Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Hashimoto's/nodules
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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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Hashimoto's/nodules

I was diagnosed with Hashimoto's and thryoid nodules after the birth of my child at the age of 41.  I am being successfully treated with levothyroxine.  The nodules have been monitored by ultrasound annually; the largest is 1.1 cm.

I recently had the largest nodule (one of 3-4) biopsied (FNA) and the diagnosis came back "rare atypical follicular cells in a background of Hashimoto's thyroiditis."  The specimen was "very celluar consisting of hurthle cells, a lot of lymphocytes admixed with hurthel cell follicles. Rare atypical follicular cells with nuclear grooves are also noted.  No nuclear inclusion is identified. Findings most consistent with Hashimoto's thyroiditis. However hurthle cell nodule/neoplasm and papillary carcinoma cannot absolutely be ruled out.  Correlation with antibody study recommended."

I already know I have HT. One ENT recommended surgery to remove half the glad; another ENT recommend watching with serial ultrasounds and another biopsy if size changes. My primary concurs with watching.  Is surgery recommended ...or do I need a third tie-breaker opinion from a specialist?
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The most important opinion is from the pathologist -- send the slides to an expert -- Dr. Massoll at University of Florida or Dr. Zabloch at U Penn or Dr. Westra at Johns Hopkins --- one of these should be covered for second opinion by your insurance.

It's likely hashi, but with the grooves a second opinion is warranted before going to surgery.
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I have a similar situation in that a nodule was found, had the FNA and cancer couldn't be ruled out, and I was having inflamed thyroid symptoms which were suppressed with synthroid (turns out I do have Hashimotos).  Given the choice, I decided to go ahead and have the nodule/lobe removed.  The nodule was 1.1cm, and, as a complete shock to me, it turned out to be cancer.  Glad its gone (but now I have to have to have the other half of my thyroid removed....).  Just offering you my story, but every situation is different.  It all depends on how much anxiety you can supress or live with....best of luck...
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Your suggestion is one that has not been mentioned to me. Thank you so very much to your insight.  This service is remarkable.  md63
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Thank you so much for responding to my post. I am sorry the results were not what you expected.  I too would be worried.  I am conflicted because I have two such varying opinions, but I am following Dr. Lupo's advice to have the pathology interpreted by a second physician. Many I ask, what kind of malignancy they identified in you?  My "possibilities were papillary carcinoma and hurthel cell.  Did you know you had Hashimoto's going into this? The synthroid supression in me has not decreased the size of the nodules.  I appreciate you sharing your story. You will be in my thoughts regarding your upcoming surgery.  And you are so right....the anxiety is more than I can live with.
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I have papillary carcinoma (with a "follicular" subtype).  No, I did not know that I had Hashimotos until the pathology report came out after the surgery.  My endo thought my symptoms over the past year might have been result of a multi-nodular goiter.  In the end, it was a blessing, because when all was well (the synthroid suppressed symptoms for a period of time) my doctors suggested the nodule could just be "watched" but, eventually, when my thyroid persisted to act up (swallowing difficulties, slight throb in my thyroid, heartburn feelings, etc.) surgery became an option. Its almost as though my body was trying to tell me to act, so I feel fortunate for that (although now my remaining lobe is giving me a good fight too...which I am trying to feel grateful for!!).
  Thank-you for your kind thoughts and best of luck to you too!
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Thyroid & Endocrine Center of Florida
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