hypo patients who may benefit from the addtiion of liothyronine but this would not be started initially (ie, re-evaluate at 3-6 months w/ TSH and symptom review)
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Thank you Dr Lupo.

According to ATA 2009 recommendation, they recommend I-131 for my case (recommendation 32) due to my tumor size.

In your opinion, what circumstances of minimally invasive FC warrants I-131? The side effects are quite scary. Leukemia risk increases by 2.5 fold in younger patients although no age was mentioned. In addition, secondar malignancy was a concern as well with its use.
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97953_tn?1193367871
Agree - current guidelines treat all FCs w/ I-131.
This will likely become more selective in 2013 guidelines (due in Fall).
Most large series on min inv FC are very reassuring - surgery alone should be curative, but some would still give 30mCi (mininal risk of side-effects/secondary cancers) to be more comfortable.
Talk to your doctor about I-131 vs observation.
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
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