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Thyroid (Expert Forum)
1/2 thyroidect -2 nodes benign (were FNA atypical follicular) Papp. Carcinoma ?
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).
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1/2 thyroidect -2 nodes benign (were FNA atypical follicular) Papp. Carcinoma ?
by ChitChatNIne, Jan 15, 2007 12:00AM
Prelim and Final Biopsy report show nodules are not cancer but they found two very small areas (I *think* the surgeon said the smaller one is 1mm and I know he said the other one is 4mm) of Eencapsulated papillary carcinoma or microcarnicoma that was found at final biopsy on the GLAND (not in the two nodules). and that I shouldn't be too too concerned as many people have these all the time and never know it and that it is found 30% of the time on autopsies in people who die from other causes.
He said "I wouldn't race out to have the other side of the thyroid removed" but we will talk more on Monday when you get out your stitches. He even cont'd to say on the phone that "I'm not even sure I'd say you have Thyroid Cancer" ? This confuses me, but maybe he didn't want me to get upset over the weekend after hearing the two main nodules were benign, etc?
I still have a 2mm nodule (hypoechic but too small for FNA) on the remaining left lobe. All labs before surgery were normal. Orig. 1.7cm nodule found on routine exam - .5cm other one. Healthy 47yr old with gallstones/kidneystones
He called the add'l finding on the biopsy report a "caveat" .. not sure if that is a technical term or his words. I will get a copy of the biopsy/surgical report & get some more opinions. He is an ENT noted for excellence in thyroid surgery along with the med. ctr. pathology dept .. both in Top Dr's Magazine.
How would you persue the health/pro-activeness of the other lobe? Should I ask for tests? Which ones? Would they have taken other 1/2 out if found on prelim you think?
He said "I wouldn't race out to have the other side of the thyroid removed" but we will talk more on Monday when you get out your stitches. He even cont'd to say on the phone that "I'm not even sure I'd say you have Thyroid Cancer" ? This confuses me, but maybe he didn't want me to get upset over the weekend after hearing the two main nodules were benign, etc?
I still have a 2mm nodule (hypoechic but too small for FNA) on the remaining left lobe. All labs before surgery were normal. Orig. 1.7cm nodule found on routine exam - .5cm other one. Healthy 47yr old with gallstones/kidneystones
He called the add'l finding on the biopsy report a "caveat" .. not sure if that is a technical term or his words. I will get a copy of the biopsy/surgical report & get some more opinions. He is an ENT noted for excellence in thyroid surgery along with the med. ctr. pathology dept .. both in Top Dr's Magazine.
How would you persue the health/pro-activeness of the other lobe? Should I ask for tests? Which ones? Would they have taken other 1/2 out if found on prelim you think?
Doctor's Answer
by Mark Lupo, M.D., Jan 28, 2007 12:00AM
, Jan 28, 2007 12:00AM
Tough case -- the current consensus on this is to do take out the other lobe and do RAI -- sounds aggressive, but some studies on the molecular genetics of these multifocal tumors suggest that any remaining thyroid tissue is at risk for developing or already harboring a cancer.
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I have an appt scheduled for Monday with my Endocronologist. More of an "emotional" mtg. vs. emmergent medical meeting.
Are there specialists who are Oncology Endo's out there or is an Endo ok who specializes in thyroids. I will also meet with my Primary Dr. and get 1 or 2 other opinions as my ins. allows me as many opinions as I want as long as in my plan (lucky) so I will go into NY City, too, until I am feeling comfortable with my diagnosis and treatment plan :) .. I guess I want to be certain most concur with the future treatment and options.
BTW, is Columbia Thyroid Center a good starting place in the City? My Urologist is a heavy hitter out of Columbia. I may ask him for a name or two ?
~~~~~~~~~~~~~~~~~
Here are the 4 lines from the biopsy report in order:
Specimen: Rt. Thyroid Lobe & Isthmus
DIAGNOSIS:
1. Two papillary microcarcinomas measuring 0.5mm, and 4mm., without extracapsular extension
2. No lymphatic invasion is identified.
3. Two adenomatous nodules are pesent
4. Margins are free of tumors
Also, last ? .. do you routinely see this kind of finding on a biopsy report (nodules clean yet pap shows up on the gland?).
I guess my major concern is the other lobe and if there are any cells in that lobe .... the other nodule is only 2mm but proof is in the pudding that size means nothing to me anymore .. actually, I am sick of stat's %'s too .... they are a comfort zone when Dr's speak with you .. I have reminded myself over and over that stats come from someplace and *somebody* is the bearer of the bad news ..you just *hope* the odds are with you.
Cheryl