FNA Results

[dscoochie]

I am a 41 year old female with no family history of thyroid disease or radiation exposure.  Approximately 6 months ago I noticed a large "lump" in my neck, which upon ultrasound was found to be a 1.9 x 1.7 x 1.3 solid rounded nodule in the isthmus.  There was no other masses or lymphadenopathy.

Blood work showed all thyroid levels were normal.

I then had a FNA, the results of which are:

Consistent with Hurthle Cell Lesion:
- Hurthle cells present
- Follicular cells present
- Colloid present
- Macrophages present

I am schedule for a Left Thyroid Lobectomy with Isthmusectomy (sp?) on April 7th.

I'm a complete mess, terrified that this IS cancer.

Can anyone help me decipher these results and tell me what the chances of cancer are?

I'm new to this board and have been trying to post to ask the Doctor, but the question limit always seems to be reached.

Thanks so much!

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[dscoochie]

Thanks, Utahmomma, you are obviously a very kind and generous person, to spend your precious time helping others.

My surgeon is quite young but VERY well respected in as a thyroid surgeon.  He is one of the best in Toronto, and came very highly recommended.  (He's also a cute - so that doesnt hurt!)

He REALLY doesnt want to do a TT.  He says he doesnt think its necessary.  I guess there is no harm in asking for a frozen section biopsy (where they send the sample down to pathology for immediate diagnosis), however, I'm sure that adds time to the surgery, which they may not have alloted for.  And I DON'T want my surgery date changed.  I will ask though.  I will call today.

Just keep me in your thoughts and prayers, and I will do that same for you (you, too, Kel - thanks!).

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[utahmomma]

Awwww, shucks.  Not wise - just been around this block a few too many times.

You two will fly through the surgeries - piece of cake!

((HUGS))

[KelDC]

Listen to Utah - she is one wise, wise woman.   =)
I really can't say it any better than she did, so print her response out, and read it whenever you're feeling unsure and/or upset!  
I'm happy to be your surgery buddy (TT on 4/7, as you know!), and remember - we can all get through this together!

Lots of luck & prayers!
Kel

[utahmomma]

Okay, no medical professional but a thyroid cancer survivor so maybe I can help a bit.  First and foremost, remember that 90-95% of thyroid nodules are BENIGN.

That being said, I had no family history of thyroid cancer or radiation either.  I found out that I was the first one in the family diagnosed (three sisters followed suit, another had precancerous thyroid nodules as did my teenage daughter).

Second thing - thyroid cancer is TREATABLE and is typically SLOW growing so, if it is cancer, take a breath.  There's plenty of us on here to help you through it because we've been there, done that too.  :-(

Hurthle cells can be either malignant or benign.  Follicular cells are a type of thyroid cell and can, and cannot, be malignant.

http://brighamrad.harvard.edu/Cases/jpnm/hcache/1091/full.html
http://www.cancer.gov/Templates/db_alpha.aspx?CdrID=44543

This is from the Harvard Medical School reference I posting above: "The only effective treatment for Hurthle cell neoplasm is surgery, due to the difficulty in making the pathologic diagnosis of malignancy from fine needle aspiration. Total thyroidectomy is advised for all malignant tumors possibly with internal jugular node sampling."

In other words, talk to your surgeon and insist on pathology right in the OR - if they find *any* sign of cancer have them take the entire thing out - if they even think it may be cancer, have them take the entire thing out.  That way you'll save yourself from having to have the surgery twice (like I did)

Macrophages are white blood cells which may indicate thyroiditis:  http://www.medterms.com/script/main/art.asp?articlekey=4238

Colloid nodules are no big deal and have no increased risk for malignancy (according to the American Academy of Family Physicians) but that doesn't mean that something isn't hiding in them.  Most thyroid nodules are colloid: http://www.aafp.org/afp/20030201/559.html

Have a long talk with your surgeon.  You do have some worrisome signs:  a large solitary nodule, normal thyroid labs and are over 40 (hey, so am I so I'm not knocking you) and female (we have more thyroid cancer than males).  Talk to him/her about either getting the pathology right there in the OR or removing the entire thyroid.

Hang in there.  We're here to help you through all of this.

Utahmomma
papillary carcinoma '03
recurrence and RAI '06 and possibly '08
three sisters with papillary carcinoma (one with Stage II and three recurrences)
sister and daughter with precancerous, atypical thyroids
No family history until '03  :-(