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Thyroidectemy vs. lobectemy
Hi there.
My boyfriend recently went in for ear problems when his ENT pointed out that he had nodes on his thyroid. After the ultrasound/sonogram they found that he had a 2x3 cm node on the right side and possibly another on the left, however, focused soley on the right side. They also found a 1cm nodie on the left of the isthmus and a .5cm on the right of the isthmus. He went in for a FNA and the results were as follows:
"Smears and cell block show a cystic lesion with areas of atypical follicular epithelium, manifested as epithelium with enlarged nuclei with a fine nuclear chromatin pattern. Rare areas are suspicious for inclusion formation. Papillary architecture is not seen. Cytologic features are of a follicular lesion, and the differential diagnosis includes an ademnomatous nodule with cystic degeneration versus follicular variant of papillary carcinoma. Recommend clinicopathologic correlation."
Needless to say we were confused and were wondering what this means. He has had a lot of of mixed answers as to what the best option for him would be. He is well informed about thyroid issues and has a family history of thyroid problems. His TSH results came back at .73 and that falls on the low end of the normal TSH range. He is having T4/T3/antibodies tests done this week.
His question is whether or not he should have the entire thyroid taken out or simply the ride node and the isthmus. He is 26 year old and very healthy and active and is worried about the effects of having a total thyroidectemy at his age. (loss of energy, metabolism issues, etc) He is also worried about being bound to a thyroid hormone for the rest of his life and what the effects of that might be. If the right node is determined to be benign during the surgery could he leave the left one in? He feels strongly about keeping at least part of his thyroid. Any information or input would be greatly appreciative. Thanks!
My boyfriend recently went in for ear problems when his ENT pointed out that he had nodes on his thyroid. After the ultrasound/sonogram they found that he had a 2x3 cm node on the right side and possibly another on the left, however, focused soley on the right side. They also found a 1cm nodie on the left of the isthmus and a .5cm on the right of the isthmus. He went in for a FNA and the results were as follows:
"Smears and cell block show a cystic lesion with areas of atypical follicular epithelium, manifested as epithelium with enlarged nuclei with a fine nuclear chromatin pattern. Rare areas are suspicious for inclusion formation. Papillary architecture is not seen. Cytologic features are of a follicular lesion, and the differential diagnosis includes an ademnomatous nodule with cystic degeneration versus follicular variant of papillary carcinoma. Recommend clinicopathologic correlation."
Needless to say we were confused and were wondering what this means. He has had a lot of of mixed answers as to what the best option for him would be. He is well informed about thyroid issues and has a family history of thyroid problems. His TSH results came back at .73 and that falls on the low end of the normal TSH range. He is having T4/T3/antibodies tests done this week.
His question is whether or not he should have the entire thyroid taken out or simply the ride node and the isthmus. He is 26 year old and very healthy and active and is worried about the effects of having a total thyroidectemy at his age. (loss of energy, metabolism issues, etc) He is also worried about being bound to a thyroid hormone for the rest of his life and what the effects of that might be. If the right node is determined to be benign during the surgery could he leave the left one in? He feels strongly about keeping at least part of his thyroid. Any information or input would be greatly appreciative. Thanks!
i'm a bit older than you (47), but am a distance runner (marathons). i had no syptoms, but my doc found several nodules during routine exam. long story short, i had a TT 12 days ago. went home from hospital the day after, no pain meds needed. walked a mile first day home, light work out second day, and normal (short) workout by day 3. back to work after 5 days. I'm going to run a 4 miler tomorrow.
my surgeon started the synthroid right after surgery. i blv this was key to my recovery. i'm not completely used to the meds yet, but doing real well. engery is fine, no weight gain, no problems to speak of. every now and then i feel a bit foggy (like i'm on cold medicine) and i have an occasional heart palpitation that gives me pause. i understand it takes a few weeks to get used to the meds.
good luck with surgery. make sure you have a surgeon that has done many TTs. mine did around 40 to 50 a year. this made all the difference.
my surgeon started the synthroid right after surgery. i blv this was key to my recovery. i'm not completely used to the meds yet, but doing real well. engery is fine, no weight gain, no problems to speak of. every now and then i feel a bit foggy (like i'm on cold medicine) and i have an occasional heart palpitation that gives me pause. i understand it takes a few weeks to get used to the meds.
good luck with surgery. make sure you have a surgeon that has done many TTs. mine did around 40 to 50 a year. this made all the difference.
MEDICAL PROFESSIONAL
If the right side only is removed and it is cancer, then usually you would need to have a completion thyroidectomy (removal of the left). The key is the FNA reading -- with the pathologist I use, this would be considered suspicious which carries an approx 70% chance cancer -- ie high probability of needed two operations if only the right is removed at initial surgery.
Would consider sending the slides for expert opinion -- U Florida (Dr. Massoll), Mayo Rochester, Johns Hopkins, U Penn -- those are among the top. Would not undergo any surgery until an expert has had a chance to review and make certain that there are suspicious findings and not just a local pathologist covering his/her bases (not to be harsh, but it happens often).
Would consider sending the slides for expert opinion -- U Florida (Dr. Massoll), Mayo Rochester, Johns Hopkins, U Penn -- those are among the top. Would not undergo any surgery until an expert has had a chance to review and make certain that there are suspicious findings and not just a local pathologist covering his/her bases (not to be harsh, but it happens often).
Dr Lupo, Thank you very much for your comments. I have sent the biopsy specimens to UT Southwestern on my cousin's recommendations (a top cardiologist at Duke). I saw my ENT yesterday again and he is very insistent that I need to have the full thyroidectomy because of how suspicious the right side is, and the 8 or so <1 cm nodules on the left. He also agrees that if the right side is malignant, the left comes out no quesion, and in his opinion doing a 2nd surgery is more risky as soon as pathology is done biopsying the right half a week later than is taking the whole thyroid out. This is the hardest part I am dealing with because of the vast amount of problems everyone on here seems to have with the hormone levels when relying solely on thyroid medication.
Also, I did speak in person with the pathologist that did the initial biopsy. She did sound like she was being agressive on her report. Mostly she said that she just couldn't call it malignant since there wasn't anything definite, however those epithlial cells with enlarged nuclei concern her that they are trying to turn into cancerous cells. The atypical cells are the only reason for her indeterminate result.
jjhh, thank you for your insight. It is great to hear that you are regaining your active lifestyle again so soon. I hope that I am able to do the same after mine!
Also, I did speak in person with the pathologist that did the initial biopsy. She did sound like she was being agressive on her report. Mostly she said that she just couldn't call it malignant since there wasn't anything definite, however those epithlial cells with enlarged nuclei concern her that they are trying to turn into cancerous cells. The atypical cells are the only reason for her indeterminate result.
jjhh, thank you for your insight. It is great to hear that you are regaining your active lifestyle again so soon. I hope that I am able to do the same after mine!
Dr Lupo, Thank you very much for your comments. I have sent the biopsy specimens to UT Southwestern on my cousin's recommendations (a top cardiologist at Duke). I saw my ENT yesterday again and he is very insistent that I need to have the full thyroidectomy because of how suspicious the right side is, and the 8 or so <1 cm nodules on the left. He also agrees that if the right side is malignant, the left comes out no quesion, and in his opinion doing a 2nd surgery is more risky as soon as pathology is done biopsying the right half a week later than is taking the whole thyroid out. This is the hardest part I am dealing with because of the vast amount of problems everyone on here seems to have with the hormone levels when relying solely on thyroid medication.
jjhh, thank you for your insight. It is great to hear that you are regaining your active lifestyle again so soon. I hope that I am able to do the same after mine!
jjhh, thank you for your insight. It is great to hear that you are regaining your active lifestyle again so soon. I hope that I am able to do the same after mine!
One more thing to note. I am seeing my ENT tomorrow again, but surgery is scheduled for May 12th right now. He wants to do complete removal. I leave in one week for a vacation of 2 weeks, so time is of the essence.
My biggest hesitance about all of this is I feel perfectly fine and am very active (just ran a 5k sat). I workout 3-5 times a week. I have zero symptoms from everything I've read, yet this dr says that I have to take it out and possibly end up in the unfortunate condition that many people on this forum are due to fluctuating hormone levels after removal. My quality of life right now is perfect and I do not want to change that at only 26, especially for what I have read as a negative on cancer from the biopsy.
Thank you very much and my appologies about the long post. This is all happening very quickly.
My biggest hesitance about all of this is I feel perfectly fine and am very active (just ran a 5k sat). I workout 3-5 times a week. I have zero symptoms from everything I've read, yet this dr says that I have to take it out and possibly end up in the unfortunate condition that many people on this forum are due to fluctuating hormone levels after removal. My quality of life right now is perfect and I do not want to change that at only 26, especially for what I have read as a negative on cancer from the biopsy.
Thank you very much and my appologies about the long post. This is all happening very quickly.
Hello, I'm the boyfriend, haha. Some more details on the initial ultrasound:
The Rt Gland is normal in shape and slightly enlarged. THere are multiple complex/Necrotic appearing nodules noted.
The Isthmus has a solid nodule to the rt which is .52cm and to the left which is 1.04cm.
The Left Gland is normal in shape and slightly enlarged in size. There are multiple cystic nodules scattered throughout that all measure les than 1cm in size. The texture is smooth and homogenous.
The Rt Gland is normal in shape and slightly enlarged. THere are multiple complex/Necrotic appearing nodules noted.
The Isthmus has a solid nodule to the rt which is .52cm and to the left which is 1.04cm.
The Left Gland is normal in shape and slightly enlarged in size. There are multiple cystic nodules scattered throughout that all measure les than 1cm in size. The texture is smooth and homogenous.
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