Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Thyroid (Expert Forum)
Large Probably benign Thyroid Nodule Surgey Suggested
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
 |
Large Probably benign Thyroid Nodule Surgey Suggested
by JerseyGirl88, Oct 27, 2006 12:00AM
Hello, I am a 35 year old femal recently diagnosed with a large 4cm length / 2.8cm trans /2.6cm AP complex nodule on my left lobe, right lobe looks normal on ultrasound. The mass was palpable on a routine exam. Results of the FNA as follows:
Microscopic Description: The aspirate is of adequate cellularity. Most of the diagnostic material is on the Diff Quik stained slides. There is abundant watery colloid in the background along with some foam cells. Multiple, loosely cohesive groups of follicular cells arranged in two dimensional sheets are present. Some of these have abundant, slightly granular cytoplasm suggesting early Hurthle cell change. Cytologic features of malignancy are not seen.
The ENT surgeon would like to remove the left lobe anyway and do a frozen section in the OR to determine if all should come out, siting the chance the FNA missed "the spot" and there is still a possibility of malignancy especially since the mass is so large.
My question is does this sound reasonable and should I just go for it, or should I seek the advice and services of an endo prior to surgery. Even if I do the surgery, will I need an endo to follow up with? I know that if the entire thyroid needs to be removed that will mean life long meds, but with half are chances good that I will not need medication? My current thyroid labs are:TSH=1.703(lab scale .35-5.5) T4=10 (4.5-12) T3Uptake=24 (24-39)Free Thyroxine=2.4 (1.2-4.9) Thanks for any advice and insight,I am wondering how long this has been growing since I am pretty sure my neck is palpated every year at my annual exam.
Microscopic Description: The aspirate is of adequate cellularity. Most of the diagnostic material is on the Diff Quik stained slides. There is abundant watery colloid in the background along with some foam cells. Multiple, loosely cohesive groups of follicular cells arranged in two dimensional sheets are present. Some of these have abundant, slightly granular cytoplasm suggesting early Hurthle cell change. Cytologic features of malignancy are not seen.
The ENT surgeon would like to remove the left lobe anyway and do a frozen section in the OR to determine if all should come out, siting the chance the FNA missed "the spot" and there is still a possibility of malignancy especially since the mass is so large.
My question is does this sound reasonable and should I just go for it, or should I seek the advice and services of an endo prior to surgery. Even if I do the surgery, will I need an endo to follow up with? I know that if the entire thyroid needs to be removed that will mean life long meds, but with half are chances good that I will not need medication? My current thyroid labs are:TSH=1.703(lab scale .35-5.5) T4=10 (4.5-12) T3Uptake=24 (24-39)Free Thyroxine=2.4 (1.2-4.9) Thanks for any advice and insight,I am wondering how long this has been growing since I am pretty sure my neck is palpated every year at my annual exam.
Doctor's Answer
by Mark Lupo, M.D., Oct 29, 2006 12:00AM
, Oct 29, 2006 12:00AM
I would see a thyroid specialist (endo). The mass is large, however Hurthle changes are not necessarily suspicious (many mis-understand this). Would check thyroid antibodies as Hashimotos can cause similar FNA pattern.
If the mass is bothering you (ie tightness, hoarseness, trouble swallowing), then surgery makes sense.
Frozen section is sometimes helpful to make a decision.
Most of these are benign, and doing surgery b/c the FNA may have "missed the spot" is not usually recommended. Instead, consider repeat FNA (as two negatives are sometimes better than one) and observe.
If the mass is bothering you (ie tightness, hoarseness, trouble swallowing), then surgery makes sense.
Frozen section is sometimes helpful to make a decision.
Most of these are benign, and doing surgery b/c the FNA may have "missed the spot" is not usually recommended. Instead, consider repeat FNA (as two negatives are sometimes better than one) and observe.
Expert Activity
Related Expert Forums
Related Communities
Dry Skin
Pregnancy
Stomach Ach
TSH
antibodies
bowel
calcium
fatigue
goiter
hyperparathyroidism
hyperthyroid
hyperthyroidism
hypothyroid
hypothyroidism
irritable
medication
nodule
pain
parathyroid
redness
stomach ache
surgery
synthroid
thyroid
thyroidectomy
thyroiditis
treatment
tsh level
ultrasound
weight
Communities
Ask a Doctor Forums
Tools and Applications
Personal Information
Medical Information
Doctors and Partners
Total vs lobectomy is a tough decision -- usually based on presence of nodules on other lobe, suspicion for cancer and patient preference. If trying to avoid meds long-term, it may work well (unless your antibodies are positive).