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Benign or Malignant, Surgery or Second opinion


I have a left thyroid nodule that was found 02/20/12, through incidental findings of a CT scan, measured 3cm.FNA done 02/24/12 showed: clusters of benign epithelium in background of colloid and blood. My endocrinologist  advised to follow up in 6months for another ultrasound & FNA.

12/21/12 : Ultrasound: Left thyroid nodule AP 2.30cm, TV 3.40cm, SAG 5.34cm, V 21.9ml , echotexture: heterogenous
Ithimus measured IATH 0.13cm

2 small nodules were found on my right thyroid.
measurments as follows: right mid: AP: 0.23cm TV: 0.26cm, SAG: 0.45cm, V: 0.014ml
echogenicity: hypo & solid
right lower AP: 0.13cm, TV: 0.13cm, SAG: 0.19cm, V: 10.3ml
echogenicity: hypo & solid

FNA results: The biopsy demonstrates thyroid follicular cells in a microfollicular pattern without atypia in background of minimal colliod(confirmed by gemsa stain). This pattern may be seen in 3 possible settings: an area of follicular hyperplasia, within the setting of goiter(which is favored), a follicular adenoma or a follicular carcinoma. Repeat aspiration and followup is recommended

Lastest Labs drwan 01/23/12, TSH(1.45), free T4(1.3), free T3(2.9), TPO<10 Parathyroid Hormone, Intact(17)

My endocrinologist suggested that I should remove my entire thyroid.  

I saw a clinical endocrinologist for a 2nd opinion , who advised that that the results were not suggestive of cancer, but suggest a follicular adenoma.  My left thyroid is hypervascular verifed via color doppler. He made the statement  that he is afraid that I may have another episode of becoming hyperthyroid again and suggest I have the left thyroid tken out.  He also advised me  that I may have a 50/50 chance of having to take synthroid for the rest of my life. He suggested that I meet with a surgeon, who he works with.  

I am very confused and still not sure what to do. Should I have my slides sent to a expert for a more definitive answer, have another FNA, or have a partial thyroidectomy?


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1 Answers
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97953 tn?1440868992
This is a large nodule (5.3cm); I am unclear why the concern about another episode of hyper - is this a "hot" nodule?  If hot, then it is not likely cancer, but w/ the TSH of 1.45, thyroid levels are completely normal.  With the negative TPO, the chance of hypo requiring meds after L hemithyroidecomy is probably 25-30% at most.  The pathology report is vague - would send for second opinion but the overall description sounds benign.  We usually repeat FNA if there is not a plan to remove a nodule this large to help improve sensitivity of FNA cytology for large nodules.  However, with the size (5.3cm), many would recommend surgery....
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