Painful Thyroid Cyst

[bozcrew]

Hello Everyone,

I have a large thyroid cyst, over 4 cm, that was drained (28cc's) just over 3 weeks ago.  It has now come back, along with quite a bit of pain in that left side.  I don't have an appointment until Sept. 16, and it feels like the cyst is now just as big as before, maybe bigger.  

My question is, do you know if thyroid cysts burst?  Can they get to big and just pop?  If so, what would happen?

Thanks,
Sandy

[bozcrew]

Dear 898,

Thank you very much for the information.

Take Care!

[898]

'Benign pattern grade I (score = 1): epithelial cells distributed in cohesive clusters. The nuclei are round or oval with dense and homogeneous chromatin. The cytoplasm is scanty and slightly eosinophilic, but some oncocytic cell change may be present. Abundant colloid may be seen. This pattern is suggestive of nodular goiter.

Indeterminate grade II (score = 2): epithelial cells distributed in solid clusters or in microfollicular arrangements. The nuclei are round or oval with homogeneous chromatin. The cytoplasm is scanty or slightly eosinophilic. Colloid is absent or scanty. This pattern can be found in adenomatous goiter or in follicular neoplasm.

Suspicious pattern grade III (score = 3): epithelial cells distributed in solid clusters or in follicular arrangements. The nuclei are round or oval with nuclear enlargement, granular chromatin, and prominent nucleoli. The cytoplasm is slightly eosinophilic or may be large, deeply eosinophilic, and granular, characteristic of oncocytic cell change. Colloid is absent or scanty. This pattern is suggestive of neoplasm.

Malignant pattern grade IV (score = 6):

a) Papillary pattern–the epithelial cells are seen in a papillary arrangement. Round or oval nuclei are seen with nuclear pseudoinclusions and/or nuclear grooves.

b) Medullar pattern– the aspirates are typically hypercellular with noncohesive cells. The cells are variable in shape with round, oval, or spindle shapes. The nuclei are often eccentric with a plasmocytoid appearance. Amyloid is rarely seen.

c) Anaplastic pattern–small, giant multinucleated, and spindle cells are the predominant types in this pattern. The nuclei are usually large, bizarre, single or multiple, and coarsely clumped with prominent nucleoli. Atypical mitosis may be present.

d) Malignant lymphoma–monomorphic lymphoid cells (frequently associated with Hashimoto's thyroiditis)."

[bozcrew]

I'd be interested in reading that table if you still have a link to it.  

The microscopic description from my needle biopsy is scary when they talk about the Hurthle cells in it.  Only one of the slides of the nodule had anything to really read, and it said: "This demonstrates small tissue fragments composed of fibrous stroma and adherent cells with relatively ABUNDANT and granular cytoplasm typical of Hurthle cells, along with individually dispersed Hurthle cells in the background."  It also said there wasn't hardly any colloid, and it didn't show Hashi's.  

The report also said a definitive diagnosis could not be made, although that one slide raises the "possibility" of a microfollicular lesion with Hurthle cell features.  I actually posted the report for Dr. Lupo, but he said that it looked like Hashi's and was probably benign, even though in the report it said no background thyroiditis is recognized.  He said I do either need to get a repeat biopsy, or send my slides to a university for a second opinion reading.  I will be seeing an Endo that only sees thyroid patients at Harbor-UCLA on Sept. 16th. so hopefully he will be better than my last Doc.

Thanks,
Sandy

[898]

I recently came across the intersesting table that makes prediction of the cancer CHANCE based upon biopsy results; according to the table "if significant {they do not give concentration percentage for that!!] amount of Hurtle cells is found, the nodule has between 20 and 40 % chance to be malignant". The trace amount of Hurtle cells however can be present in many nodules

[bozcrew]

Thank you for your answer.  I actually have to get another biopsy, because the first one was inconclusive, so I'm not sure it's benign.  I also had a nodule on the other side, which was inconclusive too.  They said something about Hurthle cells, but couldn't make a diagnosis.  

I just don't want to have to see another doctor before the one I am seeing on the 16th of September.  But since my cyst seems larger than 3 weeks ago, I am afraid it's going to pop.

[898]

Sandy, you may inquire about this procedure.
However due to the size of cyst, you may require more then one treatment{similar to another board member]

"Ultrasound-guided percutaneous ethanol injection (PEI) is safe and effective for the treatment of thyroid cystic nodules, according to two presentations on June 19 at the 85th annual meeting of The Endocrine Society (Endo 2003) held in Philadelphia, Pennsylvania.

"Simple aspiration of the fluid content of thyroid cysts is ineffective as thyroid cysts usually recur," coauthor Michele Zini, MD, an endocrinologist from Arcispedale Santa Maria Nuova in Reggio Emilia, Italy, told Medscape. "Our study provides evidence that PEI is a safe, effective, and curative treatment for benign cystic thyroid nodules."

This technique is a simple interventional procedure performed under ultrasound guidance by inserting a special needle inside the thyroid cyst. After aspirating the fluid content of the cyst, the physician injects a small amount of 95% ethanol. Compared with the traditional surgical treatment of large thyroid cysts, the advantages of PEI include avoidance of surgical risks, outpatient setting, no need for general or local anesthesia, brevity of the procedure (which can be completed in a few minutes), reduced cost, and preservation of normal thyroid tissue."