Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
follicular neoplasm and hurthle cells
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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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follicular neoplasm and hurthle cells

I had a FNA that showed rare suspicious hurthle cells.  I had a core biopsy that is showing follicular neoplasm.  I have a 1.5cm solid mass in my right thyroid.  This was found during a CT scan, due to an auto accident.  My thyroid levels are normal range - TSH is low end of normal.  My whole body aches all the time (bones, or muscles - I can't tell which).  I have a sharp pain in the right side of my neck that shoots to my ears at times.  My hands have a yellow tinge in them, but my liver levels are normal.  I had a liver scan, that only showed a 2cm spot, which they say is nothing.  I am tired a lot, my hands and feet are cold, as the rest of me just can't warm up either at times.  My heart beat is 98-124 when I am standing.  I am usually not thirsty, or hungry very often.  When I am hungry though, I eat a lot.  My weight has come down a little, but not drastically.  Digestive system is very sluggish.  
Would an ultrasound blood flow test help to see if the tumor is vascular to see if it is cancer?  How about checking to see if it is a hot, or cold tumor?  Can I have a pet scan, or is there a scan to see if it these cells have already spread to other parts of my body?  I am not interested in having my thyroid removed, IF it has already spread, as I am told that hurthle cell cancer is not treatable, if it has spread.  
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For a follicular neoplasm there is about a 20% chance of cancer - if the TSH is in the low normal range, an I-123 scan may help if the nodule is clearly "hot" then it is not likely to be cancer.  

Would consider sending the biopsy slides to an expert for a second opinion to see if it is truly a neoplasm that may need to be removed to make a definite diagnosis.  The liver lesion is unlikely related but would suggest repeat imaging to make sure it is not enlarging.  A PET scan may help, but would not be definitive in determining the nature of the thyroid lesion.

Hurthle cancer is treatable (though not as responsive as papillary and follicular), so would not delay evaluation based on that concern.
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If I have 1/2 of my thyroid taken out, do I have to have thyroid  hormone replacement therapy?  Or, will the left side of my thyroid be enough to give my body the  hormones that it needs?
Any suggestions on an expert thyroid surgeon in Minnesota?
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Do you have any suggestions on where to send my slides for a 2nd opinion for my thyroid?  I am not sure how to obtain my slides for this...  
Would a pet scan show if there is any cancer in the rest of my body (if I have it) that came from my thyroid?
How do I find an expert at thyroid surgery?  What kind of surgeon are they called?
In terms of my liver: I found out that I now have 5 lesions on my liver (3left,2 right side).  I had 1 lesion on the rt side back in 2002, which changed about 1/2 cm.  I did have 2 very large hemangiomas removed in 1994 (they changed in size from a piece of rice to a softball and pool cue ball within 10 months).  I don't know what causes them to change, but I am concerned about these 5 that are now in my liver.  I thought people were born with these?  I don't understand why lesions are showing up in my liver.  The doctor said that these don't need to be followed as he believes they are hemangiomas, but that is what they said back in 1994 too.  
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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