Aa
Can diagnostic thyroidectomy be avoided?
I've had two FNABs within the last six months, and now my endocrinologist is proposing another.
First FNAB sent for cytopathology to our local WV hospital came back indeterminate with atypical cells suggesting a possible follicular neoplasm. Then a second FNAB sample was sent for Veractye gene expression classifier testing. Result: not definitely benign, but 40% suspicious for malignancy. I want to avoid unnecessary surgery, so a sample was sent to John Hopkins university for another cytopathology. Result was one word: benign.
However, my endocrinologist now says she is not comfortable with benign as the final word, although she has been supportive of my desire to avoid unnecessary surgery, a thyroidectomy primarily for diagnostic purposes. She does say my ultrasounds have shown a single nodule only one centimeter in size that does not have suspicious characteristics. Now she is proposing another FNAB with results sent to miRinform for molecular testing. She says because I have been very compliant over the last several years with tx for Grave's disease, she is willing to continue with testing instead of referring me to a surgeon. I would appreciate another opinion on why John Hopkins' very definitive one word dx of benign can't be the final word.
After a year of methimazole tx for Graves' disease which ended in Oct. 2013, my TSH and free T4 were normal until 2014, when TSH weirdly was high. Even on 12.5 mg of synthroid, last months labs showed TSH at 9.5. She did not have time to explain why, but I am very curious. Previously my radioactive thyroid scan (diffuse markedly increased uptake), antibody labs, TSH, and free T4, eye symptoms and others symptoms, unequivocally pointed to Graves. I've been off methimazole for months now, so why the labs showing hypothyroidism? A two-part question. Thank you for any response.
First FNAB sent for cytopathology to our local WV hospital came back indeterminate with atypical cells suggesting a possible follicular neoplasm. Then a second FNAB sample was sent for Veractye gene expression classifier testing. Result: not definitely benign, but 40% suspicious for malignancy. I want to avoid unnecessary surgery, so a sample was sent to John Hopkins university for another cytopathology. Result was one word: benign.
However, my endocrinologist now says she is not comfortable with benign as the final word, although she has been supportive of my desire to avoid unnecessary surgery, a thyroidectomy primarily for diagnostic purposes. She does say my ultrasounds have shown a single nodule only one centimeter in size that does not have suspicious characteristics. Now she is proposing another FNAB with results sent to miRinform for molecular testing. She says because I have been very compliant over the last several years with tx for Grave's disease, she is willing to continue with testing instead of referring me to a surgeon. I would appreciate another opinion on why John Hopkins' very definitive one word dx of benign can't be the final word.
After a year of methimazole tx for Graves' disease which ended in Oct. 2013, my TSH and free T4 were normal until 2014, when TSH weirdly was high. Even on 12.5 mg of synthroid, last months labs showed TSH at 9.5. She did not have time to explain why, but I am very curious. Previously my radioactive thyroid scan (diffuse markedly increased uptake), antibody labs, TSH, and free T4, eye symptoms and others symptoms, unequivocally pointed to Graves. I've been off methimazole for months now, so why the labs showing hypothyroidism? A two-part question. Thank you for any response.
MEDICAL PROFESSIONAL
You appear to have autoimmune thyroid disease initially presenting as graves/hyper then progressing to hashimoto's/hypothyroidism. It can swing back-forth in the future, but this is uncommon. Autoimmune disease can cause atypical findings on FNA if the cytopathologist is not told of the disease and treatment (methimazole can also cause cellular atypia). The nodule is small and apparently not high risk appearing on US. Afirma GEC "suspicious" carries a risk of malignancy that appears to vary from 30-50%. miRinform identifies mutations known to be associated with cancer, so if one is present, risk of cancer is 80% or more. But is none is present, it does not exclude cancer. Assuming there are no worrisome lymph nodes on US and you are willing to accept a residual (??? %) risk of malignancy, for this small nodule, close f/u may be reasonable.
Dr. Lupo, thank you for your extremely helpful and highly informative response.
You are reading content posted in the Thyroid Cancer / Nodules & Hyperthyroidism Forum
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
