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Are Nodules With Hurthle Cells Worrisome In Normal Thyroid?
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Are Nodules With Hurthle Cells Worrisome In Normal Thyroid?


bmxdad,

I just read your posts from a few years ago where you say that all 3 of your doctors told you to have your thyroid removed,and you did because you had Hurthle cells in your thyroid nodule. Well, your FNA report is the same as my description without any Hashimotos,though. I had some Hurthle and Follicular cells in my nodules too. I have normal thyroid function,and in October 2006 3 small thyroid nodules were found on a thyroid ultrasound when I was 41 and a half. In June 2008, I had all 3 of the nodules biopsied even though the endo and radiologists at University of Penn keep saying none of my nodules meet the criteria for biopsy. I needed some kind of peace of mind,to get some idea of what was in my nodules.So in May 2008 I saw a different endocrinologist that gets a lot of good recommendations,he's not at UPenn though,but the hospital he worked at is part of their health system.


The pathologist said he and many children can have Hurthle cells in their thyroids. He had written in my second opinion report that I have oncocytic cell change suggesting an element of chronic lymphocytic thyroiditis.He described my nodules as hyperplastic/adenomatoid nodules which are benign. I saw a new endocrinologist Dr.Stephanie Fish at University of Penn in May 2010 but she left for the Sloan Kettering Cancer Center about a month later. She and the radiologist said that my largest nodule had grown very slightly and DR.Fish said that Hurthle cells are normally in your thyroid and that my chances of having thyroid cancer are almost 0 because my nodules haven't changed much at all,and my FNA was benign and I also spoke to the radiologist Dr.Jill Langer who has reviewed my ultrasounds for several years now,and she told me that I don't have suspicious ultrasound features of my nodules.
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I know these doctors -- if they have reviewed your ultrasounds and FNA results and recommend observation -- then that is the best course of action.
Hurthle cells often worry inexperienced pathologists and clinicians, but they are most commonly a benign finding in a FNA.  A true Hurthle lesion has no lymphocytes and little to no colloid and the cell population is <75% Hurthle.
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Dr. Lupo,

I posted this message I sent to bmxdad on your forum so you could especially address my questions and concerns. I see that you tell people that having Hurthle cells in nodules is common with Hashimotos,but I don't have this or any abnormal thyroid condition. You told a member that Hurthle cells can be present in cystic nodules too. I had asked you about my concerns about this a few years ago in your Expert forum,but you never responded.

If you could please address my concerns about this when you eventually have a chance,I would really appreciate it.

Thank You.
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I meant that my endo said he would do an FNA if I wanted to so I can have some peace of mind,even though it's not 100 % accurate only 95-98%. So I had the FNA in June 2008 of my largest nodule that is almost all solid on my left lobe which is pretty deep in my thyroid,and is a little more than 1 cm and the even smaller mostly cystic nodules,one on my Isthmus and one on my right lobe.The endo biopsied my largest nodule twice that day because some fluid,(which was colloid) came out the first time.It really hurt to do the largest nodule because as the endo said when I told him this on the phone about a week later,it's deeper than the other two. Anyway,I sent my slides to a top University of Penn pathologist that you recommend for a second opinion Dr.Zubair Baloch,and he called me back and spoke with me.I asked him if I should be worried about the Hurthle cells and even the follicular cells,and he said,and so did the endocrinologist,that most people normally have Hurthle and follicular cells in their thyroids and that it's normal and that only when there is a lot of Hurthle cells is it a concern.

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Dr.Lupo,

Thank you very much! But Dr.Fish recommended I wait two to three years for another follow up ultrasound. I don't want to wait that long though.And Dr.Baloch and my endo DRrAnthony Jennings said that it's only when you have a lot of Hurthle cells that it's more worrisome like you just said. But since my nodules are small and FNA isn't 100% accurate,can it be somewhat possible that I have more Hurthle cells than they got?

Dr.Jill Langer the Upenn radiologist told me last year on the phone that none of my nodules are taller than wide,but nobody ever told me this before. In May 2008 when Dr.Jennings looked at my nodules with me on his screen and I asked him if any of my nodules are taller than wide,he pointed to one of them and said it's slightly taller than wide. But Dr.Langer said I don't know why he said that,because I'm looking at your films right now,and none of your nodules are taller than wide.She sent this to written in the mail too after I asked her to please do.She also said that vascularity is an out dated measure for thyroid nodule features.None of mine are hypervasulare though anyway.
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I just noticed I made a few typing mistakes. I had told Dr.Langer that Dr Hoff at Upenn who I saw in 2007 and 2008,kept on insisting that the taller than wide shape is an outdated concern of thyroid ultrasound nodule features,but Dr.Langer said that's not true and that feature is still very reliable.
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Also, Dr.Baloch noted that it's only my two smallest nodules that are mostly cystic one on the right lobe ond one on my Isthmus that had the oncocytic change. I'm not sure if this is in one or both of the smallest nodules because unfortunately my former endo Dr.Jennings combined just the samples from those smallest nodules and not my largest almost all solid isoechoic nodule on the left lobe.
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