Can you help me understand this FNA report?

[LADYBUG1979]

I noticed a lump on one side of my thyroid in March.  I have had an ultrasound that showed 1 single nodule about 1 cm in size.  I also had an FNA done.  Here is what my report states:
"Impression:  Moderatley cellular specimen with groups of follicular cells with focal microfollicle formation and focal Hurthle cell change background of scant colloid.  SEE COMMENT:  The specimen shows groups of follicular cells with focal microfollicle formation.  The follicular cells have predominantly round nuclei with focal Hurthle cell change and rare grooves.  No cytologic features of papillary carcinoma are seen.  In the background there is a scant amount of colloid.  Overall, the features are consistent with follicular lesion (hyperplastic versus neoplastic)."
Ok, so that's the report.  My ENT told me that my report was "abnormal".  I have my Uptake and Scan next week.  The only feedback I am given is that with each test the docs "suspicion" is increased.  Any feedback would be appreciated.  I feel a little lost and not sure what I should prepare myself for.  I am a 30 year old female with hypertension and have also been on Synthoid for 2 months for a diagnois of under active thyroid but are not on the meds now because of the uptake scan.  I noticed the nodule myself, I have horseness and feel like I have something stuck in my throat.  I also have a little discomfort.  Thank you.  

[Mark Lupo, M.D.]

The RAI scan (as predicted) is nondiagnostic and not helpful.
Would look at thyroid antibodies -- I would predict TPO is positive.
A hyperechoic (bright) nodule in Hashimoto's is almost always benign.

[LADYBUG1979]

Ok, the short version of what tests and results I have had so far.  

Ultrasound states:  Solitary, solid, hypervascular, hyperechoic nodule, with hypoechoic rim, along the posterior central aspect of the right lobe: percutaneous fine needle aspiration is recommended.   Nodule measures 1.3 x 1.1 x 1.0 cm
My doc said this is "suspicious".

FNA states: The specimen shows groups of follicular cells with focal microfollicle formation.  The follicular cells have predominantly round nuclei with focal Hurthle cell change and rare grooves.  No cytologic features of papillary carcinoma are seen.  In the background there is a scant amount of colloid.  Overall, the features are consistent with follicular lesion (hyperplastic versus neoplastic)."
So, my doc said this is "suspicious".

RAI States:  The right thyroid gland is larger compared to left lobe, but the thyroid gland does not extend below the sternal notch marker.  No distinct hot or cold nodule is seen.  A hyperechoic nodule seen at the posterior aspect of the right lobe of the thyroid on an ultrasound study, may be ovscured by overlying thyroid tissue on the nuclear med study.  The iodine uptake is 38% (normal 7-30%)  Mildly elevated uptake.  Clinical and lab correlation is recommended.  
Opinion:  Normal Exam
Report revised:  The last line in the dictation, Opinion: Normal exam; should be deleted from the report.

Ok, so I'm confused about the RAI test.  Is it normal or not?  My doc said it was but he did not have the page that stated to delete Normal exam from report.  So not sure what that means.   Right now he has me on 75 mcg of  Levoxyl.  He wants to shrink the nodule with the meds.  But said this could take 6 months or more.  He also said I have a 15% chance the nodule is cancerous.  Just wanted to know what your take is on this.  

Thank you for having this forum.  It really does help.

[Mark Lupo, M.D.]

Would have the slides sent to a thyroid pathology expert -- such as Dr. Massoll at U Florida or Dr Baloch at U Penn.  The uptake and scan is not likely to add anything to the evaluation with this history.  Would test thyroid antibodies, as the changes seen on FNA may be due to Hashimoto's.  A true "follicular lesion" (aka "suspicious for follicular neoplasm") carries a 15-20% risk of cancer and often needs to be removed to make a definite diagnosis.