VERY FEARFUL

[MELISSA37]

I am 36 years old and in nov. of '07 had a fna on left side of my thyroid. also have several small places on other side.  THE fna came back as follicular neoplasm.  Endo, said should have all the thyroid removed.  Because this came back as not really saying that i do or do not have cancer, i am very nervous of having this surgery done.  EVERYTHING i have read about having thyroid surgery is ABSOLUTLEY HORRIBLE.  from gaing weight to hair loss, mood swings and on and on .......
It would be a heck of a lot easier decision to make if it would have just come back as cancer, or not cancer.  I honestly do not no what to do.  The blood work that I have had, is normal as far as thyroid levels are concerned.  Would it be terrible to not have this very radical surgery?

[MELISSA37]

Thank you for responding.  The endo. that I have seen, as well as the surgeon is in Houston, Tx.  The biopsy was done at the Methodist Hospital in Houston as well.  I am not sure who else that I should have look at the specimen slides for an expert opinion?  Do you have any names in the Houston area that you would feel would be worth looking into?  I live in Lufkin Tx. so the drive to Houston is about 2-21/2 hours.  How do you feel about trying to heal the thyroid before choosing to have thyroid removed? and is it safe if i choose not to have the surgery, to keep a close check on it with ultra sound?

[Mark Lupo, M.D.]

Follicular neoplasms (FNs) are a dilemma for patients and doctors.  First I would have the specimen slides sent for expert opinion as often these are benign, but a novice pathologist will waffle.  Statistically 20% of true FNs are cancer and surgical excision is the only way to make the diagnosis.  You could have only the left removed, then if it is benign, watch the right sided small nodules over-time.  If your thyroid antibodies (TPO and Tg) are normal (negative) then there's only a 25-30% chance of needing thyroid medication after removing half the thyroid.

Also, with normal TSH the chance that this is a "hot" nodule is low, but an I-123 uptake/scan may be helpful as nodules that are clearly hot are almost never cancer and would usually not need removal.

Lastly, it's not a radical surgery and even with removing the whole thyroid, replacement goes very well in the vast majority of patients.  Remember, people tend to report the bad experiences over the good experiences - in terms of what you read on the web, etc....