Last week I had a thyroid ultrasound at University of Penn to see if any of my 3 small thyroid nodules have grown and or changed.I had an FNA of all 3 in June 2008 by Dr.Anthony Jennings who isn't at Upenn. I had a second opionion by having my slides reviewed by Dr.Baloch and he didn't see any cancer. Anyway my nodules then were the 1 on the left was a little over 1cm and the one on my isthmus was some 4mm and the one on my right lobe was about 6 or 7 mm I think. The smaller 2 had been described in past reports as mostly cystic,the largest is mostly solid and then cystic.When I had my last follow up in May 2010 I saw Dr.Stephanie Fish,who was leaving soon after for The Sloan Kettering Cancer Center.She wrote me a note that said that my largest nodel only grew slightly and non-significantly and the other 2 were stable and actually had *decreased* slightly. She didn't revommend rebiopsy then,but to come back for a follow up ultrasound in 2-3 years.
All of my nodules had been described in several past reports as being non-hypervascular,but now the one on my isthmus has grown to 8mm and it's the solid part that grew and is now described as slightly hypervascular! The other two have only increased slightly in their cystic parts. I am going to have another biopsy of my isthmus nodule in a few months when they can do it at Upenn.The radiologist Dr.Jill Langer said when I spoke to her that vascularity isn't such a concern,but she recommends rebiopsy of this nodule because it increased about 50% in almost 3 years,and that fits their criteria for rebiopsy.She said she's recommend this even if it was non-vascular.I'm very concerned by the combination of growth and increased blood flow now.I know many benign nodules have some or even a medium amount of blood flow,but I know hypervascular is commonly found with cancers.
If you could let me know what you think about this,I really would appreciate it.
The isthmus nodule should undergo repeat FNA with this growth.
Vascularity is not as much of a concern as previously thought.
Jill Langer is excellent with thyroid nodules and Zubair Baloch is among the best in cytopathology for thyroid -- you are in great hands!
Would test TPO/TG antibodies if not already done to clarify if there may be evidence of hashimoto's.
I forgot to mention that the isthmus nodule has always been described as hypoechoic but not markedly which UPenn radiologist Jill Langer says that and calicification are very concerning ultrasound features.Also my isthmus former measurement was 4.x 9 x9mm and now is 8 x 15 x17.
This is what I posted to you a few years ago about what my FNA results showed.
On June 24th I had an FNA of 3 small thyroid nodules that were found by accident In the Fall of 2006 when I was 41 and a half, because I have a very slow metabolism and my thyroid blood tests have always been normal and I gained weight for the first time at age 34 and had to go on a diet for the first time in my life. So I asked my internist for a prescription for a thyroid ultrasound.
The sizes of my nodules are one on the right lobe, 0.5 x 0.7x 0.7 cm on the left lobe, 1.3 x 1.3 x 4.5 cm and on my isthmus, a 0.3 x 0.6 x 0.7 cm, biopsied by a very good endocrinologist with a good reputation, Dr .Anthony Jennings and the first pathologist at Quest Diagnostics described them as unremarkable follicular cells with
colloid and are diagnosed as colloid nodules. I have normal TSH and other thyroid blood tests. I wondered why 1 of my 2 small nodules was written as 1 nodule on my FNA results paper and Dr.Jennings told me he put both samples from both nodules into the same container because it costs less this way.
I'm not happy he did it this way and I have never heard of it done like this but I'm not an endo and don't know everything endos do. How can they tell how many cells are in both nodules if they were combined? So I was wondering what you know and think about this. I asked Dr.Jennings if it would taint each nodule's results by doing this and he said it doesn't and he's done it this way before and he said he thinks even Dr. Susan Mandel the top thyroid cancer specialist at the Unniversity of Penn Hospital has done it this way. He knows her well and he's heard her speak. Dr.Jennings also biopsed my largest 1 cm predominately solid nodule twice that day because first fluid came out.
I also asked my endo to please send my report and slides from Quest Diagnostics to a top thyroid pathologist that Dr.Mandel uses Dr.Zubair Baloch at University of Penn for a second opinion.
Dr.Baloch says in his report of my nodules, that in his opinion based on cytomorphology he will favor a diagnosis of hyperplastic/adenomatoid nodule for both specimens. He says interestingly the specimen from the right thyroid nodule shows oncocytic cells and few lymphocytes percolating among the follicuar groups suggesting an element of chronic lymphocytic thryoiditis. He says he does recommend clinical follow up and repeat FNA if there is an increase in the size of any of these nodules.
He says in summary then, my diagnoses are :1. Thyroid, right lobe nodule (size not indicated) FNA:Hyperplastic/adenomatoid nodule with oncocytic change. Focal chronic lymphocytic thryoiditis. 2. Thyroid left lobe (size not indicated) FNA: Hyperplastic/adenomatoid nodule.
Dr.Baloch didn't know my endo combined my nodule's samples into 1 container .He called me and he said when I told him my concerns about the Hurthle cells , he said I don't have a lot of them ( my endo said only when there is sheets of them can they be cancer) ,and that he could have Hurthle cells, children could have Hurthle cells in their thyroids and that it's not abnormal only when there is a large amount. But because my nodules are so small, isn't possible that the needle missed more of the Hurthle cells ( and other cancer cells!) present?
I would really appreciate your reply.
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Thank you very much for your kind informative response! I'm having a re-biopsy of the isthmus nodule on April 18th at UPenn. In May 2008 Dr.Anthony Jennings gave me a blood test in which he checked for extensive things,some of which I never even heard of. I had asked him to check my antibodies for Hashimotos because to my knowledge it had never been checked before but it was normal.
I just hope that I don't get an inconclusive result like my first cousin did over 12 years ago at UPenn when she even had her only thyroid nodule biopsied by the UPenn top thyroid cancer specialist Dr.Susan Mandel and she had half of her thyroid removed,and the nodule was benign as the majority are as we know. She didn't have any thyroid conditions either.
Her best friend has two nodules,and is borderline hypothyroid and she also got an inconclusive at Upenn and then went to a good place in New York,and got another inconconclusive FNA,so she went to Dr.Anthony Jennings and he did her FNA and they were benign! I also certainly hope the most,that my result isn't going to be a paplillary thyroid cancer on the isthmus,and that is my first and biggest concern.
But if it comes back benign again,now that it's even a bigger size to biopsy and five years later,it's very unlikely that it's cancer. But then my next concern is that it is benign,but like many benign nodules and growths,they continue to grow and get too big as long as they are in your body,and especially in the throat area could cause me breathing or swallowing problems and it will cause me to have my thyroid removed even if I had 100% proof it's benign.And on this board and many others like this,there were many people this happened to,they had very big thyroid nodules that caused them breathing and swallowing problems,and had their thyroid removed and the nodule(s) were benign.
Also, how accurate and how often is the thyroid FNA accurate? And when you say that vascularity isn't as much of a concern as previously thought,can you please specify more of what this means? I mean how often are benign nodules mildly hypervascular? I know that many can have a good amount of blood flow,but there is a difference between that and hypervascular!
And why would only the isthmus nodule now have become this way,when none of the three were before? Have you encountered a good amount of nodules with mild hypervascularity that turned out to be truly benign? And the isthmus is not the most common place for thyroid nodules to be,most are on the right or left lobes like my other two are,and it always concerned me that this one is hypoechoic too.
By the way, my father also has thyroid nodules,he has 4 and he found out when he was in his early-mid 70's after I was concerned about mine.He had only his largest biopsied which was only a little more than a cm,the others are even smaller.And he had X-Ray therapy as a teen to treat acne I never did.
>And why would only the isthmus nodule now have become this way,when none of the three were before?
Out of my keister, I think you can consider them as most separate animals. They are doing their own thing.
Also, reading a bunch lately. I believe that they've been doing a lot of statistical study of nodules over the years and that's changed professionals assumptions. So size or vascularity isn't considered as important as it used to be.
Also I think that with most thyroid cancer there is seldom any urgent rush to treat it. Because it's slow growing. They could miss the cancer with an FNA, and then three years later repeat the FNA and find it. And your prognosis is the same if they'd found it the first time three years ago. The prognosis being, you'll live.
So I think there is a tension between patients that are afraid what what may happen and want to be treated now and get it behind them, and doctors that want to be absolutely sure the patient needs treatment before they do anything.
Thank you for responding. But what you said does really worry and concern me,that the first FNA could have missed the cancer,and now find it! I recently had my thyroid T3,T4 and TSH tested over a week ago,and they are all normal. My TSH is 2.35.
I totally understand. The lab report for my nodule said false negative of 3% or less. Wonderfully reassuring. I think you just have to wait for the FNA of the nodule that's grew On the plus side, if it's not cancer this time around, it's not cancer and never is going to be anything but annoying,
BTW I have an annoying habit of not sounding as reassuring as most people would. Just so you know. (Maybe it's because I grew up within sight of the Blue Cube during the cold war)
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