Is it ok to leave?

[Travdon]

HI, I have a multi-nodular goitre with a prominent nodule. My thyroid is functioning within normal limits and I have had two FNA's that have both come back seemingly benign. It also hasn't changed much over the last year . My latest FNA results are as follows: scattered groups of thyroid follicular cells with hurthle cell metaplasia. No micro-follicle pattern is identified. Patchy slight excess of lymphoid cells in the background. In keeping with a benign thyroid.
My problem is the hurthle cells, I have read so much about the presence of these cells that it is hard to accept that they are not a problem.
My ENT consultant has offered removal on the grounds of the problems it causes i.e. breathing issues, but is confident  it is otherwise fine and if I don't have it removed he does not need to see me again for follow-up unless it causes problems later down the line.
I am concerned that if I leave it I may not be aware of changes and something may be missed, I am also worried that two FNA's on the same nodule may be incorrect and there may still be cancerous cells within the thyroid. That said, I don't want to have it removed if its not necessary.

I would really appreciate some advice on this!!

Thanks,
Donna

[Mark Lupo, M.D.]

This description is more consistent with Hashimoto's, given the lymphoid cells as well as Hurthle cell metaplasia (reactive change among follicular cells).  If there are compressive symptoms, this would be a reason for surgery.  If there is question regarding the biopsy results, then sending this for a second opinion from a expert may be helpful.  Benign fine-needle aspiration results carry a low risk of cancer but does not completely exclude cancer.

[Travdon]

Hi, Calling all experts in the field, I wonder if anyone could give me a second opinion on my goiter issues. All my test information is as follows:

1st Ultrasound 5/10/2011 results: Symptoms: Diffuse swelling in the pretracheal region, increasing in size of one year.

Findings: There is an enlargement of the isthmus and probably the left lobe of the thyroid gland.  The two extend towards the sternal notch, with a poorly defined interface between the two extensions measuring approx 3 x 3cm. There are some small nodules within both the left and right lobes of the thyroid gland, and the isthmus is slightly thickened. Although the inferior margin of the thyroid enlargement extends to the sternal notch, there is no evidence of significant retrosternal extension. There is no evidence of cervical adenopathy.
Comment: Appearances are in keeping with a multi-nodular throid with a dominant mid-line probably isthmic lesion, with a small left lobe contribution. Specialist thyroid referral is advised.

My bloods at this point were as follows:

Serum TSH - 0.61mlU/L (0.35-3.5)
Serum T4 - 16pmol/L (8.0-21.0)

My latest fna dated sept this year came back as follows:

In a background of blood and colloid there are scattered groups of thyroid follicular cells with hurthle cell metaplasia.  No micro-follicule pattern is identified.  Patchy slight excess of lymphoid cells in the background. The appearances would be in keeping with a benign thyroid aspirate. A thyroid antibody screen is recommended to exclude lymphocytic thyroiditis.
Diagnosis: Benign aspirate (thy 2)

accompanying bloods:

TSH  - 0.61ml/U/L (0.35-3.5)
Serum free trilodothyronine level 5.7pmol/L (3.8-6.0)
Serum free T4 level - 16pmol/L (8.0-21.0)
Thyroid peroxidase antibody level 10.4 ku/L (00-34.0)

The outcome is I have been told it is fine to leave with no follow-up unless it changes or I can opt for removal.  I have a few other mild symptoms that I could relate to this but am not sure if they are just a normal part of getting older or caused by worry/stress.

I would appreciate any advice/comments at all as I am totally at a loss as of whether to leave or remove.  Apologies for writing a book here just thought it best to give a full a picture as possible!!

Regards
Donna  

[Travdon]

Thank-you, appreciate your advice, hope all go's well for you tommorrow.

Best wishes
Donna

[arshiya718]

you know i am hospitalized now as i write this.... i have my thyrodectomy tomorrow.. and my FNACs and all the blood reports were similar to yours... i would suggest not to discuss here rather do what your endo says.. there is nothing much you can do if you have a goiter trust me on this.. you can do your research on it as well
but the last is a thyrodectomy
regards
arshiya