Thyroid Tumor -Surgery or Not?

[artsyrose]

Hi. New here. I am a female, 53. I was recently diagnosed with Hashimoto's. Upon visiting the Endo...she found a tumor...did an US...it is complex...calcified..singular...large...taking up almost the whole of the left lobe.. An FNA was scheduled. I had that done the day before Thanksgiving. I had not receive the results, so I called the office this afternoon only to be told the results were "on the dr's desk" and she had not yet reviewed them. I asked the lab person with whom I was speaking, to go look and tell me what the report said. She of course said she couldn't until the dr had looked at it. To make a long story short, the report stated "no malignancy"... I will speak with the dr tomorrow about the possiblity of surgery. I am not at all convinced that these FNA's are always reliable. I am also having discomfort upon swallowing, irritated throat, some coughing, ear pain, and with Hashi's I understand the gland with eventually stop working...and I would just as soon have a pathologist look at the tumor after doing a section...

Labs...
FT4 0.85  0.61-1.25
THS 1.46  0.34-4.82
ANA 570
TPO Ab 47    Thryoglobulin, Qn 88.5  0.5-55.0
Thyroglobulin Ab 25
Lipids...
Cholesterol 282
Triglyceride 714 (new meds now)
Other...
Cortisol 9.8  10.4-26.4
Vit B12  199  211-911  (got a shot...)
Vit D  16  20-100  (suppliments)
Calcium toward low end of range
Sodium toward high end
Potassium toward low end (a constant problem)
Chloride toward high end

Ok...any input you guys??? PS anybody good at the labs??? LadyGraves?

Thanks a million...

[Val1974]

I was researching online and came across this chat page. Because i do to have thyroid tumors ive seen a few docs still dont have answers. I got four tumors and yes alot of times it does depend on the medicals team experience. Last time after relocating i heard i needed sergery dont know now will find out soon its challenging but be strong and dont give up.

[MJ13]

When I had my FNA they had to stick me 4 times (I had 4 nodules also).  The thought of someone poking a needle in my neck petrified me.  Fear of the unknown is the worst kind of fear.  The numbed my neck with lidocaine first, then put a drape over my neck and head.  I felt the needle, but it didn't really hurt, just burned a little.  It was over before I knew it.  I felt kind of silly have family members come all the way to Virginia from Illinois for something that turned out  to be relatively painless.  The hardest part was waiting for the result.  The whole process took less than 1/2 hour and that was because they had to wait to make sure the pathologist had enough specimen.  

[kipland]

I had about the same experience as MJ, except they didn't put the drape over my head.  Mine was an ultrasound guided FNA, and my head was turned toward the ultrasound screen.  I watched the first needle go in, and it grossed me out so I didn't watch anymore.  Other than that, it wasn't bad at all.  I only had to get poked two times, and really because the neck is numb all I felt was pressure.  The longest part IS waiting for the pathologist to look at it.  I think I was in and out in about 30 minutes as well.  I know it's better said than done, but try not to worry.
Lori

[lm21]

What are you referring when saying an FNA?

[mamogb]

Hello, my name is Geri and I live in Nashville, TN. I just had a thyroid US done and have about four nodules, the largest measuring 2.7x1.5cm Solid. Midleft lobe. One is also Comples but smaller. i am suppsoe to go for an FNA but don't know yet when as I just found out about this friday. Of sourse I am concerned and worried. Anything you gals can help mw with as far as if this is really scary or not? Thanks so much!!

[utahmomma]

Sounds like you found a wonderful surgeon.  Even though your nodule is growing, putting your surgery off until January shouldn't be a problem.  Thyroid cancers (if that is what it is) are slow growing.  It's best to have a good, competent surgeon and it sounds like he/she really knows how to handle thyroids.  Having a pathologist in the room is critical - I'm so glad you are getting proper treatment.

There are a variety of things that can cause B12 deficiency - from types of anemia to types of autoimmune diseases.  I've included a link to medline's article:  http://www.nlm.nih.gov/medlineplus/ency/article/000574.htm

Keep us posted!  It sounds like you are in good hands.

[artsyrose]

It went ok. I am seeing a surgeon who specializes in endocrine surgery January 24. I wish it was sooner, but since the FNA did not indicate cancer, it is not an emergency. I could see another surgeon, but this guy is the best in the field in this area. I would rather wait for him. While I was at the office, I discussed other concerns, so it wasn't a "wasted" visit. She also did another exam. The tumor is getting larger. So it appears it has to come out anyway. One of the things I like about this surgeon is that he has a pathologist in the OR to do a frozen section. If anything looks abnormal, he will proceed to take out the entire thyroid instead of one lobe, as well as any lymph nodes that may be affected. So only one surgery. That is good.

I am still having problems with my vitamin B12 levels for some reason. Got an injection the day I had the biopsy, but it did no good. I am to try the sublingual doseage until I have more blood work January 5. If my levels have not increased, I will have to take weekly injections. Anyone have any idea what causes this deficiency?

Anyway, I see the Endo again to go over blood work on January 15th and to do another sonogram to monitor the size of the tumor.

[utahmomma]

How did it go with the doctor?

[artsyrose]

Finally got a call from the endo yesterday. I am going Tues to discuss the surgery options with her.

[utahmomma]

I'm glad you can get in so soon to talk to her.  Hopefully that will help you have a better weekend. Please let us know what she says and what the two of you decide!  Best of everything.

[utahmomma]

That is exactly the attitude and conviction that will get you through this with flying colors!!  Keep us posted.

[artsyrose]

I do not really trust the FNA results either. It is such a large tumor and the samples cannot possibly come from every part of it. But that aside, the tumor is causing other problems with swallowing, etc. I just want it gone. I left a message today but have not spoken directly with the doctor to discuss the surgery possibilities yet. I will. It is my body. If she will is going to be too conservative for my tastes I will find someone who isn't.

[artsyrose]

btw sorry I got your handle backwards yesterday :) I failed to mention several things...there was only so much room for the initial post. I have already been screen by a rheumatologist for RA SLE and other autoimmune diseases. I do not have the markers for those. I have been having symptoms of overwhelming fatique for months. That is what sent me to the doctor in the first place. That and the fact that I had a few instances of passing out. My BP is under control with medication. It has been elevated for 2 years. Up until that time it was always low. I have also been evaluated by a nephrologist....no damage to the kidneys...I am thirsty all the time and my electrolytes are out of kilter alot of times. Not diabetic... The endo says the thyroid function is still "within the normal range" but she will be monitoring it. I am mostly cold, but sometimes I get what seems like the worst hot flashes I have ever had...I didn't have anything like that even after I had a complete hysterectomy! All I know is that I feel generally like **** most of the time. I actually think Hashi's "won" by default.

[venora]

I do not trust FNA because of what has happened to me.
I had FNA back in April and there was nothing found.Fast Forward to Sept 25 Surgery to remove goiter and substernal goiter.Cancer was found in pathology.If it were me I would get the tumor OUT!!OF course it will be your decision.Keep us posted and you will be in my prayers.Love Venora

[GravesLady]

The rate of accurate results of a FNA depends on the skill and experience of the physician obtaining the samples and interpreting the smears under the microscope. The figures reported in the medical literature vary considerably and may be difficult to interpret accurately.
When  test results are classified as suspicious or atypical because the FNA findings do not clearly show whether the nodule is benign or malignant, the test will need to be repeated on another day. In some cases, additional tests such as a diagnostic surgical lobectomy (i.e. removal of the gland on one side of the windpipe) may be needed, particularly if the doctor thinks the nodule is cancerous. If nodule is large and/or growing then surgery is recommended.

I can not relate to your thyroid test results without the
F/T-3.  TSH and the FTs on how they relate to each other tells what is going on with the thyroid or thyroid conditions. However, your TSH nor your antibodies does not show warrant for thyroid hormone supplement.
Without thyroid test to back up the antibodies (and visa versa) antibodies aren't too reliable to thyroid condition, unless they are very high numbers (high titer) . Because antibodies are also present in of people with other thyroid diseases. Other autoimmune disorders such as Sj

[utahmomma]

Welcome.

Sorry it's not under better circumstances.

I'm confused, you said you're diagnosed with Hashi's but your TSH level looks good - are you on thyroid meds and if so what dose?

You've already picked up that GravesLady is the labs goddess - I'll leave those to her.  One thing I noticed though (and I'm a novice at labs so take it for what it's worth) with your ANA count and some of the other labs being off, have you discussed with your endo other autoimmune diseases aside from Hashi's?

Back to the thyroid.  You've probably also picked up that I'm not a huge fan of FNA biopsy results.  You have a large, complex, calcified "tumor".  None of those are good words to have in an US report.  Complex, of course, is a bad indicator as is the calcification.  Large and singular aren't so great either.  Add them all up and, if it was me, I would have a very serious discussion with my endo.  But then again, that's the route *I* took on a small, complex nodule with no visible calcification and it started my entire family onto the journey through thyroid cancer.  I admit it, I'm a bit biased (especially since two sister's FNAs came back "no malignancy" when cancer was found a few months later in the OR).

There was a good analogy posted on this forum a short while back.  (Sorry, I can't remember by whom because it's after 1 a.m. and if I scroll back I'll lose this posting and have to do it all over again.)  Knowing what you know by reading some of the postings in this forum; if they found a "large, complex, calcified "tumor" in your breast instead of your thyroid how would you want it treated?

Please don't take me wrong, I'm not pushing for you to do anything, just to consider all of your options when talking to your endo.  You mentioned having a pathologist look at it after doing a section.  Thyroid surgery - even if it was easier for me and my family than most surgeries - carries risks and is never easy.  

But, (THE FOLLOWING IS MY PERSONAL EXPERIENCE AND OPINION) if you are concerned it may be cancer, the best way to cure it is to remove it and move on to RAI or whatever your doctor AND YOU deem best.  It is very treatable BEFORE it has had a chance to metastasize.  If it's NOT cancer and just a strange calcified growth with your Hashi's then you have a pretty little scar and the knowledge that it wasn't cancer (and a great excuse for some new scarfs).  Hashi's or thyroidectomy - either way you will end up taking thyroid replacement.  Surgery isn't something to take lightly though.  Really sit down and talk it over with your doctor ask her what SHE would do if it was HER thyroid results.

There are some great on-line resources that I've posted lots of times in this forum.  If you can't find them or would like me to post them on this thread, let me know.

Hang in there and keep us posted.  You have a lot of experience on this forum and we'll help get you through whatever tomorrow brings.  You've found friends here.

[ChitChatNine]

Hello ... I think it may have been me that mentioned that if a lump was found in my breast similar to the one they found in my thyroid last month, I would be very aggressive to get it the heck out of there and do whatever surgery is needed to get rid of the lump.  Also, the same applies to my atypical moles that are oftentimes re-excised to a clear margin needing 10-15 stitches.  The problem is gone and cannot turn malignent.

I am happy your FNA results are deemed benign but as you are aware there can be a false negative % in these FNA's ... given the stats on the ultrasound and your current phys. findings that are from this tumor, I would opt to have it removed without a doubt unless the risks of the surgery outweigh the benefits for some medical reason but it doesn't seem that way based on your posting .. then again, I'm not a Dr. at all .. just a person (like yourself) looking @ surgery vs. a watchful waiting approach.

Mine is atypical, solid growth .. after 3 consults I have scheduled surgery for Jan 9th.  1 of the 3 consults was too laid back and suggested a wait and see approach and was too non-chalant about this whole thing while the other 2 opinions (1 ent and 1 endo) said to have the surgery.  So I, too, had to make a decision but I went with my "gut instincts" and they said to have it removed without a doubt.

HTH,
Cheryl

[artsyrose]

also forgot to mention that my endo has decided NOT to start me on any drugs yet ?