FOLLOW UP

[DONCHI]

Dr. Lupo,

I have written you a couple times before (DONCHI)Nand the information you have provided me has been helpful and I thank you.  My daughter who is 16 had her biopsy but it came back as Nondiagnostic with many lymphocytes and no epithelial cells.  The endocrinologist is now saying it may be a lymph node and not a nodule.  From what I have read if there are alot of lymphocytes from FNB you can get a false negative; is that information correct?  As a reminder she had abnormal TSH and Uptake with the persumed diagnosis of thyroiditis.  I am so confused on what to do at this point.  My daughter will be seeing a surgeon on Tuesday of next week and I am taking her for a second opinion with another endocrinologist on 11/8.  I obviously do not want her to have surgery to remove this nodule/node if it is not necessary, but I don't want to not do anything and find out later that was a bad decision.  How would you handle this case?
Thank you again for your time and opinion.  DONCHI

[DONCHI]

Dr. Lupo,

She had repeat TSH, TPO, TG done this week as well as CBC and ESR, but no results as of yet.  When the radiologist re-reviewed her three ultrasounds done over a 9 month period he said his differentials were: Thyroid nodule, Parathyroid adnemona or a Lymph Node.  Whatever it is, it has grown more then double the size from March to September and has the appearance of being solid.
My daugther is not feeling well and seems depressed, at this point it is hard to know if this is related to the mass or the stress of not knowing what we are dealing with.  

Again, thank you for your professional opinion.

[Mark Lupo, M.D.]

I would do a careful ultrasound to figure out if the area in question is more likely a lymph node or a nodule.  This sounds like Hashimoto's Thyroiditis - or less likely another cause of thyroiditis -- this gives a lymphocytic predominance on FNA.  Lymph nodes (LN) do not have follicular epithelial cells, so if it was only lymphocytes, then it is likely a LN.  Also, long-standing thyroiditis can have very few follicular cells, so there again one would see mostly lymphocytes.  

So it will be important for someone who is skilled in thyroid ultrasound to describe what is the area in question, possibly repeat the FNA then send it to an expert pathologist to determine if this is most consistent with benign thyroiditis (which is most likely the case).

Would check TPO and Tg antibodies if not already done.