NHL or Hashimoto's?

[momofvera]

I have been following your posts and searched for an answer that could cover this. Not finding one specifically to satisfy my concern, I was hoping you could tell me your opinion. I was diagnosed with Hashimoto's about six months after childbirth (2/20/07). I am a 26 year old female who insisted on having an ultrasound done or any other tests after being put on 50 mcgs of Synthroid and still feeling fatigued with stomach cramps. The ultrasound showed five dispersed nodules, the largest measuring just a centimeter. I was told I could put off a biopsy but I chose not to after having just watched my mother die of breast cancer a month before my child was born. A cytometry was done on the aspirated hypoechoic nodule/cyst and results are as follows.

CD19-/CD5+    T-Cells             93%
CD2                T-Cells             94%
CD7+/CD3+     T-Cells             91%
CD3                 T-Cells            94%
CD4+/CD3+    Helper/Inducer    67%
CD4+/CD3-                               1%
CD8+/CD3+  Suppressor/Cytoxic   24%
CD3+CD16/56+  T-Cytotoxic         <1%
CD3-/CD16/56+  Natural Killer Cells  <1%
CD20             B-Cells               5%
CD19+/CD5-    B-Cells                 3%
Kappa+/CD19+    B-Cells             2%
Lamba+/CD19+    B-Cells            1%
CD19+/CD5+       CLL/Mantle        1%
CD10+/CD20+      B-Cell Subset    <1%
CD10                                           1%
CD23                   B-Cells               2%
FMC7                   B-Cell Subset       1%
CD25+/CD11c+    B-Cell Subset      <1%

right lobe measures 5.2 x 1.6 x 1.8cm, left lobe 5.0 x 1.7 x 1.6cm, isthmus 3mm in AP diameter.

4/18/08 my
Antithyroglubuln AB was 46(H) IU/ML range 0-40
Thyroid Peroxidase AB was 201(H)  range  0-34, TSH .68, T4 1.0 Cortisol 7.6(L)
CBC all in range but LYMPH% 17.1(L) range 20.5-51.1 and LYMPH# 1.0(L) range 1.2-3.4

My endo referred me to my mother's oncologist and a surgeon. My endo said it could be Hodgkin's Lymphoma in which the ENT surgeon didn't disagree but my Oncologist dismissed and said it would be NON- Hodgkins.  
ALL OF THE DOCTORS said you couldn't tell until a complete thyroidectomy was done and that it could just be Hashimoto's. All the research I have done makes their case possible BUT 90% of the time FNA could tell if it was Lymphoma. Am I being fibbed to so they can tell what kind of Lymphoma it is?  HOW CAN THEY TELL WHAT KIND OF LYMPHOMA IT WOULD BE BUT NOT THAT I HAVE IT? I MEAN COMMON! :)

What do you think? A CT Scan was ordered via my whining and the nodule is stable and no lymphadenopathy found anywhere else. Thank God! I need to know true probability here.  Also, after the FNA 11/13/08 my thyroid is sore and achy. Bothersome.

Thank you in advance for the time you take to answer our questions!!

Surgery Jan 20th.....

Bethany

[Ananya4989]

Most probably a diffuse large b cell lymphoma (a type of non hodgkin's lymphoma).

[Lee12059]

I have to say that your information has been very helpful in the last few minutes of reading what you have to say.  My daughter who is 27, had thyroid ca (papillary) and had her thyroid completely removed and surrounding lymph nodes.  She is now 5 years post that surgery and treatment and has been clear for years of any signs of recurring cancer.  Yesterday we were informed by her that she had a nodule and ultra sound and needle bx and it has shown lymphocytes, not malignancy, benign, however it is an unusual finding, according to her physician.  She has been referred to an oncologist for further investigation and they have mentioned NHL...so I have been reading whatever I can find to become more informed.  I thank you for the information shared here, I am like you in that I am fascinated by the human body and I too retain so much of the research that I read, so perhaps a natural aptitude towards medical information. I see that this entry is years old, I pray that you are well and that you have gone on to  r/o anything serious and are healthy.  Thank you again.

[Dnmh]

They can find most types of thyroid cancer by FNA, just not lymphoma. I think I found that info from Mayo Clinic. It's hard to remember where. I look for a lot of medical publications for my info )and seem to be able to retain what I read). They are much more reliable than BobbyJoe's webpage.

I'm seeing my primary tomorrow for an enlarged lymph node in my neck that has only gotten bigger in the last 5 weeks (over 3cm) plus a few other symptoms that could point to lymphoma. I'm concerned I could have either.

As to the research, I have a solid thyroid nodule a little over 1 cm, with a few cysts. I also have an autonomic nervous system disorder - according to my neurologist - which can be either idopathic, or caused by 7 different disorders. They have ruled out 5 so far, including Hashimoto's - which at first they thought I had - but have not ruled out autoimmune or cancer. My father has a multinodular goiter - which according to the National Cancer Institute, puts me at an increased risk for thyroid cancer. My mother has Chronic Lymphocytic Leukemia, and according to the Journal of the National Cancer Institute puts me at an increased risk for both HL and NHL. Thyroid lymphoma is an NHL. I have an elevated ANA - but am negative for all patterns. ANA can also be elevated in cancer. One of my cousins on dad's side just died from leukemia. He also had a mass on his thyroid that was ignored because his leukemia was so aggressive. My dad's father and 4 uncles had different cancers, one thyroid, and his grandfather committed suicide in 1928 due to health reasons -  we believe he had cancer too. My mother's grandmother had "stomach" cancer as did one of the uncles. I'm starting to wonder if it may have been MALT Lymphoma but we'll never know. I was also exposed rather regularly to PVC dust growing up. My dad was a chemical engineer for a foam sealant company - PVC dust was/is the main ingredient. It came home on his clothes, and he would take me and my sister to the shop on weekends. I even worked there for a few weeks out of high school, plus we lived near a steel mill - less than 5 miles away. And, I've been a smoker for almost 30 years.
I needed to explain it all that way to explain why I'm SO very concerned about me having cancer. I have too many risk factors.

Hope that answered....

[momofvera]

I already have to be on the meds forever anyway, it would just be a higher dosage. Where did you find the info of the cells of Lymphoma being too large to fit into the needle? I have only found that they can usually tell by fna 90% of the time. Maybe just by the abnormal cell markers and not the actual Lymphoma cells? Why all the research? Did they think you had HL or NHL?

[Dnmh]

Honestly, that is a personal decision you have to make. If it was me that had to make that choice, I would weigh out all my options. Having your thyroid removed means being on meds the rest of your life. Is that a fair trade-off? Only you can make that choice. As for reducing the risk, I think it does, but I'm not a doctor. Others here with more experience may pipe in about that.

Whatever choice you make, I wish you the best.

[momofvera]

Thank you for your comment. It seems like they feel it is unlikely but instead of ordering another FNA they (4 docs including an oncologist) want to do a TT. Surgery is next Tuesday. I am now wondering if I take it all out if that reduces the risk for any type of thyroid cancer in the future. If not, maybe I should keep it in and just do an open biopsy. However, two of these doctor's wives had it all removed because they were sick of "dealing with it". I'm 26 and have more smaller nodules, I can see how doing fnas over and over again would be annoying. I just want to avoid the double surgery thing so many people have experience here. And my thyroid is still achy. What do you think?

[Dnmh]

FNA cannot tell if it's lymphoma. It can detect the other thyroid cancers, but not lymphoma. From everything I've read, and I've read tons, the lymphoma cells are too big to fit into the needle. They would need to do at minimum, a core needle biopsy.
Generally, if it's a thyroid lymphoma, it is non-hodgkins lymphoma. It is an aggressive lymphoma so the sooner you have a biopsy, the better. They shouldn't need to do a total thyroidectomy, but a surgical or core biopsy really is the only way to tell.

On the positive - while people with Hashimoto's are at an increased risk for thyroid cancers - it is generally pappilary carcinoma - which is highly treatable.

Best of luck!

[redheadaussie]

I am not really sure to be honest. Perhaps if you posted your concerns to the doctor's page they might be able to give you a better answer.
  I do know that when you have FNA and you have Hashimoto's it does cause some discomfort as the thyroid tries to figure out what the heck happened. I had 3 FNA's and they made my thyroid tender and quite swollen.
  It is good you are taking an active role in your health care. It is obvious to me that you are concerned about it all, especially as your mum died not too long ago.
Good luck with the surgery!