Help understanding diagnosis - follicular variant of papillary thyroid carcinoma

[billintn]

My wife recently had a partial thyroidectomy based upon a "suspicious" fna. The initial hospital labs said it was benign but the mayo clinic labs came back today reading as follows:
"The sections present in A contain a follicular patterned neoplasm with slight hurthle cell features. This measured 3.2 cm from the slided. The tumor contains irregular nuclei, focal areas with prominent nuclear grooves as well as nuclear clearing. The stains that we performed showed that the tumor cells were positive for cytokeratin 19 and galectin -3 diffusely with focal staining for HBME-1.  Based on the histopathologic features and immunophenotype, we would consider this to be a follicular variant of papillary thyroid carcinoma.

Our general surgeon wants to start her on thyroid medicine tomorrow and then remove the remaining thyroid in approx. 6 months followed by radioactive iodine.

My questions:
1) Can you help us understand this diagnosis?
    a) Especially "slight Hurthle features" because what I have read about Hurthle scares me
2) Is a second opinion advised?

My wife is a very healthy 40 year old athlete

Thank you

[Reese120]

One more thing, I am 40 as well!!!  

[Reese120]

Hi ~

I am living the same thing your wife is going thru right now.  I totally agree with Utah, do not wait to get this out!  I had my first surgery 11/4 and they told me that the frozen section taken during the surgery was benign.  5 days later I got the call that it was papillary thy ca and that they were taking out the 2nd 1/2 on 11/14.  I wanted to wait and they said no.  The surgeon said you do not want scar tissue to form and they wanted the other 1/2 half out asap.  I had the surgery and I am going tomorrow for my 1st endo appointment and to find out my RAI date.  My surgeon is ranked 1 of the top 10 in the country for head and neck cancers and he specialzes in thyroids.  I also was not sent home with any thyroid replacement.  My tumor size was 3.5 cm.  PLEASE do not let her wait!!  Get another opinion fast if need be!!

Take care!!!

[utahmomma]

The general practice would be to schedule your wife for the followup surgery ASAP - not to wait 6 months.  Follicular carcinoma is more aggressive than simple papillary carcinoma and I-131 (radiated iodine therapy or RAI as we call it here) is necessary.  RAI cannot be performed until the remaining thyroid tissue is removed.  There are many on here who have had the second surgery right after the first one.

Here's some information regarding follicular carcinoma:  http://www.endocrineweb.com/cafol.html

Get a second opinion - preferably from an ENT, endocrinologist (who specializes in thyroid conditions) or an oncologist would be the best.  There is no need to have her wait 6 months.

One thing I'm confused about; how large was the tumor?  I'm guessing from the description that the 3.2cm means how far away from the edge of the thyroid capsule it was located but I'm not sure.  If the caner itself was 3.2cm large then the surgery shouldn't wait 6 months!

Please take care and keep pushing the doctors.

Utahmomma
papillary carcinoma '03, second surgery '04
recurrence and RAI '06
three sisters with papillary carcinoma; another with precancerous nodules; daughter with precancerous nodules