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Surgery or re-do FNA in three months?
U/S in 05 impression: multiple solid nodules in right lobe and region of isthmus. No increased vascularity noted in these regions. THYROID UPTAKE & SCAN in 06 impression: Negative thyroid scan and euthyroid uptake.
U/S in 10 impression: one of the nodular density seen within the thyroid gland previously*2006, the one situated at the junction of the right thyroid lobe and the isthmus anteriorly has enlarged and demonstrated hypoechoic halo. Increased vascularity is also seen, because of suspicion of neoplastic pathology.
US-FNA 2010 Diagnosis: Bethesda Class - Benign Thyroid/Follicular Nodule -- Nodular goiter, predominantly hyperplasia, Comment: FNA smears and cell block show features consistent with hyperplastic nodular goiter,however, the pattern is somewhat unusual and a repeat FNA within 12 months should be considered to entirely rule out a follicular neoplasm.
Second Opinion on above FNA: 8 FNA slides-Thyroid right lobe, 1.8 cm nodule, US-FNA: Follicular lesion of undetermined significance (Bethesda Thyroid FNA Classification Scheme). Recommend repeat FNA after 3-months.
(Must note T3, Total at 81 (reference range: 76-181 ng/dL. Thyroid Peroxidase Antibodies <10 (reference range: <35 IU/mL). Good? ok? Done after U/S before FNA.
What do I do now? Go along with the three month re do of the FNA? Have a few slices of tissue surgically removed and typed? Or go for a full blown removal of nodules/type - possible removal of thyroid??
Daughter went in for the final of three after TWO separate inconclusive FNA and found NO cancer but took half of thyroid and she is on synthroid and cytomel and her life is not the same.
Does it seem to everyone that no matter what, the only way to tell of cancer is by surgically going in? And why the loss of half of the thyroid to find out there is none? Can ONLY the nodule be removed with OUT taking any of the thyroid? Once the thyroid has been messed with surgically it seems to damn one to an eternity of health issues and problems that NO doctor really wants to deal with. Just give scripts of synthroid and/or cytomel and show them the door. Never dealing with the weight issues, other hormonal issues, hair/skin, nutrition.
Also seems to me that NO FNA determines squat. Nor the U/S. So why bother???? Maybe once a nodule is noted just remove thyroid - give out scripts and tell them good luck. Save alot of time, energy and money, no?
(Don't mean to upset anyone - offend anyone - but really this is becoming a nightmare and there is NO clear plan of action. Cancer or life time struggle? Which would YOU choose?
U/S in 10 impression: one of the nodular density seen within the thyroid gland previously*2006, the one situated at the junction of the right thyroid lobe and the isthmus anteriorly has enlarged and demonstrated hypoechoic halo. Increased vascularity is also seen, because of suspicion of neoplastic pathology.
US-FNA 2010 Diagnosis: Bethesda Class - Benign Thyroid/Follicular Nodule -- Nodular goiter, predominantly hyperplasia, Comment: FNA smears and cell block show features consistent with hyperplastic nodular goiter,however, the pattern is somewhat unusual and a repeat FNA within 12 months should be considered to entirely rule out a follicular neoplasm.
Second Opinion on above FNA: 8 FNA slides-Thyroid right lobe, 1.8 cm nodule, US-FNA: Follicular lesion of undetermined significance (Bethesda Thyroid FNA Classification Scheme). Recommend repeat FNA after 3-months.
(Must note T3, Total at 81 (reference range: 76-181 ng/dL. Thyroid Peroxidase Antibodies <10 (reference range: <35 IU/mL). Good? ok? Done after U/S before FNA.
What do I do now? Go along with the three month re do of the FNA? Have a few slices of tissue surgically removed and typed? Or go for a full blown removal of nodules/type - possible removal of thyroid??
Daughter went in for the final of three after TWO separate inconclusive FNA and found NO cancer but took half of thyroid and she is on synthroid and cytomel and her life is not the same.
Does it seem to everyone that no matter what, the only way to tell of cancer is by surgically going in? And why the loss of half of the thyroid to find out there is none? Can ONLY the nodule be removed with OUT taking any of the thyroid? Once the thyroid has been messed with surgically it seems to damn one to an eternity of health issues and problems that NO doctor really wants to deal with. Just give scripts of synthroid and/or cytomel and show them the door. Never dealing with the weight issues, other hormonal issues, hair/skin, nutrition.
Also seems to me that NO FNA determines squat. Nor the U/S. So why bother???? Maybe once a nodule is noted just remove thyroid - give out scripts and tell them good luck. Save alot of time, energy and money, no?
(Don't mean to upset anyone - offend anyone - but really this is becoming a nightmare and there is NO clear plan of action. Cancer or life time struggle? Which would YOU choose?
Best Answer
Welcome to the imperfect science of the thyroid...I had four nodules, ranged from .8 mm up to 2.1 cm...they did a biopsy on the largest one, found "benign follicular clusters" and gave me options of removal or watch and wait. Three were on the right side which was almost all nodules. I am a singer and was getting too hoarse to continue singing, so I chose to remove the three on the right hoping that would relieve the hoarseness. The recurrent laryngeal nerve runs through the thyroid and it controls vocal function. I also had swallowing issues. I, too, was hoping to preserve thyroid function, but after the surgery they did find cancer. Turns out "benign follicular clusters" doesn't mean benign...the fact that the cells were clustering was the tip off that it may be cancer. After the left side was removed, the biggest tumor was found...it was 1.5 cm, almost the total size of the nodule. If they had just biopsied that nodule, we may have saved me two surgeries. After 7 weeks, I had RAI to kill off the remaining thyroid tissue, and now, almost 1 year after the second surgery, I finally feel normal. I am running 5 days a week and singing again. You can feel normal with no thyroid, but it does take being firm with the Endocrinologist, they tend to favor conservative doses of meds. I am now on .1875 mcg of levothyroxin, a high dose, but I am a very active person, I exercise almost every day, so I need that high dose. I am gearing up for another test in June where they give me thyrogen and then test my thyroglobulin for recurrance. In your case, it probably does not hurt to watch and wait, thyroid cancer in general grows slowly and does not often metastisize, but if it does start growing quickly, then you should have it removed. The most dangerous type of thyroid cancer grows very quickly. The things that may indicate cancer in a thyroid nodule are vascularity (cancer needs a blood supply), calcifications, solid or mixed consistency, irregular margins...however, there is not one singular thing that can diagnosis this type of cancer yet. Yes, if you get lucky on the FNA biopsy (like my sister did) you could get a diagnosis on the first try, but in general it is not an exact test. Good luck.
With all of the medical technology today they cannot find a way to determine cancer without going in and removing? I am experienced with having cancer as well: MELANOMA. Of course I don't WANT cancer. But I don't want to have everything removed that could possibly have or NOT have a cancer. Where does it end??? How many organs/tissue/limbs do you give up for the possibility? It could actually be in your stomach. Liver. Pancreas. Bones. Blood. Try living without one of those.
It seems there are more stories of thyroids being removed and there is no cancer found, which is good. But I'll tell you it seems to me that every thyroid of late seems to have nodules so it is likely the only alternative is removal. Because there is NO definitive test available to determine the nodules contents. None. Why even bother with us and fna. Just schedule surgery.
I am going to be sure to bug every possible medical professional to get going on this because of a lifetime of replacement hormones is hell for most. Sooner or later. I know. My daughter is living the hell now. She had her non-cancerous thyroid removed six years ago at 19. Diagnosed with Hashimoto's, gluten intolerance and now PCOS. They all seem to go hand in hand. The hormones are doing squat for her.
My very very small lesion on my arm was removed and the doctor desired a wider excision just to be sure. I being frightened of the C word gave him the go ahead. There is a very very large scar and hole in my upper arm that CANNOT be shown. I took my slide to a specialist and he promptly told me "we don't do THAT anymore" *meaning the very large hole with skin grafted from leg* "They got it all the first time"
I am happy the doctor removed it the first time. There was no need for any more tissue removal.
Maybe there will come a day when the doctors will say "Oh, we don't remove thyroids just to check anymore" "Now we have an actual test that will determine cancer."
That is all I ask. We all deserve that.
It's time.
It seems there are more stories of thyroids being removed and there is no cancer found, which is good. But I'll tell you it seems to me that every thyroid of late seems to have nodules so it is likely the only alternative is removal. Because there is NO definitive test available to determine the nodules contents. None. Why even bother with us and fna. Just schedule surgery.
I am going to be sure to bug every possible medical professional to get going on this because of a lifetime of replacement hormones is hell for most. Sooner or later. I know. My daughter is living the hell now. She had her non-cancerous thyroid removed six years ago at 19. Diagnosed with Hashimoto's, gluten intolerance and now PCOS. They all seem to go hand in hand. The hormones are doing squat for her.
My very very small lesion on my arm was removed and the doctor desired a wider excision just to be sure. I being frightened of the C word gave him the go ahead. There is a very very large scar and hole in my upper arm that CANNOT be shown. I took my slide to a specialist and he promptly told me "we don't do THAT anymore" *meaning the very large hole with skin grafted from leg* "They got it all the first time"
I am happy the doctor removed it the first time. There was no need for any more tissue removal.
Maybe there will come a day when the doctors will say "Oh, we don't remove thyroids just to check anymore" "Now we have an actual test that will determine cancer."
That is all I ask. We all deserve that.
It's time.
Forgive me for not reading the post thoroughly...being that both fna's were inconclusive, i honestly do not think that the fna is going to change from inconclusive to something else in a matter of 3mos.
My biopsies were all benign and i was recommended to have a TT because of the cells (follicular and hurthle) that were found through Cat Scan and Fine NeedleBiopsy. Follicular on one side and Hurthle cell on the other, These types of cells cannot always be detected as cancerous by biopsy, even if the results are benign. They have to removed the entire thyroid and disect it in order to determine if any cancer is there. After a year of contemplating surgery, i went ahead and decided to do it and prayed that all came out ok and it did. Although it's tough without a thyroid, it's better to be without it considering the circumstance.
Be sure to educate yourself on your diagnosis and then determine your pro's and con's in regard to surgery or not.
My biopsies were all benign and i was recommended to have a TT because of the cells (follicular and hurthle) that were found through Cat Scan and Fine NeedleBiopsy. Follicular on one side and Hurthle cell on the other, These types of cells cannot always be detected as cancerous by biopsy, even if the results are benign. They have to removed the entire thyroid and disect it in order to determine if any cancer is there. After a year of contemplating surgery, i went ahead and decided to do it and prayed that all came out ok and it did. Although it's tough without a thyroid, it's better to be without it considering the circumstance.
Be sure to educate yourself on your diagnosis and then determine your pro's and con's in regard to surgery or not.
First, let me please tell that I am hopeful new meds or treatments are on the horizon to actually find any/all cancers to prevent any surgical removal. And that meds can be given then will give people their lives back for what my daughter goes through with her Hashimoto's, gluten intolerance and PCOS, I would not want anyone to experience at all. Hugs to all.
Personally, having had malignant melanoma, I think one cancer per person is enough. I just want to have enough faith in the medical professionals that what they suggest is best. Of course I don't want cancer--I have a huge hole in my upper arm for a very small superficial lesion that was removed.
I just want the best possible information. Something is nagging at me, that perhaps I am not. That it's easiest for the medicos to just cut me open, take it out then say, "oh, there was no cancer" and subject me to a lifetime of medicines that don't quite do anything well.
People all over were praising the use of Armour. Now, they have gone and changed it to where it is NOT working like before. Some docs replace the T4 and the T3, some don't. Most people suffer. Gain weight. Feel exhausted. Still lose hair. Neither the surgeon NOR the endo that cared for my daughter practice any more, she had hers removed in 2005. I don't know. I am a bit skeptical.
Personally, having had malignant melanoma, I think one cancer per person is enough. I just want to have enough faith in the medical professionals that what they suggest is best. Of course I don't want cancer--I have a huge hole in my upper arm for a very small superficial lesion that was removed.
I just want the best possible information. Something is nagging at me, that perhaps I am not. That it's easiest for the medicos to just cut me open, take it out then say, "oh, there was no cancer" and subject me to a lifetime of medicines that don't quite do anything well.
People all over were praising the use of Armour. Now, they have gone and changed it to where it is NOT working like before. Some docs replace the T4 and the T3, some don't. Most people suffer. Gain weight. Feel exhausted. Still lose hair. Neither the surgeon NOR the endo that cared for my daughter practice any more, she had hers removed in 2005. I don't know. I am a bit skeptical.
I had a partial thyroidectory in 06 due to FNA and U/S showing nodule and possible cancer. Hurthle cell in particular. I could get it out or wait and see. My 30 yr old sister was dying of stage 4 breast cancer so i just wanted any potential cancer OUT OF ME. The surgeon said if it was her sister she would recommend a partial and if cancer is found at biopsy during surgery take the rest right then. They didn't find cancer luckily. I couldn't deal with the not knowing or put my family through it as well. I have hashimoto's and sometimes wonder if it wouldn't have been easier to have a TT in regards to regulating since my thyroid is being killed off anyway. After a couple of years of regulating I am finally feeling really good. Now I have to deal with changing from the old Nature Throid to the new version. We'll see how it goes. It can be done and many people do feel well after regulation. I keep trying to remember that people who feel great often don't have the need to research and vent that sick people do. Therefore we hear more bad situations than good ones. Remember that there are many versions of the sysnthetic medicines and several of the dessicated. Keep trying until a good match is found. I'm on 4 grains/230mg of NatureThroid right now.
Thank you for the very informative reply, I truly appreciate you sharing your personal experience. (I feel like a big whiney baby.) I guess the thing that is bothering me MOST is the thought of yet another #(@&)#$ scar!!!
My body looks like I have been blown up and sewn back together by someone in a dark closet! The thought of those meds, yuck. I don't know. Every little med - OTC and prescription - has always bothered me with bouts of terrible headaches, dizziness, upset stomach, and the list goes on. Which is why I can honestly say I am not look forward to a lifetime of up and down T3 or T4. And they are synthetic, too. Good thing I went organic and I eat right --- like it's even going to do any good now. I hate it.
I wonder how many numbers are out there that went thru all the false positives and HAD NO CANCER but are doomed to a life of meds and symptoms.
My body looks like I have been blown up and sewn back together by someone in a dark closet! The thought of those meds, yuck. I don't know. Every little med - OTC and prescription - has always bothered me with bouts of terrible headaches, dizziness, upset stomach, and the list goes on. Which is why I can honestly say I am not look forward to a lifetime of up and down T3 or T4. And they are synthetic, too. Good thing I went organic and I eat right --- like it's even going to do any good now. I hate it.
I wonder how many numbers are out there that went thru all the false positives and HAD NO CANCER but are doomed to a life of meds and symptoms.
I think that my endo worked very slowly as far as increasing my dosage and her excuse was this: She doesn't want my heart palps/skipped beats to get worse....honestly, i know that it's the low dosage that causes them. I believe that i should be at least where you are at this point. She just increased me from 75 to 88 this past week.I see a new endo in a few weeks and we will take it from there.
I am no where near 100%, i do have energy most of the day, but i also have increase medical issues that occured after the TT...however, i know that they will improve when i am at my correct dosage...my TSH is at 8.60 and that is still high. I am being patient however i am also staying on top of things.
I am no where near 100%, i do have energy most of the day, but i also have increase medical issues that occured after the TT...however, i know that they will improve when i am at my correct dosage...my TSH is at 8.60 and that is still high. I am being patient however i am also staying on top of things.
I started at 50 mcg the day after RAI and gradually worked up to 125 mcg which is what I'm currently taking. My TSH is around 2.5 so it might need to be bumped up a little more. (It's so better than being at 50...not sure how those of you who are up near 100 or more do it.) I will have it checked again in a couple of weeks. I hope you're feeling 100% (or close to it) very soon.
" Well, my opinion is this: Repeat the fna in 3mos to see if there are any changes, however if you have seen more than one doc for more than one opinion, what are they suggesting?? "
No just one doc. Sent the FNA slides to two places. Both times were inconclusive. He is leaving it up to me. If I want to just wait the three months and re-do the FNA, or do a tissue sample, or surgery to remove nodule and do cancer typing there in OR to possibly remove thyroid. I can't decide.
" My fna's (all three) were benign but due to follicullar and hurthle cells within the nodule, it was suggested that i have a TT, which i did ." Just a question - how were the follicular/hurthle cells found? I don't understand this. Sorry. I am a noobie. What troubles me, is the same procedures were done on my 17 year old daughter of which both FNA procedures were found inconclusive. They talked her into surgery. She had NO cancer but now only HALF of her thyroid. Again, I don't understand.
No just one doc. Sent the FNA slides to two places. Both times were inconclusive. He is leaving it up to me. If I want to just wait the three months and re-do the FNA, or do a tissue sample, or surgery to remove nodule and do cancer typing there in OR to possibly remove thyroid. I can't decide.
" My fna's (all three) were benign but due to follicullar and hurthle cells within the nodule, it was suggested that i have a TT, which i did ." Just a question - how were the follicular/hurthle cells found? I don't understand this. Sorry. I am a noobie. What troubles me, is the same procedures were done on my 17 year old daughter of which both FNA procedures were found inconclusive. They talked her into surgery. She had NO cancer but now only HALF of her thyroid. Again, I don't understand.
It's great that you woke up feeling yourself again, i am waiting for that day and i know that it will soon come. I pray that you continue to feel that way as well. BTW, what dosage of synthroid are you on?? I am on 88mcg (just increased a couple of days ago).
Well, for myself I would rather have the challenge of regulating medication and some of the other symptoms than have cancer. I'm only 31 and I have a son to raise, am hoping for more kids someday, etc.
I had extensive lab work, ultrasounds and FNA this past year after having Hashi's for 10 years. My FNA was also negative but they wanted to do another ultrasound in 6 months (Dec. 09)...after that the first recommendation was to do another FNA. It felt like I was delaying the inevitable of having surgery. The roller coaster of waiting and not knowing was tough for me. I felt the same as you in that it seemed as though they would never know for sure without surgery. The only thing I knew was that something wasn't right so I scheduled a partial thyroidectomy for Feb. It ended up being a TT due to papillary carcinoma. The tumor was 1.2 cm. So far I've trusted my gut. Endo wanted to take wait and see approach as the first choice but I opted for surgery. Oncologist said he could go either way with RAI and he would support either decision. I had RAI (100 millicuries) and while it was tough at times (especially being off medication for 6+ weeks and the LID) I'm glad I did it. Whole body scan showed uptake in enlarged lymph nodes. Hopefully the RAI is doing it's magic and my next scan will be negative.
I've been back on synthroid for 7-8 weeks. I woke up easily early this morning and it's the first day since before my TT that I feel completely normal. I'm not tired or in any discomfort. I know every day isn't going to be like this but I'm so relieved to feel like myself. I've been terrified that my body was never going to be the same. I feel extremely lucky even though I know there is a long road ahead of me and this is just a good day. I fully expect that there will be bad days, but for me personally, I can deal with it if I know what it is we're dealing with. Hope this makes sense. Before my TT I had so much anxiety and now I know what needs to be done.
I don't mean for this to be one sided as this is just my personal experience. When I was in your shoes I found comfort in hearing others' stories. I hope this helps in whatever you decide. Good luck to you.
I had extensive lab work, ultrasounds and FNA this past year after having Hashi's for 10 years. My FNA was also negative but they wanted to do another ultrasound in 6 months (Dec. 09)...after that the first recommendation was to do another FNA. It felt like I was delaying the inevitable of having surgery. The roller coaster of waiting and not knowing was tough for me. I felt the same as you in that it seemed as though they would never know for sure without surgery. The only thing I knew was that something wasn't right so I scheduled a partial thyroidectomy for Feb. It ended up being a TT due to papillary carcinoma. The tumor was 1.2 cm. So far I've trusted my gut. Endo wanted to take wait and see approach as the first choice but I opted for surgery. Oncologist said he could go either way with RAI and he would support either decision. I had RAI (100 millicuries) and while it was tough at times (especially being off medication for 6+ weeks and the LID) I'm glad I did it. Whole body scan showed uptake in enlarged lymph nodes. Hopefully the RAI is doing it's magic and my next scan will be negative.
I've been back on synthroid for 7-8 weeks. I woke up easily early this morning and it's the first day since before my TT that I feel completely normal. I'm not tired or in any discomfort. I know every day isn't going to be like this but I'm so relieved to feel like myself. I've been terrified that my body was never going to be the same. I feel extremely lucky even though I know there is a long road ahead of me and this is just a good day. I fully expect that there will be bad days, but for me personally, I can deal with it if I know what it is we're dealing with. Hope this makes sense. Before my TT I had so much anxiety and now I know what needs to be done.
I don't mean for this to be one sided as this is just my personal experience. When I was in your shoes I found comfort in hearing others' stories. I hope this helps in whatever you decide. Good luck to you.
Well, my opinion is this: Repeat the fna in 3mos to see if there are any changes, however if you have seen more than one doc for more than one opinion, what are they suggesting??
The nodule is solid and that is cause for confirm, as well as the size and more than likely it will grow. Although the biopsy was benign, cancer cannot be ruled out due to the follicular cells.
I speaking from experience with a multi-nodular goiter with one solid and cold nodule @ 3.7cm. My fna's (all three) were benign but due to follicullar and hurthle cells within the nodule, it was suggested that i have a TT, which i did. I can truly say that i am not the same either, however, better days are ahead and i won't quit until i become very close to my old self again. It's difficult living without a thyroid and we as patients find this out on our own, but with the advise and encouragement from others who have been through it, we will all get through it.
God Bless you and you will be fine.
The nodule is solid and that is cause for confirm, as well as the size and more than likely it will grow. Although the biopsy was benign, cancer cannot be ruled out due to the follicular cells.
I speaking from experience with a multi-nodular goiter with one solid and cold nodule @ 3.7cm. My fna's (all three) were benign but due to follicullar and hurthle cells within the nodule, it was suggested that i have a TT, which i did. I can truly say that i am not the same either, however, better days are ahead and i won't quit until i become very close to my old self again. It's difficult living without a thyroid and we as patients find this out on our own, but with the advise and encouragement from others who have been through it, we will all get through it.
God Bless you and you will be fine.
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