Large Thyroid Mass - suggested course of treatment

[Carolinagrace]

I recently had an ultrasound of my thyroid after feeling a lump on the right side of my neck.  The ultrasound report is below.  There is a history of Thyroid Cancer in my family. My TSH levels are normal and I am 30 years old, mother of two.

"The right lobe of the thyroid gland is enlarged measuring 4.9 cm in the craniocaudad dimension by 1.9 cm in AP dimension by 2.6 cm in transverse dimension. There is a large, slightly hypoechoic mass in the mid portion of the right lobe of the thyroid gland. This measures 3.3 x 1.5 cm. This demonstrates hyperemia. No other masses are identified in the right lobe of the thyroid gland. "
A biopsy was preformed, the pathology report showed "No malignancy" but "scant cellularity".  Endo recommends rebiopsy in 2 months, but not surgical removal.  Is this a typical course of action and what criteria would increase recommendations for surgical removal?  I posted two ultrasound images of the mass to my profile if you care to take a look. Does it appear to be more cystic or more solid/cellular?

Thank you!

[Mark Lupo, M.D.]

Would sit tight and re-evaluate at 6 months.
Would test TPO antibody for Hashimoto's but Hurthle cells can also be seen in cystic lesions.  Their presence does not increase risk of cancer in this setting.

[Carolinagrace]

Hello,
I had a follow up biopsy - results came back benign, colloid fluid present, but Hurthle cells also present.  Doc says this could be a sign of Hashimotos.  TSH levels normal, nodule still approx 3.5 cm X 1.9 cm.  Measurement change was slight, so could be due to difference in US measurement area etc...I have a repeat ultrasound scheduled for 6 months to follow up.  
Still wondering if I should just have the right lobe removed and sent to pathology to be sure.  Hesitant to do that now that Hashimotos may be in the works...What would you suggest?

Thank you so much!

[Carolinagrace]

Thank you for your input and telling your story.  It is hard to tell what to do because like you said, it seems like one of those things you won't know for sure until you get it removed.  I hate to go through an unnecessary procedure, but sounds like I won't know if it was necessary until it's done.  I do have some throat pressure and some pressure on the ride side of my neck.  I have a repeat ultrasound in October and will probably make plan after that.  Please keep me posted on how your 2nd surgery went and if you decide to receive the radioactive iodine treatment.

[SaraSuperMom]

This sounds like what I went through as well.  I had a 3x2 cm mass on my right thyroid and some smaller ones scattered on both. I did not have the FNA.  My radiology report said my mass looked suspicious. Often I would get pressure in my throat and hoarseness.  I don't know if you are having symtoms. I saw the endocrinologist and he said his rule of thumb was anything bigger than 3 cm he would take out.  He didn't want the thing matastisizing on me and causing me breathing problems ect.  So off to the ENT doc I went.  I chose not to have the FNA because I was planning to get the thing out anyway and they would do a biopsy in surgery to see if they needed to take both sides.  Everything came back good with the frozen disection and they only took the right side.  Just got the results back Friday from the final biopsy and there was cancer. So I am actually having surgery tomorrow to take the other side out since there were masses there.  I'm thinking they probably aren't cancerous, but we don't know for sure and I don't want them spreading to the lymph nodes and everything else that's in there. Just wanted to tell you my story.  My thought on the whole thing was that it didn't belong in there and I didn't want it there.  They cancer cells were actually a pretty small area hidden in the tumor, so they may not have found them with the FNA. I am glad that I had it taken out now before things could have been worse.  I just wanted to let you know what I went through and how it turned out. I hope all turns out well for you.

[Carolinagrace]

Thank you very much for your input.  I think it's wonderful that you take time out of your day to answer questions for concerned patients.  I will follow up with the repeat ultrasound and FNA in October and continue to monitor things.  Thanks again!

[gscarfe]

Everything you have posted sounds very similar to my own trip through the thyroid. I elected removal hafter consulting with the ENT that my Edo recomended. It seems for me it was the correct choise in that my larynx was being pressed over 1 cm and I felt discomfort by the enlargement. My surgey was this morning and I already feel relief. So I hope that everything works out for you as well and I think most Docs will tell you straight up what a good recomendation is. I find simply telling them how I felt and their listening was the key. It helped in choices along with all the testing.

[Mark Lupo, M.D.]

The nodule appears to be about 25% (+/-) cystic, has regular borders, no apparent calcifications.  This led me to the "intermediate" classification sonographically.

[Mark Lupo, M.D.]

I reviewed images.
This is a vascular nodule that in intermediate otherwise in terms of ultrasound risk appearance.  The increased blood flow makes it more difficult to get cellularity on FNA.  The family history, size & vascularity is concerning.  Agree w/ repeat FNA at 2 months, but low threshold for removal if increases in size or FNA still scanty.