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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Confused about multi-nodular goiter and very high thryoid antibodies.
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
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.
Confused about multi-nodular goiter and very high thryoid antibodies.
by nmfarmgirl, Apr 26, 2007 12:00AM
Hello. I'm confused about what's going on with my thyroid. The short story is that I was diagnosed with a multi-nodular goiter. I then had an u/s and found that my my left thyroid lobe was enlarged, and I had 4 nodules (dominant being 2cm). I was then sent for a FNA -- twice. The first FNA result was indeterminate and the second negative (for malignancy). In the meantime I had my TSH, T4 total, free T4,free T3 and total T3 tested -- all were in "normal range". However, when my Dr requested the Thyrogobulin test, it was unmeasurable due to my high (2358) Thyroglobulin Ab levels.
My GP tells me not to worry about the first indeterminate FNA as it now appears that I probably have Hashimoto's Thyroiditis. I have an appointment in early May with an endocrinologist.
Therefore, what I'd like to know is:
1. What questions should I be asking the endo at my appointment?
2. Is it true that I should diregard the first FNA result?
3. Could my high thyroid antibodies be caused by the first FNA (my GP couldn't answer that)?
Thanks so much for your time!
My GP tells me not to worry about the first indeterminate FNA as it now appears that I probably have Hashimoto's Thyroiditis. I have an appointment in early May with an endocrinologist.
Therefore, what I'd like to know is:
1. What questions should I be asking the endo at my appointment?
2. Is it true that I should diregard the first FNA result?
3. Could my high thyroid antibodies be caused by the first FNA (my GP couldn't answer that)?
Thanks so much for your time!
Doctor's Answer
by Mark Lupo, M.D., Apr 26, 2007 12:00AM
, Apr 26, 2007 12:00AM
If indeterminant means 'follicular lesion' -- get a second opinion on the first FNA slides (ie, send off to a university). The endo will/should know how to get this done.
The FNA did not cause the high Tg Antibodies - these suggest hashimotos -- which should not be confused with indeterminant follicular lesion -- so this does not explain the first FNA result.
Ask the endo what normal is a TSH (I say 0.3-3.0).
The FNA did not cause the high Tg Antibodies - these suggest hashimotos -- which should not be confused with indeterminant follicular lesion -- so this does not explain the first FNA result.
Ask the endo what normal is a TSH (I say 0.3-3.0).
The indeterminate FNA reads:
The specimen is markedly cellular. In the above clinical setting, the findings likely represent a benign hyperplastic nodule. However, a follicular neoplasm cannot be excluded. Microscopic Description: The specimen is cellular, showing numerous groups of focally crowded and enlarged follicular cells arranged in sheets and clusters. Although some of the nuclei appear enlarged, nuclear features of papillary carcinoma are not detected. The background shows minimal proteinaceous debris and scattered histiocytes.
My TSH level was 3.940 (.0490-4.670 uiu/ml)