Thyroidectomy/Nodule/age 32

[Cricrillia]

I have a 2.2cm complex left lobe thyroid nodule that was found incidentally by c-spine MRI, TSH blood work was done and all within normal limits. Biopsy was performed and this is the results:

FINAL PATHOLOGIC DX: Fine needle aspiration biopsy of left thyroid nodule-atypical cellular lesion (TC-3). A follicular neoplasm cannot be excluded. Please see microscopic examination.  

MICROSCOPIC EXAMINATION: The smears are hypercellular with multiple groups of follicular epithelial cells some which have undergone hurthle cell metaplasia. A microfollicular element is present. Colloid is present and there are pigmented macrophages present consistent with cyst contents. In some areas there appear to be small benign lymphocytes present raising the possibility of a chronic thyroiditis. There are some areas present suggestive of fibrosis. The possibility of a follicular neoplasm cannot be excluded. The differential diagnosis would include an adenomatous nodule with degenerative change and hurthle cell metaplasia, follicular adenoma, and although considered less likely the possibility of a well-differentiated follicular carcinoma cannot be completely excluded by cytopathologic study. Fixed tissue studies are recommended.

My question is:
The doctor I am seeing for this is a general surgeon, he is not an endocrinologist, but he claims he does hundreds of thyroidectomys a year. His response to my biopsy results is to perform a total thyroidectomy, I am 32 years old and I don't understand why he wouldn't remove only the left lobe, he only states he doesn't want to risk anything or take chances that it would be better to just remove the whole thyroid. I am not looking forward to having to take thyroid medication for the rest of my life, please help with your thoughts on this, and what would you do with these results! Thank you so much!

[Cricrillia]

Continued..

Does the liver convert T4 to RT3? Not T3? I'm confused at that point.. I've read that the thyroid gland produces T3 and T4 then the liver converts T4 to Reverse T3 so that is why I wonder if  the T4 synthetic medication is enough..

Also calcitonin, my Endo says I don't need to worry about that hormone.. That doesn't make sense either because the thyroid produced that as well.. Shouldn't I be on some type of calcium or vitamin D?  To replace what I'm not getting now that I don't have a thyroid.. Thank you in advance for your time with this.. I appreciate it so much!!

[Cricrillia]

Thank you for your response! I'm so sorry, with everything going on, I forgot to recheck this post! I did get a 2nd opinion with an Endo and with the results, he suggested at TT as well. Well here I am 1 month post TT and just started taking Tirosint 88mcg daily yesterday.. I feel horrible, and very frustrated! I wish I would have seen your response first! My thyroid came back from the lab as follicular adenoma, totally benign.. Which I'm very happy about but.. Now I'm hypothyroid, I wish I would have taken other steps as you have suggested. What's done is done and now I am in a dilemma of what medications I want to take. If you don't mind me asking, what are your thoughts on natural desiccated thyroid hormone? I am an all natural organic person and I am not comfortable with putting these synthetics in my body! Besides don't I need T3 and T4 hormone anyway now that I don't have a thyroid? Rather than synthetic T4 only med?

[Mark Lupo, M.D.]

Atypical FNA cytology carries a 5-10% risk of cancer (depending on the pathologist).  Usually we repeat the FNA in 3 months and if still atypical consider a lobectomy (not upfront total) or the use of the Afirma test on FNA depending on the clinical situation.  Would consult with an endocrinologist who does his/her own ultrasound to help make this very important decision.  A good option at this point would be to have the slides read by an expert as many times it will come back straight-forward benign.