Hoping for a little more information

[arress]

with a nodule on my thyroid. Had a fine needle biopsy, which came back inconclusive. Had a TSH blood work but no information back on that as of yet..

Was sent to a general surgeon who now states that it needs to be removed.  I do at times have trouble with swallowing. But does this warrant the removal of my thryoid? I would prefer the non-surgical approaches if at all possible. But when I asked if there was another treatment available she said just another biopsy and or surgery.

Would I be fine trying a thyroid medication and or the radiation? Updated result I have to offer.  
Hard, cystic 1 ML is what the report is stating in terms of size and density.  I have had symptoms that include unusual weight gain. Always feeling drained. It seems to be interfering with my ability to think clearly. At times I have difficulty with swallowing but not often.


Diagnosis Cytologic Findings
Specimen Adequacy- Satisfactory but limited by, low epithellal cellularity. Cellular degeneration.

Comments:
This thyroid FNA specimen is extremely low in epithellal cellularity. It contains a single group of mildly atypical, but degenerat follcular cells, a few of which appear to contain intranuclear cytoplasmic inclusions. Well developed nuclear grooves are not identified. Otherwise, the specimen contains scant colloid, histiocytes, pieces of skeltal muscle and blood. Focal changes raise the possibility of papillary thyroid carcinoma, but the specimen is of borderline adequacy in terms of epithellal cellularity and cellular preservation. Suggest repeat FNA of the thyroid, especially if this is a clinically or radiographically suspicious lesion.

I would if at all possible prefer not to go the surgical route due to an extreme intolerance to anesthesia. I become violently sick from it and medication to stop vomiting and nausea don't seem to help much. I am willing to do another biopsy. Should I try this route again?    

[arress]

Just to update.
Findings: The left thyroid lobe is normal siz, measuring 4.5x1.5x1.5. The right thyroid lobe is enlarged, measuring 4.6x2.5x2.5 Cm. A complex systic mass is present within the right thyroid lobe in the midportion of the lobe,measuring 2.3 in maximal diameter, with a solid nodular component arising from the wall of this lesion. The solid component measures approximately 13mm in diameter. This correlates with one of the areas of palpable concern. A smaller benign-appearing nodule is also identified in the right thyroid lobe, measuring 5 mm in diameter and possibly correlating with the other area of palpable concern. The left thyroid love is homogeneous and normal in echotexture. No left thryroid nodule is identified.
Impression:
A complex cystic mass with a solid nodule is identified in the thryoid lobe, correlating with one of the areas of palpable concern. Malignancy must be considered. Tissue diagnosis is recommended.

Small benign.appearing right thryoid nodule,possibly correlation with the other palpable lump. This can be followed with a repeat ultrasound of the thyroid in one year.

GP recommends having it removed. Seems resistant to another FNA . His response was if that came back inconclusive, how will  you sleep at night. Well why isn't there a more accurate way of testing? It appears to me that some unneeded surgeries happen due to the fact that they (biopsies) don't shed enough light on whether it truly is cancer, or a benign cyst. How frustrating to know that basically it is a shot in the dark unless you have the area of concern removed. Then taken and tested. So upsetting and frustrating!
  I will have to call insurance company as he was somewhat unwilling to refer me to an endro. Not sure what direction I will turn to .

[arress]

Thank you! I felt like I was so rushed into everything that transpired..that my head was spinning. I don't even know the size of the nodule. All I have is what I was told via phone and the biopsy result.

I do go back to my GP on Wed. I hope to be referred to an endocrinologist soon. I am suprised by the milliliter reference myself. I wonder if it was a typo. But I am more convinced that I need another biopsy done. Thank you!

[Mark Lupo, M.D.]

From what you describe, a repeat biopsy would be appropriate.  The initial biopsy was lacking in cells, there is not enough information from a biopsy standpoint to go directly to surgery.  We typically repeat the biopsy in this situation.  The size of the nodule was not clearly given, we measure this in centimeters.  You mentioned one milliliter.  It sounds like additional evaluation is warranted prior to surgery consideration.