Follicular neoplasm in hot nodule

[MariaGonzalez]

In the context of a euthyroid multinodular goiter with hot nodules (Technetium scan), I had FNA on dominant nodule (22 x 14 mm) and the result was follicular neoplasm... The pathologist report recomended, in fact, nodule resection.

I am not sure, but think I have read somewhere that the "follicular" result in hot nodules is quite common, suggesting benign follicular adenoma, and that some physicians would even favour "watch and see", and not surgery.  Will surgery be the most reasonable option, even if the nodule is autonomous? (and not growing in the last six months)

Now I am waiting for a consult with the surgeon, and maybe we will discuss the extent of the surgery... ¿Lobectomy, Thyroidectomy? Lobectomy with the dominant nodules would be my first choice... But I have also nodules in the other lobe, and I wonder if a second surgery will suppose more risks... I am a university lecturer, and I am worried, for example, about my voice..

I am so confused, because everything seemed to be an innocent multinodular goiter... And I am now scaried, facing thyroidectomy.

Thank you very much...I am in a mess.

[898_1]

Usually if such pattern microfiollicular sheets and scant colloid (neolasm) is found in COLD nodule removal of the half of the thyroid is the next step. According to Tarik M. Elsheikh, MD, "There are, however, several cytologic features reported to be associated with increased cancer risk (These features include an increased nuclear size (at least twice the size of RBC --red blood cells), marked nuclear atypia including significant nuclear pleomorphism and irregularity, significant nuclear overlapping, and predominance of microfollicular structures (involving > 75% of thyroid clusters)". [http://webcache.googleusercontent.com/search?q=cache:Ku02VEu7WxsJ:www.papsociety.org/guidelines]
Again, I am not sure that this applies to the HOT nodules.
Have not found anything specific about "cytoplasms with fragile limits"  
I read about similar condition been treated with radioactive iodine, but the pathology report just mentioned "microfollicular pattern", with  no details.

[MariaGonzalez]

Thank you, 898_1. I am actually very confused.

In two days I already visited two endorcrinologists, and they seem to agree in surgery, even if they say that the most probable result (I wish so) is benign. One of the endos seems to favour hemithyroidoctomy, and the other total thyroid excision.

I am not a native English speaker, and I am not sure of my Spanish-English translation, but the report is something like this:

"aboundant follicular cells forming sheets, microfollicules, and also in a dissociated pattern.  Scant colloid" Something that also worries me is "citoplams with fragile limits and nuclei with light pleomorphism" (which I suppose  cell atypia, I do not really know).

Nothing is said about bleeding, I can not know if blood was too much.

Any insight would be very appreciated. Thanks again.

[898_1]

Hot thyroid nodules exhibit a wide range of morphologic appearances; hot nodules are almost always benign.
What does the pathology report says about presence of colloid,
Micro or macrofollicular pattern?
Evdence of internal bleeding?
Sometimes the sample can have too much blood that alter pecentage of watery colloid, leading to neoplastic vs hyperplastic diagnoses.
You may need to get second opinion about this matter.