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Thyroid (Expert Forum)
Thyroid follicular neoplasm
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
Thyroid follicular neoplasm
by judithlorraine, Jul 21, 2008 03:07PM
I am 59 in good health and had an incidental finding a year ago during a carotid artery sonogram of nodules on my thyroid. After sonograms and 2 FNA biopsises, the results are still inconclusive. The TSH and Free T4 tests were normal. I have no symptoms and the nodules cannot even be felt by my doctor.There are 2 nodules on the right lobe; the inferior one is .8 by 1 cm and the superior one is .93 by .88 by 1.9 cm and significantly hypervascular. There are some small cysts on the left lobe with a bright fleck of calcium. Both last year and this year my endocrinologist has recommended surgery of the entire thyroid since cancer cannot be ruled out. I am going for a radioactive iodine thyroid uptake scan before I decide what to do. I did have Xray treatment to my face for acne when I was 30, but was covered with a lead apron.
I am extremely reluctant to remove my thyroid if the odds are truly 80% that it is benign.
I would appreciate your opinion. Thank you very much.
I am extremely reluctant to remove my thyroid if the odds are truly 80% that it is benign.
I would appreciate your opinion. Thank you very much.
Doctor's Answer
by Mark Lupo, M.D., Jul 22, 2008 06:14AM
, Jul 22, 2008 06:14AM
If inconclusive means "indeterminate" (the preferred term of an FNA that is adequate, but shows a pattern of follicular cells or hurthle cells in which a cancer can not be excluded, and 20% are cancer) then surgery is the diagnostic next step. An I-123 scan showing that the 1.9cm (presumably the indeterminate mass) is clearly HOT would help prevent surgery and increase comfort level of observation. But with normal thyroid function, this is less likely to be a hot nodule. The XRT at age 30 is not likely to have contributed much risk, but may have.
The small cysts and fleck of calcium on the left may not be enough to make a total thyroidectomy the procedure of choice....a right lobectomy may be the first step and if benign, ultrasound follow-up of the left lobe would be needed, if cancer then a second surgery to remove the left lobe.
Lastly, ask that the FNA slides be sent to an expert (ie Dr. Massoll at U Florida or Baloch at U Penn) to confirm this is truly an indeterminate lesion.
The small cysts and fleck of calcium on the left may not be enough to make a total thyroidectomy the procedure of choice....a right lobectomy may be the first step and if benign, ultrasound follow-up of the left lobe would be needed, if cancer then a second surgery to remove the left lobe.
Lastly, ask that the FNA slides be sent to an expert (ie Dr. Massoll at U Florida or Baloch at U Penn) to confirm this is truly an indeterminate lesion.
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