fna containing Follicular cells with focal atypia

[kar21]

Anyone who has had a FNA  that contained Follicular cells with focal cytologic atypia, Hurtle cells,abundant colloid and few Lymphocytes?  US findings were: 1.2 x 0.7 x 0.8 solid vascular nodule.  I have had 3  different opinions. (Have surgery, another biopsy,repeat US in 6 months).  Really do not want surgery if at all possible!  

[Mark Lupo, M.D.]

My guess would be hashimotos' but would have the slides sent to an expert for review -- Dr. Massoll at U Florida or Dr. Baloch at U Penn  --- or to Mayo, Hopkins, etc....

If it is benign then observation is all that is needed.  This is a small nodule so should not be causing you any symptoms.  The abundant colloid is usually a benign feature..

[Kaveh]

I have a lot of confidence in New York Eye and Ear, I understand they get a high case load of thyroid cancer.  Also, both their pathologist and head and neck surgeon are very dedicated and good people.  If you need another opinion in the local area I recommend them.  Hurtle cell carcinoma(bad) is difficult to distinguish from adenoma(not bad) by FNA from what I gather, however the “bad" is supposedly aggressive and worth the risk of taking out.  I read a retrospective study that should about 50% of patients with hurtle cells and follicular atipia ended up having cancer (based on the pathology after surgery).  I could imagine the frustration of getting three different opinions.  Their job is to explain their reasoning so it makes enough sense for you to be confident in their recomendation, or confident seeking someone elses, don't settle for less.  

[kar21]

I have tested negative for Hashimotos. All other thyroid functions are normal as well. The doctors I have consulted with are at Sloan and Ny Pres.  in NYC.  All top in the field...all having a difference on treatment.  With Sloan advising surgery asap! Have had some hoarsness that goes away when I clear my throat, but then comes right back.  (Feels like some mucus accumulats.)  Would you still send slides for review some place else,even though biopsy was performed at Sloan? Who are the top thyroid surgeons at Mayo and Hopkins?  Thank You!