Why am I being strongle\y advised to have a TT?

[catlady55]

This is a LONG question...I am a 53 year old woman with no symptoms, no family history, no radiation exposure, etc. My GP found the nodule in June during my exam. I've done blood work (OK), an ultrasound and a FNB (Right side "heterogeneous w/ no discrete mass") but left side has a 1.74 x 1.6 nodule. The ultrasound said that "flow is identified w/in the nodule" (I don't know what that means) and that it's "a follicular lesion, favor neoplastic; diagnosis included adenoma vs carcenoma as well as follicular varient of papillary carcinoma".  The surgeon said (I'm scheduled for 9/25/08) said he prefers to remove the whole thyroid. The new Endo (I didn't need one before) said remove the whole thing. too.  She said it's easier to treat me if it's malignant and the entire thyroid is removed, The surgeon said that  my pathology report was pretty "vanilla". He also said that the frozen section during the surgery are usually inconclusve, too. He said the only accurate benign vs malignant results are a few days after the surgery, but by then, the whole thyroid is history and they both said "you'll just take medication for the reist of your life". So I guess this is my question: I know the left lobe goes, I tell the surgeon that I want to keep the right lobe. The nodule turns out to be maignant.  What happens then? I go back  in IMMEDIATELY even thought the right lobe has no nodules, or we monitor my thyroid and if in a few yeras something pops up, I have it removed? I'm sort of stunned that there isn't a way to accurately biopsy a nodule before or during the proceedure, but that seems to be the case. Hate to lose a perfectly good right lobe, because "it's easier" for the docs. I'd love to hear if anyone is out there with my FNB results and what you're doing. I'd hate to become a crying, raving (overweight) lunatic  on thyroid medication. I feel good now and "fixing" my problem may end up scewing me up permanently. Like I said, LONG question.

[Mark Lupo, M.D.]

frozen is unreliable for these types of nodules

20% of these are cancer -- only determined on permanent section.

If there are nodules on the other side, then about 50=60% are totals; if not, I would think only 20-30% are totals, but have not seen good data on these practice patterns.

[Mark Lupo, M.D.]

This is a problem for all of us -- the indeterminate nodule -- 15-20% of these are cancer and the only way to know for certain is removal of that side of the thyroid.  If it is cancer, then the patient goes back for a completion thyroid removal.  If the other lobe is normal, then I usually recommend removing half with the warning that if it is cancer, that means more surgery.  Patient preference is very important and should be considered in these cases.

I would have the FNA slides sent for another opinion -- eg Hopkins, Mayo, U Penn (Dr. Baloch), U Florida (Dr. Massoll) to make certain it is indeterminate -- sometimes they will call it benign.  Increased flow (blood flow) was thought to be an increased risk factor in nodules but a current ongoing study is suggesting that it may not be.

[catlady55]

Dr. Lupo:
Disregard my 8/18 post. I was given misinformation about the biopsy slides. The lab stores them for a year. They're on their way to Dr Massoll @ Shands.
On another note: where can I go for some statistical info? Like what percentage of frozen sections during surgery show (A) definitive cancer (B) benign growth and (C) still uncertain.
What percentage of surgeries are Total vs partials? Of the partials, how many are determined to be cancer after the other pathology report?
I'm not a betting person but I'd like to know the statistical odds.
Thanks

[catlady55]

From Catlady55
To: Dr  Lupo: I was going to send my slides to to Gainesville, but I found out on Friday that they've alreay been destroyed (less than a month from the FNB)? I spoke w/ Dr. Massoll's office and they thought that was odd. I'm going to call my insurance company today and see about having a second FNB done. May even go to Dr. Massoll for it if I can work it out.
I'm not too worried about the actual surgery, it's the thyroid medication that really concerns me. What percentage of your TT patients actually do well on medication? I know the internet is filled w/ those who don't.
BTW....Good luck w/ TS Faye. I'm up in the middle of the state, myself.

[898]

If the nodule has well defined borders, the cancer most likely was contained in the nodule without spreading to the different lobe.

[mjane]

Oh, I'm sorry you are going through this!  Not knowing what decision to make is the hardest ever!  I had a similar case 4/07.  FNB showed a "suspicious" nodule in the left lobe.  But both surgeon and endo said to remove the whole thing.  I had the surgery and the bx showed disease in both lobes and papillary cancer throughout.  I had RAI 9/07.  The surgery was not too difficult and after a couple weeks of adjustment, I haven't had any difficulty with thyroid meds.  Best to you.   Let us know what you decide.

"I have placed the Lord ever before me.  Because He is at my right hand, I will not be shaken."  Psalm 16:8