Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Lymph Node biopsy
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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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Lymph Node biopsy

Hello Dr. Lupo,

I had a total thyroidectomy in Sept. 2006, after a needle biopsy was inconclusive.  The pathology report came back papillary cancer both lobes with follicular varient.  I had two whole body scans done with radioactive iodine and both came back negative so I did not have and RAI treatment.

In March I changed endo doctors, and the new one ordered an ultrasound on my neck.  It showed an atypical lymph node.  We waited two months, and did another ultrasound and the lymph node was still present.  She did a needle biopsy and the results came back inconclusive.  There was a lot of cystic fluid and some thyroid tissue.  My doctor said I could have surgery to remove it or another biopsy.

I decided to have another biopsy because I really don't want to have an unnecessary surgery.  My question is, if this biopsy comes back inconclusive should I have the lymph node removed?  Thanks for your opinion.
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I am concerned about "cystic fluid and some thyroid tissue" in a lymph node.
If the node is in the thyroid bed, then this may be post-operative change and not cancer, but if the node is elsewhere in the neck, this is likely a metastasis to that node.  Would correlate with thyroglobulin blood tests and if you have another biopsy, ask your doctor about sending the FNA sample for "thyroglobulin washout"
I agree that you don't want to jump into more surgery unless there is a clear and significant recurrence (or persistence) of your cancer.
If in doubt, go to a specialty center for an opinion.
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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