the right lobe measures 5.0 cm x 1.3 cm x 1.2 cm in size
the left lobe measures 4.2 cm x 1.3 cm x 1.5 cm in size. There is a complex nodule at the mid to lower aspect of the left lobe measuring 15 mm x 8 mm x 11 mm in size. Differentials include goiter nodule and/or adenomatous nodule with cystic degeneration, although thyroid tumor or neoplasm not entirely excluded. Adjacent to theis complex nodule is a cystic lesion measuring 4 mm x 3 mm in size.
the isthmus measures 2 mms in thickness.
Enlarged thyoid gland, primarily the right lobe, with a complex nodule on the left lobe as described and noted above. Clinical correlation and follow up thyroid ultrasound is recommended. If desired, isotopic thyroid uptake and scan also advised and would be more informative.
atypical, no definitve evidence of malignancy.
Hurthle cell nodule with cystic change.
comment: a Hurthle cell neoplasm cannot be excluded. Histologic correlation recommended.
now my question:
this biopsy was completed one month after inital ultrasound. In that time, the nodule changed to 16 mm x 9 mm x 12 mm I saw the surgeon today, and PT is scheduled for 5/4. frozen section to be completed during surgery, and if lobe is malignant, will proceed with TT. My endo has indicated she will prescribe thyroid meds to control the size of the right side. Now, if this is cancer, it's a mute point, but should the size of the right lobe be a concern, or will 'keeping an eye on it' be sufficient?
Both my endo and the surgeon both seemed to focus on the small, solid "satellite(term they used)" nodule, that is situated in close proximity to the large complex nodule. From what I understand, hurthle cell cancer is diagnosed by those cells being spread out into the lobe, which is why the biopsy came back inconclusive-when only doing the small section of cells, you have no way of knowing if those cells are out in the lobe, unless you sample that entire lobe. So maybe I'm reading too much into it, but it almost seems as though this is cancer, and the cells have spread into the next nodule. Does anyone have any experience with the hurthle cells??
The surgeon told me today that he's never done such an in-depth explanation of the surgery. He said it was obvious I'd done my homework, and that I could probably do the explanations for him. I don't know if he was complimenting me, or if I annoyed him with my internet education :) I'm happy to say he does a number of thyroid surgeries weekly-when I asked him how often he does them, he said he'd done 2 yesterday, and was doing 2 more tomorrow. In the back of my mind though, I still wonder if this turns out not to be cancer now, and they only do the PT, should I have gone ahead with the TT and not have that bubble looming over my head, wondering if it was going to happen to the other side somewhere down the road. I'm just ready for all of this to be over with. And I still want to punch my internist in the face, for telling me he could tell by looking at me, that I didn't have a problem with my thyroid(when I'd gone about my symptoms, but "normal" bloodwork) and that I was just depressed. It's going to be fun to go see him to have my pre-surgery exam :)
Wow....not sure I can be of much help as I am pretty much in same boat as you. I was supposed to have PT on 4-14 but cancelled as that surgeon only does about a dozen thyroid surgeries a year and I wasn't comfortable with that. So, now I'm going to Johns Hopkins (3hrs away) for consults and testing next week.
Like I said I'm in a very similar boat and I too am so ready for all of this to be over with and to get on with life. For me, I've decided that I really want to preserve as much of my thyroid as possible. Like you said, if it's cancer the whole things gotta go anyway. But, if the pathology comes back benign, I will choose to keep my other half and have it monitored very closely. For me, I think the horror stories of people who've had a TT and continue to struggle with getting their meds adjusted and life back to normal (even years post-op), has me thinking it's really best to keep as much of my natural thyroid as possible. The thyroid affects everything! It's definately a personal choice though and I wish you the best on your decision and your surgery.
Have you been tested for thyroid auto-immune disease?
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