Thyroid Surgery - Chance of malignancy?

[Deni222]

I was diagnosed with a 2.4 x 1.4 x 2.0 cm hypoechoic mid lobe nodule with posterior enhancement and vascular halo in April of 2007. I am euthyroid. I have had one biopsy and the results were: bland follicular epithelium and scattered lymphocytes, colloid is absent. The doctor told me the results were benign but the lab report said malignancy cannot be ruled out. About a month ago I started having compressive symptoms and my surgeon did an uptake RAI scan and the thyroid nodule is cold. He recommended that i have surgery and I'm scheduled for July 10th. He said I have about a 15% chance of malignancy. Does this sound conservative or about right? I'm not fearful of a malignancy because I know the cure rate is extremely high, but I am concerned with losing all of my thyroid and being on medication. My endo put me on Synthroid for about 3 weeks to try and shrink my nodule and I had an averse reaction, chest pain, heart palpitations, etc. Are there alternative medications if I do end up losing my thyroid?

[Mark Lupo, M.D.]

The cold nodule with an indeterminate FNA carries a 15% chance cancer.  There is no role of synthroid to "shrink" it -- according to current guidelines.  Would have the FNA slides sent to an expert for an opinion -- if truly indeterminate - then remove that 1/2 of the thyroid to make a definite diagnosis -- this would be the standard of care.

places to send slides - U Florida (Massoll) or U Penn (Baloch) or John Hopkins

[ChitChatNine]

You may not have those same symptoms on Synthroid  without your thyroid in place bcz now you are adding add'l hormone to your already existing hormones in an effort to shrink the nodule (your body may have become hyper).  That is my thought to you as a synthroid patient.  I had a partial thyroidectomy 1/07 and the other side decided to stop working so I am now on Synthroid & had major concerns about taking the med and have had some side effects come and go until we zero'd in on the right dosing for me.

If I had compression symptoms with a compression diagnosis that, alone, would be enough for me to strongly consider surgery.  You always have the option of a 3rd opinion (Dr. Lupo is fabulous and I considered his online opinion as one of my add'l 2nd opinions when I had to decide on my surgery, etc.)

Hang in there .. Dr. Lupo will have wonderful advice for you I am certain.

Cheryl - partial thyroidectomy 1/07 .. Synthroid 75mcgs TSH 1.8

[Deni222]

Thanks for your reply. Question - how long after you had your partial did your other half stop producing/working? How did you know, what symptoms did you have?

I'm going to go ahead and have the surgery - the compression symptoms alone are making me miserable. The anticipation is getting to me so I'm trying to prepare for each possible outcome.

Thanks again.