FNA showed high lymphocytes?

[Bananie22]

I have Hashimoto's disease and have a large hard nodule on my neck.  I had an FNA done last week and it came back showing an unusually high number of lymphocytes.  I thought that was normal with Hashimoto's?  It seemed to concern my endo a lot and he thinks I should consider having my thyroid removed.  While I'm not opposed to that (it's not functioning anyway) I'm really scared that he's leaning toward Thyroid Lymphoma.  How common is thyroid lymphoma?  I'm really scared.

[Mark Lupo, M.D.]

Lymphoma of the thyroid accounts for 1-3% of thyroid cancers -- overall it is not very common, but is more common in Hashimotos.  While surgery is the most definitive way to make certain it is not lymphoma, there is a process called Flow Cytometry that can be performed on the FNA sample to sort out what type of lymphocyte population is present. This may have already been done.

You are right that Hahsimoto's has large numbers of lymphocytes as well and the odds are in favor of this being Hashimoto's and not a lymphoma.

If an FNA (or core needle biopsy which is a larger biopsy sample) is repeated to get Flow Cytometry, it may be worthwhile to send the slides for a second opinion to a University -- or ask that the slides already done can be tested by Flow Cytometry &/or sent for second opinion.

[Truelee]

Hi, I am having my throid removed tomorrow because I have "numerous atypical lymphocytes",  My docs are also concerned about thyroid lymphoma.  I have Hashimoto's, but my thyroid is working and I take no meds.  Have 890 on TPO, though, so I know that things are not perfect with my thyroid. TSH 3.59...
I wish you the best in making the decision.  It took me several months, but I finally decided that I did not want to keep monitoring it -- only to find out some day that I have lymphoma.  I have never had surgery, so, I am a bit on edge tonight.  I also have negative reactions to drugs and anesthetics...sure be glad to get this behind me. I have read countless articles and researched this since September -- there is no set answer when the FNA is not definite about cancer and no amount of studying ever came up with a clear answer.  I also had PT/CT scan that showed no lymphoma anywhere. The thyroid lit up, but that can happen with thyroiditis, too. Sigh...once I made the decision (before Christmas) I was very comfortable with it.  It has taken me this long to get the surgery with the surgeon that I want to use.  I guess my advice to you, with your non-working thyroid, is -- Just get the sick thing out of there.  Well I am of to bed -- hope the surgeon is too!

[Mark Lupo, M.D.]

Truelee has conveyed a nice account of the situation from a patient's perspective.  It's true that surgery is the best and most definitive way to sort this out.  Also true that PET/CT will be positive over the entire thyroid in Hashimotos -- and would only be helpful if there is a focal area of increased uptake corresponding to the nodule OR there is other uptaked in the neck corresponding to abnormal lymph nodes.  So PET could be used in this situation to add more info but not answer the question definitively.  I would start with the Flow &/or second opinion.  In the end, it often winds up being the patients decision from a standpoint of "peace of mind."

[Bananie22]

Ok, first to the Doc...thank you for answering me.  I am relieved to read that the percentage is so low.  I have such a messed up thyroid with bad TSH numbers and haven't been able to get leveled off in a year.  (my doctor actually told me it's the worst case of Hashi's he's ever seen...at least I'm interesting for him!)  I think for me removal might be a good thing for two reasons.  One, I've heard that getting the right TSH may be easier now (which would be awesome because I feel pretty lousy most of the time), and two, peace of mind.  I think it'll always be in the back of my mind wondering "Do I have cancer?  Is it spreading"...if I don't remove it.
Trulee...I wish you good luck with your surgery.  Please post when you can, I would love to know how you made out.  Take care.