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thryoid nodule FNA biopsy
HI please help am very nervous and confused ......45 year old female....
Recently found on ultrasound 3.3 cm solid vascular nodule . Got fna biopsy results which show Diagnosis: Suspicious for Neoplasm Bethesda cat 1V.
Microscopic : Moderatley cellular specimen consists of scattered microfollicles and syncytial clusters of overlapping follicular cells showing pale but slightly smudgy chromatin. The backround consists of abundant blood
These findings are suspicious for a follicular neoplasm
Clinical impression: Vascular
Am so scared does this mean surgery/cancer? Has anyone had this and it is not cancer? Also have 3 other small nodules less than 1 cm that have not been biopsied. I am worried ..I am reading other posts and most people dont have so large (3.3 mine) and mine is vasular....anyone have anything similar?
Recently found on ultrasound 3.3 cm solid vascular nodule . Got fna biopsy results which show Diagnosis: Suspicious for Neoplasm Bethesda cat 1V.
Microscopic : Moderatley cellular specimen consists of scattered microfollicles and syncytial clusters of overlapping follicular cells showing pale but slightly smudgy chromatin. The backround consists of abundant blood
These findings are suspicious for a follicular neoplasm
Clinical impression: Vascular
Am so scared does this mean surgery/cancer? Has anyone had this and it is not cancer? Also have 3 other small nodules less than 1 cm that have not been biopsied. I am worried ..I am reading other posts and most people dont have so large (3.3 mine) and mine is vasular....anyone have anything similar?
Hey, I am following this post... I looked up exactly what this was because I am not familiar. This is what I have found: Background:
“Thyroid nodules diagnosed as Bethesda category IV (follicular neoplasm/suspicious for follicular neoplasm (FN/SFN)) are recommended for surgery. However, only 25% of these nodules turn to be malignant on histopathology. Therefore, selection of nodules for surgery diagnosed as Bethesda category IV is important. We aimed at to define the predictive factors for malignancy and predictive risk indices for selection of surgery.”
This is the website I found it on. Your doctor should update you, but follow up with your doctor, and stay on them. Best wishes to you.
http://www.endocrine-abstracts.org/ea/0049/ea0049GP243.htm
“Thyroid nodules diagnosed as Bethesda category IV (follicular neoplasm/suspicious for follicular neoplasm (FN/SFN)) are recommended for surgery. However, only 25% of these nodules turn to be malignant on histopathology. Therefore, selection of nodules for surgery diagnosed as Bethesda category IV is important. We aimed at to define the predictive factors for malignancy and predictive risk indices for selection of surgery.”
This is the website I found it on. Your doctor should update you, but follow up with your doctor, and stay on them. Best wishes to you.
http://www.endocrine-abstracts.org/ea/0049/ea0049GP243.htm
5 Comments
Thank you so much for your response
There are very knowledgeable people on here that I am sure have gone through what you have. I’m a “newbie” to all of this, my issues have been ongoing, but only recently have I put my foot down with my dr. Just want you to know that you have support :)
Hi bird100,
I'm so sorry you are going through this! I'm not an expert, but I am a 37 yo female in a similar position, just a couple weeks ahead of you with the suspicious diagnosis. I have a nodule that is "suspicious for Hurthle cell neoplasm" from biopsy result. (Hurthle cell thyroid cancer is considered a subdivision of follicular thyroid cancer, but is often harder to treat if it has spread and often occurs in older patients). They did genetic testing on mine (Afirma) and it is still suspicious so I am currently awaiting surgery for it (scheduled for June 21). I think my chances of it being cancer are slightly higher than a follicular neoplasm, but there is still a very good chance that it is benign (but good to get it out now, because it could turn in to cancer later on if I just leave it).
As soon as I heard the words surgery I panicked and got very anxious, especially about cancer - but now that I have had some time to process, I understand that there is a good chance it is not cancer, if it is cancer the sooner it is out the better, and thyroid cancer (even if it is Hurthle cell, which is harder to treat than papillary and follicular cancers) is very treatable in someone younger than 55. The only way to know for sure if it is cancer or not is to remove the whole nodule intact, which means a lobectomy (partial thyroid removal of one lobe) or total thyroidectomy (TT) (both lobes and isthmus removed). I believe the lobectomy usually takes ~30 min., and TT takes longer (maybe 4 hr??). Usually requires 1-2 nights in the hospital (after surgery they keep you for 24 hr to make sure your Calcium levels are ok and that there are no complications/bleeding problems, and you need to rest for about a week but can return to work/normal activities after 1-2 weeks (depending on what you do). I was told I won't be able to lift anything more than 10 pounds for 4 weeks after the surgery.
I am not looking forward to the thyroid surgery, but from what I can find researching it, the biggest problem I will probably have is dealing with the scar until it heals, and adjusting to life with half a thyroid (or no thyroid at all) which will require some work and time in my case to determine the correct dosage of thyroid hormone to take. I am already experiencing hypothyroidism symptoms, so if I have a lobectomy I will probably require synthetic thyroid hormone, but if your thyroid functions fine some people do not need extra hormone after a lobectomy.
If it is cancer, follicular and papillary thyroid cancers use age at diagnosis to determine what stage the cancer is, if you are under 55 the maximum for these types of cancers is Stage II (2) according to American Cancer Society, even if it has already metastasized! The prognosis/rate of survival is excellent, especially at your age. If it is found to be cancer, the follow-up treatment will be removal of the entire thyroid (if you had a lobectomy) plus radioactive iodine treatment.
My newest anxiety is if I remove my whole thyroid (I have a choice of lobectomy or total thyroidectomy - I have lots of large, benign nodules on my "good" side and I have Hashimoto's which is an autoimmune disease that attacks the thyroid), I will be totally dependent on taking hormone for the rest of my life. My grandmother had her thyroid removed at age 47 and lived fine without it until she was 86, so I know it's doable, I just need to wrap my head around the idea. I know lots of people on this site also have had TT and have successfully managed their thyroid hormone levels.
I hope this helps - I know it is very scary to hear the words cancer and surgery. As I said, I am not looking forward to my surgery, but I am looking forward to being on the other side of not knowing if it is cancer - hopefully it is not cancer, and if it is, thyroid cancer is very treatable, but the only way to know for sure is to have the surgery. You definitely have the option of getting a second opinion if your doctor recommends surgery, and even a second biopsy if you don't want to have an unnecessary surgery if it is benign. In my case, Hurthle cell cancer is harder to treat with Radioactive Iodine if it metastasizes (compared to papillary or thyroid cancer), and the Afirma result of suspicious confirmed my pathologist's analysis, so getting it out before it becomes cancerous (if it's not already!) is an important concern of mine, and I've decided to go through with the surgery.
Good luck! I know I have gone through periods of extreme anxiety and then acceptance every time I move on to the next step with my thyroid nodules diagnosis - it's frustrating and scary to go through but I am luckily at a more calm and accepting stage right at this moment.
I'm so sorry you are going through this! I'm not an expert, but I am a 37 yo female in a similar position, just a couple weeks ahead of you with the suspicious diagnosis. I have a nodule that is "suspicious for Hurthle cell neoplasm" from biopsy result. (Hurthle cell thyroid cancer is considered a subdivision of follicular thyroid cancer, but is often harder to treat if it has spread and often occurs in older patients). They did genetic testing on mine (Afirma) and it is still suspicious so I am currently awaiting surgery for it (scheduled for June 21). I think my chances of it being cancer are slightly higher than a follicular neoplasm, but there is still a very good chance that it is benign (but good to get it out now, because it could turn in to cancer later on if I just leave it).
As soon as I heard the words surgery I panicked and got very anxious, especially about cancer - but now that I have had some time to process, I understand that there is a good chance it is not cancer, if it is cancer the sooner it is out the better, and thyroid cancer (even if it is Hurthle cell, which is harder to treat than papillary and follicular cancers) is very treatable in someone younger than 55. The only way to know for sure if it is cancer or not is to remove the whole nodule intact, which means a lobectomy (partial thyroid removal of one lobe) or total thyroidectomy (TT) (both lobes and isthmus removed). I believe the lobectomy usually takes ~30 min., and TT takes longer (maybe 4 hr??). Usually requires 1-2 nights in the hospital (after surgery they keep you for 24 hr to make sure your Calcium levels are ok and that there are no complications/bleeding problems, and you need to rest for about a week but can return to work/normal activities after 1-2 weeks (depending on what you do). I was told I won't be able to lift anything more than 10 pounds for 4 weeks after the surgery.
I am not looking forward to the thyroid surgery, but from what I can find researching it, the biggest problem I will probably have is dealing with the scar until it heals, and adjusting to life with half a thyroid (or no thyroid at all) which will require some work and time in my case to determine the correct dosage of thyroid hormone to take. I am already experiencing hypothyroidism symptoms, so if I have a lobectomy I will probably require synthetic thyroid hormone, but if your thyroid functions fine some people do not need extra hormone after a lobectomy.
If it is cancer, follicular and papillary thyroid cancers use age at diagnosis to determine what stage the cancer is, if you are under 55 the maximum for these types of cancers is Stage II (2) according to American Cancer Society, even if it has already metastasized! The prognosis/rate of survival is excellent, especially at your age. If it is found to be cancer, the follow-up treatment will be removal of the entire thyroid (if you had a lobectomy) plus radioactive iodine treatment.
My newest anxiety is if I remove my whole thyroid (I have a choice of lobectomy or total thyroidectomy - I have lots of large, benign nodules on my "good" side and I have Hashimoto's which is an autoimmune disease that attacks the thyroid), I will be totally dependent on taking hormone for the rest of my life. My grandmother had her thyroid removed at age 47 and lived fine without it until she was 86, so I know it's doable, I just need to wrap my head around the idea. I know lots of people on this site also have had TT and have successfully managed their thyroid hormone levels.
I hope this helps - I know it is very scary to hear the words cancer and surgery. As I said, I am not looking forward to my surgery, but I am looking forward to being on the other side of not knowing if it is cancer - hopefully it is not cancer, and if it is, thyroid cancer is very treatable, but the only way to know for sure is to have the surgery. You definitely have the option of getting a second opinion if your doctor recommends surgery, and even a second biopsy if you don't want to have an unnecessary surgery if it is benign. In my case, Hurthle cell cancer is harder to treat with Radioactive Iodine if it metastasizes (compared to papillary or thyroid cancer), and the Afirma result of suspicious confirmed my pathologist's analysis, so getting it out before it becomes cancerous (if it's not already!) is an important concern of mine, and I've decided to go through with the surgery.
Good luck! I know I have gone through periods of extreme anxiety and then acceptance every time I move on to the next step with my thyroid nodules diagnosis - it's frustrating and scary to go through but I am luckily at a more calm and accepting stage right at this moment.
thank you how large is your nodule?
Hi bird100
Sorry I didn't answer you sooner!
My suspicious nodule is 1.3 cm, hypoechoic on ultrasound, suspicious for Hurthle cell neoplasm.
I also have a vascular, isoechoic nodule that is 2.8cm but was benign, so larger size does not mean it is cancer!
I can't remember what I wrote before, but I just had my pre-op appointment today with my ENT. It is impossible to tell whether the suspicious cells are cancer or not without removing the suspicious nodule. That does not mean that the nodule is cancerous, even with the Afirma test saying ~50% risk. In my case Hurthle cell neoplasm show up as suspicious 60-70% of the time on Afirma, but only 16-20% of those that are suspicious are actually cancer. But... if left untreated I believe the Hurthle cell adenoma could become cancerous, so removing it is a good idea in my situation.
I am only having a thyroid lobectomy (one lobe removed), which seems to have a pretty fast recovery time, and would not require an overnight hospital stay, just a couple hours of observation after the surgery.
My doctor basically said that if I do have cancer I shouldn't worry because it's thyroid cancer and easily treatable... I'm not sure how much stock I put in that because Hurthle cell cancer is actually quite hard to treat compared to papillary/follicular, but Hurthle cell cancer is not very common at all, especially in someone my age (37).
Things to keep in mind - is it cancer, has it spread to lymph nodes in neck, has it metastasized throughout the body? With follicular thyroid cancer, the main course of treatment is to 1.) remove the thyroid/lobe to determine if it is cancer. If it is then 2.) remove the entire thyroid. 3.) remove any swollen lymph nodes in the neck and determine if they contain cancerous cells. 4.) Do a radioactive iodine scan of the neck/body to determine if cells have spread, and 5.) treat with radioactive iodine to kill off cells that have metastasized.
While this list does sound a little scary, you would only move forward with each treatment IF it is cancer, and IF the doctors determine it has spread. The good news is it is treatable and while radioactive iodine sounds scary, it has much lower side effects than traditional chemotherapies for other cancers.
I think the hardest part of where I am right now is trying to balance the fact that my nodule is probably not cancer with keeping in mind that it could be and I still need to be prepared for what comes next with dealing with it.
I hope you are feeling less anxious now - sorry I took so long to respond. I go through periods of extreme anxiety about the whole thing then flip to complacency because there's nothing I can do about it right now and it is what it is, and I'm getting treatment for it. I find the more info I know, the better I feel about things (but probably because this is a thyroid problem and thyroid cancer is very often treatable with very good prognosis, especially in people our age range).
Sorry I didn't answer you sooner!
My suspicious nodule is 1.3 cm, hypoechoic on ultrasound, suspicious for Hurthle cell neoplasm.
I also have a vascular, isoechoic nodule that is 2.8cm but was benign, so larger size does not mean it is cancer!
I can't remember what I wrote before, but I just had my pre-op appointment today with my ENT. It is impossible to tell whether the suspicious cells are cancer or not without removing the suspicious nodule. That does not mean that the nodule is cancerous, even with the Afirma test saying ~50% risk. In my case Hurthle cell neoplasm show up as suspicious 60-70% of the time on Afirma, but only 16-20% of those that are suspicious are actually cancer. But... if left untreated I believe the Hurthle cell adenoma could become cancerous, so removing it is a good idea in my situation.
I am only having a thyroid lobectomy (one lobe removed), which seems to have a pretty fast recovery time, and would not require an overnight hospital stay, just a couple hours of observation after the surgery.
My doctor basically said that if I do have cancer I shouldn't worry because it's thyroid cancer and easily treatable... I'm not sure how much stock I put in that because Hurthle cell cancer is actually quite hard to treat compared to papillary/follicular, but Hurthle cell cancer is not very common at all, especially in someone my age (37).
Things to keep in mind - is it cancer, has it spread to lymph nodes in neck, has it metastasized throughout the body? With follicular thyroid cancer, the main course of treatment is to 1.) remove the thyroid/lobe to determine if it is cancer. If it is then 2.) remove the entire thyroid. 3.) remove any swollen lymph nodes in the neck and determine if they contain cancerous cells. 4.) Do a radioactive iodine scan of the neck/body to determine if cells have spread, and 5.) treat with radioactive iodine to kill off cells that have metastasized.
While this list does sound a little scary, you would only move forward with each treatment IF it is cancer, and IF the doctors determine it has spread. The good news is it is treatable and while radioactive iodine sounds scary, it has much lower side effects than traditional chemotherapies for other cancers.
I think the hardest part of where I am right now is trying to balance the fact that my nodule is probably not cancer with keeping in mind that it could be and I still need to be prepared for what comes next with dealing with it.
I hope you are feeling less anxious now - sorry I took so long to respond. I go through periods of extreme anxiety about the whole thing then flip to complacency because there's nothing I can do about it right now and it is what it is, and I'm getting treatment for it. I find the more info I know, the better I feel about things (but probably because this is a thyroid problem and thyroid cancer is very often treatable with very good prognosis, especially in people our age range).
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