Nodules and High Dose Radiation

[DrHook]

My husband is 46 years old. He had 5,000 (yes 5,000) rads of radiation to kill a spinal cord tumor located at the base of his brain at the age of 9/10.  Tumor came back at the age of 25 and was surgically removed. He already had his uvula remved as well as his tongue shaved down due to thickening they believe from the radiation.  He had an ultrasound and they have found one 4cm nodule in the lower left pole and one 2,3cm nodule in the lower right pole as well as several 1 cm nodules in the upper right pole.  The thyroid is almost twice it's normal size.  He is scheduled for surgery on 8/4.  No thyroid scans - no biopsies.  The doc says almost 50% of the surgeries he has done the biopsy was incorrect..i.e.  FNA came back negative and it turned out that some of the nodules were cancer and it is impossible to FNA all of the nodules.  The doc was surprised that the radiation did fry the thyroid completely.

Is this the right approach given his history and size of the nodules?  

[Mark Lupo, M.D.]

I would usually FNA the larger nodules but with multiple 1cm nodules sometimes this gets impractical.  The risk of cancer is elevated with the XRT exposure as a child and surgery is the most definitive way to answer that question, but with a good thyroidologist and pathologist as well as ultrasound follow-up often surgery can be avoided if a benign goiter is the diagnosis.

The 4cm nodule with this history is worrisome however and many would advocate surgery on this basis -- given the multiple nodules a total thyroidectomy would be my choice if it were my neck and surgery was being done.

Try to re-post to tell what the results are/were -- sorry for the delay in responding.

[DrHook]

The total thyroidectomy was done last Saturday - results:

Left Thryoid Lobe and isthmus:
Benign multinodular hyperplasia
Dominant Nodule 3.5cm in greatest dimension

Pyramidal Lobe:
Benign multinodular hyperplasia

Right Thyroid Lobe:
Follicular adenoma with adipose metaplasia of the stroma (adenolipoma), 2.5 cm in greates dimension


Can you explain this in english?  All the surgeon said was everything was benign - isn't hyperplasia  a pre-cancercous condition?

What is metaplasia?

Thanks,
Tracy

[jitterbug_here]

hyperplasia  An abnormal increase in the number of cells in an organ or a tissue with consequent enlargement

metaplasia
Metaplasia (change in form, Greek) is the replacement of one differentiated cell type with another mature differentiated cell type. The change from one type of cell to another is generally caused by some sort of abnormal stimulus. In simplistic terms, it is as if the original cells are not robust enough to withstand the new environment, and so they change into another type more suited to the new environment. If the stimulus that caused metaplasia is removed or ceases, tissues return to their normal pattern of differentiation. Metaplasia is not synonymous with dysplasia and is not considered carcinogenesis. It is also contrasted with heteroplasia, which is the abnormal growth of cytologic and histologic elements without a stimulus.

[Mark Lupo, M.D.]

appears benign.  Metaplasia of the stroma as described is a benign condition.  That is all good news -- now it's just an issue of thyroid replacement dosing.