make the right choice

[annie170]

I had an FNA about three weeks ago, where the final diagnosis was: Atypical follicular cells. In the comments it mentions" small clusters of atypical follicular appearing cells with cellular overlapping and vague papillary configuration." I have read many stories on here where a lot of you had your thyroids removed and cancer was NOT present.  I have perfect thyroid levels right now and NO hyper or hypo symptoms.... No family history of any thyroid issues on both sides.  I am afraid to mess with a good thing.  I found a great neck surgeon... but no endocrinologists around, so i am nervous about my life long treatment. I feel like i have to make a choice on changing the type of person that i am.  i am a teacher, caregiver and very active...
question: what are your suggestions before i agree to surgery.... please help.  

[898_1]

The article about molecular testing can be found on Medscape at http://www.medscape.com/viewarticle/721912.

[Kat1777]

Mine says nothing about overlapping at all. All it says is there is a microfollicular pattern. I'm wondering where that puts me in relation to the others' reports? My slides have been sent to Sloan Kettering, where I have a surgical consult this week. I'm hoping their expert staff will be able to give me a clearer picture.

Would you mind explaining what molecular testing is?

[898_1]

Annie170: you need to double check if there are cellular or NUCLEAR overlapping in the sample; nuclear overlapping generally increases likehood of cancer. In your case the molecular testing procedure can be next step to determine if surgery is needed
JulieFR; you may request molecular testing as well

[JulieRF]

Best of luck making your decision. I would be interested in what you ultimately decided to do.

I'm sort of in the same boat as you. Got my FNA back today and it said:

Right tyroid, fine needle aspiration:
- Adequate for evaluation
- Follicular lesion of undetermined significance

COMMENT: The aspirate is cellular with focal mild cellular atypia and overlapping patterns.

Clinical correlation and a repeat aspirate in appropriate interval (e.g. Three months) are suggested.


So some of the same terminlogy has shown up on my report too. I hate waiting it out. I'm so confused. My doctor is out of town and cannot discuss this with me for a couple of days. Even then, I'm not so sure I want to wait to get this out.

[Kat1777]

I'm in the exact same situation right now and am meeting with a surgeon at the end of the week. Here are a few things that are going into my decision:

1. How large is the nodule in question? -- Mine is quite large so surgery is warranted regardless of cancer status.

2. Are there nodules on the other side? -- I have two very tiny ones on the other side that can't be biopsied. If I leave that half in, they will need to be monitored every six months and potentially biopsied if they grow. This process will go on indefinitely.

3. Am I mentally prepared to deal with a second surgery if cancer is found? -- With follicular cancer, the frozen section is usually not much help. After surgery the half that is taken out must be investigated thorougly before maligancy can be ruled out. That usually takes a week. If it turns out to be cancer, you must go back in to have the other side removed. Papillary is more definitive on frozen section.

If you are worried about not having easy access to an endo, I wouldn't be. Many primary care physicians are well-versed in thyroid treatment and medication. I would ask around and find one who is. And it's true that if you only need half out, you may not need medication at all. Then again, you might. Everyone is different. Best of luck to you whatever you decide.

[annie170]

Thank you for your comment.  The more positive information i get, the more comfortable i feel about this procedure. I appreciate you taking time to answer. Best of luck to you.

[MANmom]

I can only tell you I am much the same, very active, walk or jog at least 6 times per week, music teacher...I had normal thyroid function, but was getting hoarse and had hot/cold spells, blood pressure issues, strange mensrual cycles, etc. My FNA read "benign follicular clusters", I had my thyroid removed after they found cancer, but they couldn't tell it was cancer until they took out 1/2.  After 2 surgeries and RAI, it took a while to get on the right meds, but now I am feeling much like I did before.  I walk or run 6 - 7 days a week and am feeling pretty normal.  I know others have had difficulties, but for me it was really no big deal (except for the cancer, which I am glad is out).  You could have 1/2 removed and have it tested.  People who have 1/2 removed are 40% likely not to need medication at all.