Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Partial or TT? How might miscarriage affect?
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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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Partial or TT? How might miscarriage affect?

I appreciated your responses to my last two posts and now I have more info which leads to another question. What we knew a month ago: 4-5 cm. nodule on one side and two 1 cm nodules on the other, TSH was high in the normal range for hypo (4.0), high antibodies (441), FNA done on left lobe only, and we found out we were pregnant. What we know now:  Endo prescribed 50 mcg Synthroid, FNA came back Suspicious on Gene Expression Classifier so referred to surgeon, ob confirmed I'm miscarrying but hoping I can do it on my own if it doesn't take too long.  So would a miscarriage have to be totally competed and HCG's down to zero before a surgeon would consider surgery or would you recommend D & C and then surgery?  If the endo didn't biopsy the smaller nodules on other side, how common is it for surgeon to go in and do a quick biopsy of other nodules while removing one side?  I'm seeing a surgeon in La Jolla on Tuesday but would appreciate your thoughts. Thank you.
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Would defer the D&C decision to OBGYN, but from thyroid surgery standpoint, probably preferable to recover from miscarriage (and possible D&C) then do surgery.  The smaller nodules on the other side could under FNA prior to surgery to help plan extent of surgery OR with the 40% risk of cancer w/ "suspicious" GEC result and the borderline high TSH w/ positive TPO antibodies (making dependence of levothyroxine after partial quite likely) and bilateral thyroid nodules, a total thyroidectomy upfront may be the best choice.  Make sure the surgeon does a lot of thyroid surgery (at least 30 per year).
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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