Is surgery necessary?

[Aru4Health]

Sir / Madam,

I am from India.

My friend has recently been diagnosed with thyroid problem. I have attached the medical reports. There are different view points being expressed by her consulting doctors. Some are unsure while others are suggesting surgery. No one is able to give a clear cut picture. My friend is absolutely healthy barring her Hb level which is 2 units below normal. She is non-diabetic and no other complications that are generally associated with patients of her age.

Please help, so as to help my friend take a positive decision to further course of action. In case Surgery is not required then what should she be prescribed with? What precautions she needs to take for general well being.

Thanking you

Aru

blood report
(Tests done on Random Access electro chemiluminescence system of Roche USA)

TSH:   1.8 micro IU/ml
T4:    9.6 micro gr/dL
T3:    85 ng/dl
F.T4:  1.16 ng/dl
F.T3:  2.54 P gr/ml

Cytology report

Specimen : FNAC of Thyroid swelling
Microscopic: Smears show follicular epithelial cells,few Hurthle cells and plenty of foamy macrophages against colloid mixed haemorrhagic background.

Impression: Cytological features suggestive of Adenomatous Goitre with cystic change.

Ultrasound neck

Both lobes of thyroid are mildly enlarged.
Right lobe of thyroid measured 37x13x19mm
Left lobe shows a 35x26x23mm multiloculated cystic lesion.
Bilateral neck vessels are normal in their course, calibre and flow velocities.
There is no evidence of any cervical lymphadenopathy seen.

IMPRESSION: Thyromegaly with a large multi cystic nodule in the left lobe s/o nodule with colloid degeneration.
Smaller nodules noted in the right lobe.

[Aru4Health]

Thank you Sir. Your answer has somewhat eased the confusion regarding surgery. I could not include the ultrasound photos as it could not be posted here.

She is not having any pain/choking/hoarsenss/trouble swallowing, etc from the goiter.  But the size of 11mm and 5mm...and the word "follicular" ???? ..... gives a little pinch to the mind..........Does she requires any medication for restricting the growth of the goiter.... may be stagnate to the present state etc.?

Are there any other tests that she needs to undergo Sir?

Or is it a case where we keep our fingers crossed and observe ..... leaving it on time to answer the query. TIME ...till what time to observe, Sir?

[Mark Lupo, M.D.]

She appears to have normal thyroid function and a benign biopsy.  In these cases, we observe without surgery unless she is having pain/choking/hoarsenss/trouble swallowing, etc from the goiter.

Diagnosis, based on information presented, is euthyroid benign nodular goiter.