Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
How long can I wait before surgery
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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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How long can I wait before surgery

Dear Dr. Lupo.

My endo told me that I need to perform complete thyroidectomy because my FNA was suspicious for papillary cancer although it was indeterminate. You suggested that I do another biopsy and have it reviewed by experts. I was wondering how long I can wait before performing the surgery.If it was really cancer does waiting another month and having another biopsy negatively affect the prognosis?

Thanks


My medical history:

Lab results:

TSH = 1.34, FT3 = 3.45 and FT4 = 1.00
anti-TPO = 280 (normal 0-60)
anti-TGB = 70 (normal 0-60)

Ultrasound results

The ultrasound says that I have a large well defined nodule measuring  3.5 x 2.5 x 2.25 cm solid, highly vascular, mildly echogenic in the left lobe. There are also several ill-defined hypo- and hyper echoic nodules in left and right lobes.


FNA ressults

Smears and the clot section show a bloody sample, and thus colloid is difficult to assess, though cellularity is sparse and most nuclei appear round. However,  rare intranuclear pseudoinclusion are seen in the smears from the second pass, as well as some cells with groove nucleus and the case will forwarded to Dr. AAA at UCSF hospital for expert consultation. Dr BBB. concurs with the presence of suspicious intranuclear pseudoinclusions, a finding which may be associated, though is not specific for, papillary carcinoma.

Expert comments (university hospital)

There are some oncocytic change, though not to the degree as would be expected in classic Hurtle cell neoplasia. However, the finding of nuclear inclusions does support that that this is a neoplastic nodule, but does not indicate it is benign or malignant. He also notes that surgical excision is prudent, though points out that even frozen section will likely not follow definitive classification.
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I cannot give any specific advice on time frame in this type of forum.
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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