Thyroid Disorders Community
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312144 tn?1262226991

Follicular Neoplasm. Cancer?

I have had multi nodular thyroid for three years.  "The right lobe measures 5.6 cm.x 2.0 cm x 1.9 cm.  Left lobe 5.2 cm x 2.0 clm x2.0 cm x1.9 cm.  Echogenicity of right lobe is diffusely inhomogeneous.  It has a nodular texture because it is actually composed of numerous thyroid nodules the margins of which are difficult to differentiate from one another.  Measurements difficult to acquire.  Adjacent to the r. margin of the isthmus there is a solid 2.9 cm thyroid nodule.  No dfinable margins.  Adjacent to this nodule are at least 2 hypoechoic areas each measuring 5 mm in size and may represent cyusts.  The isthmus is thickened.  It contains no definable masses.
The echogenicity of the left lobe is inhomogeneous similar to that seen on the right.  The l. lobe contains several thyroid nodules some of which are isoechoic with adjacent tissue whereas others are hypoechoic."   8/22/06  No treatment, no medication given.  Just watch.

I recently went to another Doctor whose slide showed "follicular neoplasm".  He advises a Total Thyroidectomy, for which I am scheduled sometime in Dec. or January.  

I would appreciate any information anyone would have regarding the relationship of follicular neoploasm to carcinoma.  Has anyone had a follicular neoplasm which turned out to be cancer of the thyroid?  I have had Breast Cancer, and, irradiation of the thymus gland as an infant.  Thank you.
25 Responses
Avatar universal
I had two solid nodules both about 1 cm. One cystic. Two path labs differed about what the two solid ones were suspicious for.  One local one said highly suspicious for papillary carcinoma. The other Univ of PA med center said follicular neoplasm with oncocytic features. Both recommended TT.  After total thyroidectomy, turns out both nodules were cancerous. One had begun to grow outside the thyroid.  I had sweated taking out an organ if it wasn't cancerous and was frustated by inability to tell for sure.  However, my thyroid didn't look too good otherwise, and my endo said in his opinion, given family history, it was better to get rid of.

Was glad to have gotten it out.
312144 tn?1262226991
Thanks for that good information.  It seems best to have the TT. Your input helps a lot with my decision.  . I'll be going to Mass. General in Boston and have a lot of confidence in the Doctor there.  Univ. of PA has a great reputation too.  I wish the surgery could be sooner .  Did you have a sore throat before your surgery?    
Avatar universal
No, I actually had no symptoms.  It was discovered on a physical exam.  I certainly had one after!

Funny about your user name, thought you might be from PA as there is a town called Nanticoke near us here!

Good luck.
Avatar universal
Hey there,
I had a TT a little over a month ago. I had a nodule the size of 2cm on one side and 2.5 cm on the other side. They did a needle biopsy and suspected papillary carcinoma. Turned out that they were not cancerous, but I am happy to have the gland out. Prior to the surgery I had a sore throat, scratchy voice, trouble swallowing, and trouble breathing.  From what the surgeon said, my gland had enlarged in such a way that it was restricting the muscles in my throat and blocking my airway.

Good luck with your surgery.  You will find that your wound from the surgery will heal fast, but the muscles and nerves underneath will take awhile. Also, it will take awhile for your body to get used to missing part or all of the gland. You might experience emotional swings, fatigue, etc... just be patient with yourself and remember that it may take a few months before you feel more like ayourself.

Good luck to you. I wish you a speedy recovery.

312144 tn?1262226991
Nanticokecreek was the first place I went swimming in Endicott, NY.   I can still see the clear water and the pebbles on the bottom.  I guess I am in for a sore throat then.  I've had one for a year, but, not too bad.  It's getting worse.  You were lucky that someone discovered it on that physical exam.  Hope you are feeling all better now.
312144 tn?1262226991
Thanks for your input.  You people are wonderful.  That's just what I have...a sore throat, voice which seems to slip out of gear sometimes, and, wheezy ......swallowing is scary sometimes.  I'm afraid of aspirating.  Will be glad when the surgery is over, though I don't like to have to depend on a pill to live.  
Avatar universal
Do not worry about the pill.  I have been on thryoid replacement med for 10 years now. The way I have managed taking the pill is:

I set my alarm for 5:00 am.  I have my water and my meds beside the bed each night. When the alarm goes off, I wake-up, take the pill and go back to sleep for few more hours.

This solves 2 issues... 1.) I am reminded to take the pill at the same time everyday  2.) I am taking the pill on an empty stomach for maximum absorption and I give my body enough time to absorb the med. The pill requires a wait of 1 hour before eating food. And another tip, wait 4 hours before eating anything with fiber, soy or calcium. They all affect the absorption of the meds.

The hardest part with the meds is getting the dose right.  Just be patient with your body.  It usually takes 6 weeks or so for your body to adjust to any change in your meds. And try to get your doc to ease you into the meds. (Slowly increasing your dose). This will help keep your body from freaking out.

Best wishes to you.  
Avatar universal
Hi there,

Just read your story...

I understand you wanting to have the surgery as soon as possible but be patient... If your crew is the best - they know what they are doing.  I suggest the following before surgery:

1.  Ask your Dr. if there's anyone you can talk to that has had the kind of surgery you are about to have?

2.  Be prepared.  Ask him EXACTLY what to expect after the surgery.  Will you have drains? If so, how long?  Should you expect swelling?

3.   How many days are you supposed to be in the hospital?

4.  Have you had an MRI?  Ask Dr. about having one before surgery if you have not...

I went in the surgery room completly unexpecting what they were going to do.  Knowing wouldn't of made it any easier but it would of helped me prepare emotionally.  If all they are doing is taking out your thyroid - great, but you need to know what's going to happen without any suprises.

Good luck to you.  Don't loose the faith - it's the only thing that really helped me get through.

Take care,

Avatar universal
Your thyroid description sounds like what mine was. My symptoms were the voice going scratchy from time to time, pain when I could feel one of the cysts getting inflamed (like a zit inside my neck), the feeling I was going to choke when swallowing food, and the feeling that I always had a really tight turtleneck sweater constricting around my neck.  My doc found follicular neoplasms and she was worried it was cancer so she recommended TT. I had the surgery 2 months later (that's how long it took to get an operation appointment at my hospital-- a regionally well-respected teaching hospital). Biopsy showed it wasn't cancer, but it was thoroughly disgusting (my opinion based on the report). Took a week off work, recovery was easy, and all has been well. The scar faded swiftly and now is imperceptible unless you know to look for it.  I have none of those awful symptoms I had before, plus there's no unsightly goiter or neck swelling anymore. I used to look like I had a fat neck.

Best wishes!
312144 tn?1262226991
Thank you all for your input.  I got lost on this website or would have written sooner.  I am going in for a probably TT on Jan. 23.  Yes, I am waiting a long time for the best Doctor, so I don't mind.  Taking the pill doesn't sound so bad.  Looking forward to no sore throat, no swallowing issues, and, of course the fat lump in my 'bow tie' section being gone.  The Surgeon said I had a 1 in 3 chance of it being malignant because of the thymic irradiation as a child.  It's nice that he tells the truth.  I would rather know, even if it's bad.  After all this, it probably will be benign.  I'm sure it will be thoroughly disgusting whatever it is because it just feels that way.  Thanks a million again!
301640 tn?1302652334
hi michelle here i just had my right side out 3 weeks ago when i was at hospital they were looking for neoplasm cancer like u i get my pathology results back today  mine grew extremly fast and was pressing against my wind pipe  it still feels like somethings stuck in my throat i dont know what but my left side was healthy.
Avatar universal
Dear nanticokecreek,
"Follicular neoplasm" in FNA includes benign and malignant follicular neoplasms. The only way to differentiate the benign and malignant is to prove of tumor capsular invasion in histologic section (exam by pathologists), that's mean TT. Good lunck for the operation :)
Avatar universal
Dear Nanticokecreek
It's been over 30 years since I had a total thyroidectomy due to cancer.  Although it is important to be consistent, thyroid replacement medication has a half life that is long enough that you don't notice if you forget to take the pill one day so don't be very concerned about that aspect.  

Check out the thyroid cancer survivors website, it has lots of helpful information.  http://www.thyca.org/thyroglobulin.htm
Avatar universal
I just had a TT last Monday.  The operation went great.  The reason was I have had a complex cyst on my left lobe for five years which I have ultrasounded every six months.  In a recent biopsy the results came back with "possible follicular neoplasm".  Because I had three small nodules, cysts, on the other side, the doctor opted for a TT.  I go back Tuesday for results.  I am scared that it will come back with cancer.  Any advise, or similar situations?
Avatar universal

I recently had a FNA and the diagnosis was follicular neoplasm.  Instead of a TT I would like a diagnostic lobectomy, which is where they only take half of the thyroid, the one with the nodule, with the main purpose of doing pathology on it.  If it turns out not to be follicular cancer, then the other half could likely provide enough hormones so I don't need the pill.  In my opinion, jumping to a TT is too aggressive for me anyway, but it also depends on your particular circumstances.
Avatar universal

I am a 28 year old male, and I found a lump on my thyroid (right lobe,2.7x2.0.1.5 cm). FNA result came back as "Follicular Neoplasm, probably benign". My doctor recommended a hemithyroidectomy, I am on a waiting list for an operation, but my doctor seems to think it's routine and has not flagged as urgent, which means a fairly long wait (a few months). This is the UK National Health Services, so I am not paying, but the flipside is that there are long waiting lists.

My question is, how risky is this wait? Is my doctor right to consider it a routine procedure? I just need some peace of mind, since no one seems to have an answer to this question.
Avatar universal
Hey, similar situation here.  What was/is your outcome?
Avatar universal
Since April 2005 I  was diagnose with  a slight inhomogenous and hypoechoic nodule in the upper right pole. I had a FNA done, the results were insuffient cells to determine. In Feburary of 2009 I had another  ultrasound  done. I was told I had another nodule in my left lobe. I had another FNA done  the results on the rt lobe stated unsatisfactory for evaluation, only rare follicular cells are seen. the left lobe favors a goiterous process or an adenomatoid nodule: howerver follicular neoplasm cannot be entirely excluded. I  sat with a Military doctor yesterday who advised me to keep watching it and follow up in 3 months. Iam scared and need some advise.
Avatar universal
I was also diagnosed w/ follicular neoplasm by FNA. 4 yrs ago I had an US of the thyroid which should multiple nodules on both sides. I had another US  in Nov 08. The nodule grew half the size from 4 yrs ago. I am scheduled for a minimally invasive TT Friday. My sister just had a TT 6 weeks ago and she was found to have papillary CA and today she will be in isolation due to the radioactive pill. Her thyroid grew into the chest area and wrapped around her trachea and esphosagus (sp?). The MD said it was just a matter of time before it would attack her aorta.

Please check out your MD to make sure he has done plenty of this type of surgery. My MD specializes in endocrine surgery.
Avatar universal
Reading all your comments have eased my mind.  I am having surgery on Thursday, July 30th.  I appreciate the possitive thing said about recovery.  I teach middle school, therefore, I will have to tone down my voice.
945934 tn?1289046024
Being a teacher as well, I was totally apprehensive about surgery.  Had to have a TT for a large goiter and follicular lesion on the left.  Voice came back immediately but please rest your voice as I was told.  I did not have any calcium drops as of yet so 2 out of 3 isn't bad for my worries.  The third was cancer which it turned out to be.  So when the other posts talk about follicular neoplasm and possibility of cancer, it turned out to be so with me.  Glad to have the TT taken care of on July 20, 2009, and now it is RAI for me in September to rule out any cancer cells.  Do you go back on August 10th like a lot of us in Southern California for public school?  Hopefully you have more time off to recover from the TT.  I haven't been able to turn my neck yet and it is one week out (essential for driving).  Take care.
1100591 tn?1265778539
     These past 9 mos. I have been experiencing throat/neck pain.  At first I thought it was from not drinking enough water with my night meds.  I went through a few lidocaine cocktails at work to get me by, but they didn't work,lol.  The pain has gotten to be quite bothersome lately, which prompted me to get it checked.  My wonderful ARNP, JoEllen, found a lump that she felt needed to be examined by an ultrasound.  I had the test on October 9,2009.  
      I recieved results and the report read of a hypoechoic noncystic nodule with vascular character 1.2cm maximum dia. in the lower pole right lobe of my thyroid gland.  There is also a 4mm vascular nodule hypoechoic focus centrally observed in the left lobe.  The gland is otherwise homogeneous in echotexture and normal in vascularity and normal in size.  I was told by my Doctor that I would need to find an oncologist.  I was scheduled for the next step which was a thyriod scan.  It was fine.  

Thyroid Peroxidase Antibodies <10   ref. range <35 IU/mL

Thyroglobulin Antibodies <20     ref. range <20 IU/mL

Thyroglobulin 9.8       ref range 2.0-35.0 ng/mL

Path Report is so hard to understand though

It appears mostly microfollicular with nuclear overriding.
Classification: Indeterminate.
Due to the predominance of the microfollicular pattern a follicular neoplasm cannot be totally excluded.

I drove 6 hours to Moffitt to be seen to sch. surgery like edno said but the surgeon didn't act concerned and told me to repeat all tests in 6 months...
it has been almost 3 and I have had no relief from the dull ache in there. I am having night sweats on and off too, can anyone help?

640719 tn?1277140030
I also had Follicular Cells come back from a FNB. Endo told me he was pretty certain it was not cancer but I was at a very high risk and it needed to come out asap. My surgeon said 20% chance that the pathology would come back cancer after surgery. They removed just my right lobe. No cancer! I was on meds before surgery but they needed to be increased. I used to take 88mcg and now I'm taking 125mcg and still increasing. Endo told me I will need more meds after partial TT. He was right.

Surgery was easy... I was surprised how I had so little discomfort.

1100591 tn?1265778539
I went to work this morning, knowing I had to leave early to take my daughter to the ENT today for preop for tonsillectomy,andenoidectomy, and turbinate (sp?) reduction.
My office refers to this particular ENT all the time since he is top notch. I have not heard anything negative about him. So, I phoned over to see if they could get me in to get established at the same time we had to pick up my daughter's paperwork to take to the surgery center. To my surprise they could! I knew I needed to get a second ... See moreopinion about the follicular adenoma/neoplasm since it has been three months since going to Moffitt Cancer Center Endocrine Tumor Program. I brought all of my test results and he looked everything over. He asked how it all started last April... I said with pain (dull constant ache). He agreed with endogrinologist that the lobe should be removed. He spent quite a bit of time listening to me and noted the growth in the nodule when he palpated. He validated my pain by saying that it was a way to let me know my body was responding to something that should not be there. He has all records except my slides and films, which are at Moffitt, but I do not think he needs them since he has the reports. I simply asked him what would he suggest I do and he said it definately needed to come out and I agreed to let him be my surgeon. I asked him how he planned to do the surgery and he told me he does the traditional cut. He explained that way may be best so he could place a drain to control a possible hematoma since I have developed them after every surgery so far. He walked me to the surgery scheduler's office and chatted with her while I waited and she asked me to come in and told me he wanted the first available date. I did not expect to be scheduled so quickly, I guess, since I just went in for a second opinion and to discuss my case. At first I kinda freaked that there was an opening on the 26th (my anniversary) so I asked her if we might be able to PENCIL it in for the following month, because I needed to talk to my family and my job, and she did. We decided on March 2nd and that was the latest she wanted me to go out. I was able to sit and discuss all the details with my husband. He had a lot of questions of course and he said to go ahead with Feb. 26th. He dosen't want to wait. I called the Scheduler with him and she said that would be fine but she would be at my chosen hospital on the 16th (Feb.) with Dr. for surgeries that morning. They perform surgery at two hospitals in the area and he also works at a free standing surgery center where he is part owner. She told me he may be able to cancel his office visits, or clinic to be able to do it that afternoon. I was shocked that he would do that! I told her that I would wait until the 26th and she said the 16th would be fine and to give her 10 minutes so she could text him! Wow, I felt odd, lol. She called me back in five and told me he said it was a go and to be back there on Monday for preop at 1pm AND told me she was going to book me to see him, which is not heard of! He is cancelling his clinic for that afternoon! She said to gather all the questions and bring them in and he will patiently answer all of them. So! Surgery is set for Feb 16th 2010. I am comfortable with this as I am very tired of dealing with the achiness in my throas and the other symptoms. I am not ready for the healing time and the wait for pathology to come back, even though I KNOW God is performing miracles and all WILL come back fine! I have had to deal with surgical menopause and hate the idea of another hormone shift. However this has been going on since last April-May and this too shall pass, right?

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