Aa
To Dr. Lupo
Hello there!
My mom is 47 and she had never had any complains about her thyroid before. Once, however, non thyroid specialist recommended her to check the thyroid gland. They found cold nodules and recommended a surgery. They removed half of her thyroid gland and only in the biopsy they discovered encapsulated cancer in one of the nodules. They said it was too tiny to be seen in scintigraphy or in any other examinations. Does ‘encapsulated’ mean that luckily the cancer didn’t have a chance to spread? But is it possible that cancerous cells get into lymph during the surgery ?
There is another thing, few days after the surgery my mom lost her voice. At the beginning she was only able to whisper, but now she can talk up to some diapason. The voice disappears when she gets worried or in large rooms. At the beginning they said her vocal cords were paralyzed, then – the vocal nerve. The ORL said such thing is common after thyroid surgeries and that she should still wait. It has been couple of months now since there are no major improvements. Is there anything you could recommend her do,or paralyzed nerve is paralyzed, and there is nothing to be done?
She has another scintigraphy test to be done soon and then the doctors will decide what to with her other half of the thyroid. The worrying part is that if they say there is another surgery needed, there is also a chance that the other nerve can get paralysed, meaning that she could loose her voice. Could you please share your opinion what would be better in this situation?
I have many questions here, I know.
Thank you in advance for your advice.
My mom is 47 and she had never had any complains about her thyroid before. Once, however, non thyroid specialist recommended her to check the thyroid gland. They found cold nodules and recommended a surgery. They removed half of her thyroid gland and only in the biopsy they discovered encapsulated cancer in one of the nodules. They said it was too tiny to be seen in scintigraphy or in any other examinations. Does ‘encapsulated’ mean that luckily the cancer didn’t have a chance to spread? But is it possible that cancerous cells get into lymph during the surgery ?
There is another thing, few days after the surgery my mom lost her voice. At the beginning she was only able to whisper, but now she can talk up to some diapason. The voice disappears when she gets worried or in large rooms. At the beginning they said her vocal cords were paralyzed, then – the vocal nerve. The ORL said such thing is common after thyroid surgeries and that she should still wait. It has been couple of months now since there are no major improvements. Is there anything you could recommend her do,or paralyzed nerve is paralyzed, and there is nothing to be done?
She has another scintigraphy test to be done soon and then the doctors will decide what to with her other half of the thyroid. The worrying part is that if they say there is another surgery needed, there is also a chance that the other nerve can get paralysed, meaning that she could loose her voice. Could you please share your opinion what would be better in this situation?
I have many questions here, I know.
Thank you in advance for your advice.
I am seeking more information on a FNA biopsy report. I am going to write the results and if I have a question I write it within the result info.
Under microscopic evaluation it reads:
All smears show cluster of follicular cells infiltrated by abundant mature lymphocytes. (What does this mean and is this bad?)
Clusters of Hurthle Cells are present. (I've done research and to my understanding these cells may be tumors and surgery is needed to determine whether they are cancerous or not. If it is cancer is it treatable and how treatable is it? If the thyroid is completely removed does that remove all possibilities of thyroid cancer or any type of neck and or head cancer?
Smears of the left upper pole node show abundant Hurthle cells. Loose and in clusters showing prominent variation in nuclear size. (What does this mean and is it bad?)
Under interpretation it reads:
Findings are compatible with Hashimoto's Thyroiditis. (Does this mean the person has or may have this condition? If not what does this mean?)
Findings from the left upper pole node, although most probable due to the severe inflammation, are worrisome and may represent a Hurthle cell neoplasm. (Severe inflammation, what can cause this? What's the difference between having Hurthle cells, Hurthle cells loose and in clusters showing nuclear size and possibly having Hurthle cell neoplasm? Does having Hurthle cell neoplasms mean you may have cancer?)
Close follow up is recommended. (The endocrinologist recommended surgery a thyroidectomy to be exact. Is this what is meant by follow up, I mean is that the next step? With these results, how necessary is a complete thyroidectomy? How does this improve the condition and what kind of effects can it have on the patient in the future? Will having to take thyroid hormone replacement medication make it seem like you've never had any problems with your thyroid in the first place?)
The patient in question is my mother she is 43 years old has been diagnosed with hypothyroidism for about 10 and has been taking Synthroid (doses have change over the years of course) her sonogram show that she has a normal size thyroid gland (with the obvious nodules problem), and usually tested with normal TSH levels, however her last exam read ULTRA hTSH result 127.534 uIU/ml, T4 TOTAL 2.59 ug/dl and T-4 FREE was 0.40 NG/DL, another test she had done was one that said MICROSOMAL ANTIBODIES (TPO)...IU/ML.....>1000 (What is this test for and what do the results mean) All test were done on or around 1/18/10 which is close to one month ago. Also she has been experiencing menstrual irregulations for months or more likely for about a year, she is under treatment with her gynecologist but both the gynecologist and endocrinologist say it may be contributed to her thyroid issues.
What I'm looking for is more information in which to help us discuss our options with the endocrinologist and whether or not we should be seeking a second opinion. I hope you can help us with our concerns and I apologize if for rambling on it's just my mother and I have never gone through these sort of problems and we are a scared and have many questions and concerns.
Thank you for taking the time to read my concerns and will be anxiously waiting your opinion
Thanks again,
A concerned daughter.
Under microscopic evaluation it reads:
All smears show cluster of follicular cells infiltrated by abundant mature lymphocytes. (What does this mean and is this bad?)
Clusters of Hurthle Cells are present. (I've done research and to my understanding these cells may be tumors and surgery is needed to determine whether they are cancerous or not. If it is cancer is it treatable and how treatable is it? If the thyroid is completely removed does that remove all possibilities of thyroid cancer or any type of neck and or head cancer?
Smears of the left upper pole node show abundant Hurthle cells. Loose and in clusters showing prominent variation in nuclear size. (What does this mean and is it bad?)
Under interpretation it reads:
Findings are compatible with Hashimoto's Thyroiditis. (Does this mean the person has or may have this condition? If not what does this mean?)
Findings from the left upper pole node, although most probable due to the severe inflammation, are worrisome and may represent a Hurthle cell neoplasm. (Severe inflammation, what can cause this? What's the difference between having Hurthle cells, Hurthle cells loose and in clusters showing nuclear size and possibly having Hurthle cell neoplasm? Does having Hurthle cell neoplasms mean you may have cancer?)
Close follow up is recommended. (The endocrinologist recommended surgery a thyroidectomy to be exact. Is this what is meant by follow up, I mean is that the next step? With these results, how necessary is a complete thyroidectomy? How does this improve the condition and what kind of effects can it have on the patient in the future? Will having to take thyroid hormone replacement medication make it seem like you've never had any problems with your thyroid in the first place?)
The patient in question is my mother she is 43 years old has been diagnosed with hypothyroidism for about 10 and has been taking Synthroid (doses have change over the years of course) her sonogram show that she has a normal size thyroid gland (with the obvious nodules problem), and usually tested with normal TSH levels, however her last exam read ULTRA hTSH result 127.534 uIU/ml, T4 TOTAL 2.59 ug/dl and T-4 FREE was 0.40 NG/DL, another test she had done was one that said MICROSOMAL ANTIBODIES (TPO)...IU/ML.....>1000 (What is this test for and what do the results mean) All test were done on or around 1/18/10 which is close to one month ago. Also she has been experiencing menstrual irregulations for months or more likely for about a year, she is under treatment with her gynecologist but both the gynecologist and endocrinologist say it may be contributed to her thyroid issues.
What I'm looking for is more information in which to help us discuss our options with the endocrinologist and whether or not we should be seeking a second opinion. I hope you can help us with our concerns and I apologize if for rambling on it's just my mother and I have never gone through these sort of problems and we are a scared and have many questions and concerns.
Thank you for taking the time to read my concerns and will be anxiously waiting your opinion
Thanks again,
A concerned daughter.
MEDICAL PROFESSIONAL
This is a complicated case. Would consider seeing an ENT who specializes in voice to determine options to improve the way the vocal cords interact. Sounds like the nerve (recurrent laryngeal) was injured during surgery. A micropapillary cancer that is encapsulated (I assume this is what the pathology report said) usually carries an excellent prognosis and does not mandate automatic removal of the remaining thyroid tissue.
A scintigraphy (nuclear) scan is relatively useless in this setting. Would be better to have a good thyroid/neck ultrasound evalution to determine if there are any suspicious areas that need attention.
Consider finding a local univeristy or specialty clinic setting that could give a second opinion....
A scintigraphy (nuclear) scan is relatively useless in this setting. Would be better to have a good thyroid/neck ultrasound evalution to determine if there are any suspicious areas that need attention.
Consider finding a local univeristy or specialty clinic setting that could give a second opinion....
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