Confused!!!! Nodule Malignant?

[kjn4evr]

Hi.  I'm confused about whether the dr should do right lobe thyroidectomy or total thyroidectomy.  

My thyroid ultrasound results were:  In right thyroid lobe, there is an ill-defined, somewhat heterogeneous nodular density measuring approximately 1.2 x 1.5 x 1.6 cm; solid, although is has hypoechoic and hyperechoic features and part appears fairly well-circumscribed

My FNA results are:  

Atypical follicular cells of uncertain significance; relatively hypocellular with scant atypical but poorly preserved follicular cells, occasional microfollicles, scant Hurthle cells, macrophages, stromal fragments, bare nuclei, skeletal muscle fibers and scant fibroadipose tissue in a background with some thin colloid and ultrasound gel.  Suboptimal preservation precludes evaluation of fine nuclear details;

Cell block shows only 2 minute fragments of stroma containing rare small clusters of degenerated follicular cells and a few microfollicles; a neoplastic process cannot be excluded

I am already hypothyroid and would really rather have a total thyroidectomy than just having the right lobe removed.  

Based on the information I gave here, can anyone make any comments, suggestions, etc.  Possible malignant nodule?

Thanks so much for your help!!!!

[tataylor]

I had a partial on April 8, 2011 which they took my right one out.  The doctor said it was not cancer from the frozen biopsy, but when I got the full pathology report back it was milignant.  He said he did not see anything on my left thyroid with the ultrasound.  I then got a second opinion at MD Anderson Cancer Center in May 2011 and with ultra sounds and FNA they found precaner cells on a small mass that was on my left thyroid - which the original surgeon said just 4 weeks proir that there was no mass or any findings with the ultrasound of my left thyroid.  My endocrine specialist at MDA scheduled another surgery for July 20 to remove my left thyroid and and on Aug 29, 2011 I had my first dose of radioactive iodine. I've been taking 175 mg of Synthroid and haven't had  to many problems up until May of 2012 at my check up.  They found a nodule growning on my thyroglossal duct measuring 0.9x0.8x0.6cm.  I am about to start another taking radioactive iodine on October 10-12.  I hope this information helps - wish me luck!!!

[RodeoQueen]

ME the FNA means NOTHING! I have cacner and might have 2 kinds! FORGET ANY More FAN get the whole thing out. As UTahmomma said surgery 2 times really isnot waht we want but noe I have to do she already has. DO NOT mess with it get it all out. I have a right lobectomy nad a partial lobectomy to leave a little left so I might not have to take synthroid. NOT Gotta take that and have a another surgery. GOTTA LOVE IT!  Forget the IF!! Get it all out and go from there!!!  GOOD luck!!! I am so not a fan of tha FNA AT ALL!!!!

Rodeo Queen

[kjn4evr]

I talked to a surgeon, however, I have contacted the doctor (Dr Durkin) who did my tonsillectomy back in 2005.  The surgery is scheduled for next Thursday, however, I faxed all my endocrinologist's notes, ultrasound & FNA results to Dr Durkin yesterday afternoon.

The surgeon (Dr Mittal) who is the one scheduled to do my surgery says this :  Go in and take the right side out, biopsy frozen section while I'm under and if it's malignant, he'll take the thyroid out.  He said if they can't tell if it's malignant or benign, they will biopsy the permanent section and if that shows malignancy, then he would go back in and take the left side out.

I am hoping that Dr Durkin will agree with me and do a TT to begin with.  If not, I'll keep searching for a surgeon who will do a TT.  I do not want to have one side taken out and then have to have a second surgery to take out the other side.

Hope you have a great day!!!

[utahmomma]

Okay - in cancer terms "atypical" means that the cells are undergoing changes that, while they may not be malignant yet, they will turn malignant.  It's also called "precancer" (had a daughter and sister with this diagnosis).  The "rare small clusters of degenerated follicular cells" and the fact that a "neoplastic process cannot be excluded" are also poor signs.

There's not 100% diagnosis of cancer but there are some clear warning signs.

*IF* you do decide to go ahead with surgery, consider getting the entire thing out.  Trust me, not much fun having to have the surgery twice (Rodeo Queen can attest to this one too).   As many of us will tell you - "if in doubt, get it out".

What does your doctor say?

Utahmomma
papillary carcinoma '03
recurrence and RAI '06 and possibly '08
three sisters with papillary carcinoma; one with atypical (precancer) and daughter with atypical