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My Thyroid Nodule Grew 4mm More In Almost 3 Years Had FNA Almost 5 Year...
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My Thyroid Nodule Grew 4mm More In Almost 3 Years Had FNA Almost 5 Years Ago

Dr.Lupo,

Last week I had a thyroid ultrasound at University of Penn to see if any of my 3 small thyroid nodules have grown and or changed.I had an FNA of all 3 in June 2008 by Dr.Anthony Jennings who isn't at Upenn. I had a second opionion by having my slides reviewed by Dr.Baloch and he didn't see any cancer. Anyway my nodules then were the 1 on the left was a little over 1cm and the one on my isthmus was some 4mm and the one on my right lobe was about 6 or 7 mm I think. The smaller 2 had been described in past reports as mostly cystic,the largest is mostly solid and then cystic.When I had my last follow up in May 2010 I saw Dr.Stephanie Fish,who was leaving soon after for The Sloan Kettering Cancer Center.She wrote me a note that said that my largest nodel only grew slightly and non-significantly and the other 2 were stable and actually had *decreased* slightly. She didn't revommend rebiopsy then,but to come back for a follow up ultrasound in 2-3 years.

All of my nodules had been described in several past reports as being non-hypervascular,but now the one on my isthmus has grown to 8mm and it's the solid part that grew and is now described as slightly hypervascular! The other two have only increased slightly in their cystic parts. I am going to have another biopsy of my isthmus nodule in a few months when they can do it at Upenn.The radiologist Dr.Jill Langer said when I spoke to her that vascularity isn't such a concern,but she recommends rebiopsy of this nodule because it increased about 50% in almost 3 years,and that fits their criteria for rebiopsy.She said she's recommend this even if it was non-vascular.I'm very concerned by the combination of growth and increased blood flow now.I know many benign nodules have some or even a medium amount of blood flow,but I know hypervascular is commonly found with cancers.

If you could let me know what you think about this,I really would appreciate it.

Thank You
97953_tn?1193367871
The isthmus nodule should undergo repeat FNA with this growth.
Vascularity is not as much of a concern as previously thought.
Jill Langer is excellent with thyroid nodules and Zubair Baloch is among the best in cytopathology for thyroid -- you are in great hands!
Would test TPO/TG antibodies if not already done to clarify if there may be evidence of hashimoto's.
13 Comments
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Avatar_f_tn
I'm sorry I just noticed I made a few typing mistakes. I'm tired from not enough sleep which is partly due to worry about this and other non-related issues.
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Avatar_f_tn
I forgot to mention that the isthmus nodule has always been described as hypoechoic but not markedly which UPenn radiologist Jill Langer says that and calicification are very concerning ultrasound features.Also my isthmus former measurement was 4.x 9 x9mm and now is 8 x 15 x17.
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Avatar_f_tn
I also forgot to mention that my thyroid blood tests have always been normal for decades although I'm going to have it tested again soon since it hasn't been tested in several years.
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Avatar_f_tn
I meant the measurements of my isthmus nodule not the isthmus itself.
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Dr.Lupo,

This is what I posted to you a few years ago about what my FNA results showed.


On  June   24th   I   had   an   FNA   of   3    small  thyroid  nodules  that  were   found   by  accident  In  the  Fall   of   2006  when  I  was   41  and  a   half,  because  I  have   a   very  slow   metabolism  and  my  thyroid  blood   tests  have  always  been  normal   and  I   gained   weight   for   the   first  time   at  age  34  and  had   to   go  on   a   diet   for   the   first   time   in  my  life. So  I  asked  my  internist   for  a  prescription  for   a thyroid  ultrasound.

The  sizes   of  my  nodules   are  one  on  the   right lobe, 0.5 x 0.7x 0.7  cm  on  the  left   lobe, 1.3 x 1.3 x 4.5 cm   and  on   my  isthmus,  a   0.3 x 0.6 x 0.7 cm, biopsied  by   a  very  good  endocrinologist  with  a good   reputation, Dr .Anthony  Jennings   and   the  first  pathologist   at  Quest   Diagnostics  described  them  as   unremarkable   follicular  cells  with
colloid  and   are   diagnosed   as   colloid  nodules.  I   have  normal  TSH  and  other  thyroid  blood  tests. I wondered  why  1  of  my  2   small  nodules  was  written   as  1  nodule  on  my   FNA  results  paper  and  Dr.Jennings  told  me   he  put  both  samples  from  both  nodules  into   the   same  container  because  it  costs  less  this  way.

I'm  not  happy  he  did  it   this  way  and   I   have never  heard  of   it   done  like  this  but   I'm  not  an  endo  and   don't   know  everything  endos  do. How  can  they  tell  how  many  cells  are  in  both  nodules if   they  were  combined?  So  I  was  wondering what  you  know  and   think  about   this. I  asked  Dr.Jennings  if  it would taint  each nodule's results by doing  this and he said  it  doesn't and  he's done  it  this way  before and  he  said  he  thinks  even  Dr. Susan  Mandel  the  top  thyroid  cancer  specialist  at  the Unniversity  of  Penn  Hospital  has  done  it   this  way. He  knows  her  well  and  he's  heard  her  speak. Dr.Jennings  also  biopsed  my  largest   1   cm   predominately  solid  nodule  twice  that   day  because   first  fluid  came  out.

I  also  asked  my  endo  to  please  send  my  report  and  slides  from  Quest  Diagnostics  to  a  top   thyroid   pathologist   that  Dr.Mandel  uses  Dr.Zubair Baloch  at   University  of  Penn   for  a  second  opinion.

Dr.Baloch  says  in  his  report  of  my  nodules, that  in  his  opinion  based  on   cytomorphology  he  will  favor  a  diagnosis  of   hyperplastic/adenomatoid  nodule   for both  specimens. He  says  interestingly  the  specimen  from  the  right   thyroid  nodule  shows  oncocytic  cells  and   few   lymphocytes  percolating  among  the follicuar  groups  suggesting  an  element   of  chronic lymphocytic  thryoiditis. He  says  he  does  recommend   clinical   follow  up  and   repeat   FNA   if   there  is  an  increase   in  the  size  of  any  of   these  nodules.

He says  in  summary   then,  my  diagnoses  are :1. Thyroid, right  lobe  nodule  (size  not  indicated) FNA:Hyperplastic/adenomatoid  nodule  with oncocytic  change.  Focal  chronic  lymphocytic  thryoiditis. 2. Thyroid  left  lobe (size  not  indicated) FNA: Hyperplastic/adenomatoid  nodule.

Dr.Baloch  didn't  know  my endo  combined  my nodule's  samples  into  1  container .He  called  me  and  he   said  when  I   told   him  my  concerns  about   the  Hurthle  cells , he  said   I  don't  have  a   lot  of   them ( my  endo  said  only  when   there  is   sheets  of   them  can  they  be  cancer) ,and  that  he  could  have  Hurthle cells, children  could  have  Hurthle  cells  in  their thyroids  and  that  it's  not  abnormal  only  when  there is  a  large  amount. But  because  my  nodules  are  so  small, isn't  possible   that   the  needle  missed  more  of   the  Hurthle  cells ( and  other  cancer  cells!)  present?

I  would  really appreciate your  reply.



Thank You.







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Avatar_f_tn
I was *so* hoping that you would have responded!
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Thank you very much for your kind informative response! I'm having a re-biopsy of the isthmus nodule on April 18th at UPenn. In May 2008 Dr.Anthony Jennings gave me a blood test in which he checked for extensive things,some of which I never even heard of. I had asked him to check my antibodies for Hashimotos because to my knowledge it had never been checked before but it was normal.

I just hope that I don't get an inconclusive result like my first cousin did over 12 years ago at UPenn when she even had her only thyroid nodule biopsied by the UPenn top thyroid cancer specialist Dr.Susan Mandel and she had half of her thyroid removed,and the nodule was benign as the majority are as we know. She didn't have any thyroid conditions either.

Her best friend has two nodules,and is borderline hypothyroid and she also got an inconclusive at Upenn and then went to a good place in New York,and got another inconconclusive FNA,so she went to Dr.Anthony Jennings and he did her FNA and they were benign! I also certainly hope the most,that my result isn't going to be a paplillary thyroid cancer on the isthmus,and that is my first and biggest concern.


But if it comes back benign again,now that it's even a bigger size to biopsy and five years later,it's very unlikely that it's cancer. But then my next concern is that it is benign,but like many benign nodules and growths,they continue to grow and get too big as long as they are in your body,and especially in the throat area could cause me breathing or swallowing problems and it will cause me to have my thyroid removed even if I had 100% proof it's benign.And on this board and many others like this,there were many people this happened to,they had very big thyroid nodules that caused them breathing and swallowing problems,and had their thyroid removed and the nodule(s) were benign.
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Avatar_f_tn
Also, how accurate and how often is the thyroid FNA accurate? And when you say that vascularity isn't as much of a concern as previously thought,can you please specify more of what this means? I mean how often are benign nodules mildly hypervascular? I know that many can have a good amount of blood flow,but there is a difference between that and hypervascular!

And why would only the isthmus nodule now have become this way,when none of the three were before? Have you encountered a good amount of nodules with mild hypervascularity that turned out to be truly benign? And the isthmus is not the most common place for thyroid nodules to be,most are on the right or left lobes like my other two are,and it always concerned me that this one is hypoechoic too.

By the way, my father also has thyroid nodules,he has 4 and he found out when he was in his early-mid 70's after I was concerned about mine.He had only his largest biopsied which was only a little more than a cm,the others are even smaller.And he had X-Ray therapy as a teen to treat acne I never did.
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Avatar_m_tn
>And why would only the isthmus nodule now have become this way,when none of the three were before?

Out of my keister, I think you can consider them as most separate animals. They are doing their own thing.

Also, reading a bunch lately. I believe that they've been doing a lot of statistical study of nodules over the years and that's changed professionals assumptions.  So size or vascularity isn't considered as important as it used to be.

Also I think that with most thyroid cancer there is seldom any urgent rush to treat it. Because it's slow growing. They could miss the cancer with an FNA, and then three years later repeat the FNA and find it.  And your prognosis is the same if they'd found it the first time three years ago. The prognosis being, you'll live.

So I think there is a tension between patients that are afraid what what may happen and want to be treated now and get it behind them, and doctors that want to be absolutely sure the patient needs treatment before they do anything.
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Avatar_f_tn
Thank you for responding. But what you said does really worry and concern me,that the first FNA could have missed the cancer,and now find it! I recently had my thyroid T3,T4 and TSH tested over a week ago,and they are all normal. My TSH is 2.35.
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Avatar_f_tn
Also, I'm beyond petrified of *any* surgery especialy being put to sleep,I won't even have a colonoscopy for my bowel pain of 19 years!
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Avatar_m_tn
I totally understand.  The lab report for my nodule said false negative of 3% or less. Wonderfully reassuring.  I think you just have to wait for the FNA of the nodule that's grew  On the plus side, if it's not cancer this time around, it's not cancer and never is going to be anything but annoying,

BTW I have an annoying habit of not sounding as reassuring as most people would. Just so you know. (Maybe it's because I grew up within sight of the Blue Cube during the cold war)
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