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Thyroid Nodule Treatment
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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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Thyroid Nodule Treatment

After chronic sore throats all year my GP felt a lump on my thyroid.
I had an ultrasound which found that in the mid and lower pole of the left lobe there is a 3 x 3 x 2.2cm solid mass with retrosternal extension. There are a couple of "small scattered nodules in both lobes measuring in the order of 3-4mm"
GP noted that larger nodule was heterogenis.

A FNAB of that nodule states:
Follicular epithelial cell and rare microfollicular arrangements.  Colloid is not present.  Comment states that 'features are of a cellular follicular nodule' which cytology cannot differentiate between hperplastic nodule, follicular adenoma or a well differentiated carcinoma.

The recommended treatment has been hemithyroidectomy- with final results 5 days post surgery.  If carcinoma- then reoperate 8 weeks later to take remaining thyroid out.

Questions:
(1) What on earth do you think "rare microfollicular arrangements" mean- no one seems to want to discuss that aspect with me.

(2) If benign- is it likely that I will need the other 1/2 of my thyroid out in a few years due to the tiny ones growing?  Aren't follicular adenomas essentially pre-cancerous?

Trying to get my head around all of this, thanks for your input.
Em
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follicular epithelial cells are the cells of the thyroid.  microfollicles are small arrangements of these cells and are present in follicular lesions (ie follicular adenomas and follicular cancers).  Macrofollicles are associated with benign nodules.  

15-20% of these types of nodules are cancer, but the key is the read on the needle FNA -- many pathologists will call something indeterminate -- kind of as a CYA....I would recommend sending the slides to an expert -- eg U Penn, U Florida (Dr. Massoll) or John Hopkins for a second opinion before going to surgery.  

Of course if the  nodule is causing symptoms, surgery may be indicated even if the FNA is clearly benign.

There is no one right answer as to the initial surgery of a follicular lesion (indeterminate FNA) -- most opt for hemithyroidectomy, but if there are nodules on the other side then a total is reasonable as the initial surgery --- patient preference plays a role in this decision.
2 Comments
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287230_tn?1197864963
Let me add: all bloods including TSH levels were normal.
Em
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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