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Large Probably benign Thyroid Nodule Surgey Suggested
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Large Probably benign Thyroid Nodule Surgey Suggested

Hello, I am a 35 year old femal recently diagnosed with a large 4cm length / 2.8cm trans /2.6cm AP complex nodule on my left lobe, right lobe looks normal on ultrasound. The mass was palpable on a routine exam. Results of the FNA as follows:
Microscopic Description: The aspirate is of adequate cellularity. Most of the diagnostic material is on the Diff Quik stained slides. There is abundant watery colloid in the background along with some foam cells. Multiple, loosely cohesive groups of follicular cells arranged in two dimensional sheets are present. Some of these have abundant, slightly granular cytoplasm suggesting early Hurthle cell change. Cytologic features of malignancy are not seen.
The ENT surgeon would like to remove the left lobe anyway and do a frozen section in the OR to determine if all should come out, siting the chance the FNA missed "the spot" and there is still a possibility of malignancy especially since the mass is so large.
My question is does this sound reasonable and should I just go for it, or should I seek the advice and services of an endo prior to surgery. Even if I do the surgery, will I need an endo to follow up with? I know that if the entire thyroid needs to be removed that will mean life long meds, but with half are chances good that I will not need medication? My current thyroid labs are:TSH=1.703(lab scale .35-5.5) T4=10 (4.5-12) T3Uptake=24 (24-39)Free Thyroxine=2.4 (1.2-4.9) Thanks for any advice and insight,I am wondering how long this has been growing since I am pretty sure my neck is palpated every year at my annual exam.
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I would see a thyroid specialist (endo).  The mass is large, however Hurthle changes are not necessarily suspicious (many mis-understand this).  Would check thyroid antibodies as Hashimotos can cause similar FNA pattern.

If the mass is bothering you (ie tightness, hoarseness, trouble swallowing), then surgery makes sense.  

Frozen section is sometimes helpful to make a decision.

Most of these are benign, and doing surgery b/c the FNA may have "missed the spot" is not usually recommended.  Instead, consider repeat FNA (as two negatives are sometimes better than one) and observe.  

3 Comments
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I read your post and remember that I had the same problem with my nodule. This always comes down to Murphy's Law. I listened to my doctor and had one lobe removed (for the same reason as you...lifetime meds, half a thyroid is better than no thyroid, etc.) and had to undergo the second surgery 30 days later since the pathology report showed that the left lobe showed evidence of malignancy and spread to the other lobe. I tried to talk my doctor into taking the whole thing out the first time and I let her sway me. However, personally, I'd rather take the pill for the rest of my life than go through the surgery twice or later in life have another problem. With my luck though, I would have stood my ground and the nodule would have been benign. It's a tough call. Good luck.
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ADDENDUM

Total vs lobectomy is a tough decision -- usually based on presence of nodules on other lobe, suspicion for cancer and patient preference.  If trying to avoid meds long-term, it may work well (unless your antibodies are positive).

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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
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