removal of thyroid

[sha170]

Dear Dr.,my name is sharif and i have had goiter problem in left side, since mid 90, this runs in my family.I have had biopsy 3 times.last one on 2/10/11. the following are pathology report: "the findings are those of Atypia of undetermined significance(bethesda system).Findings of nuclear overlap,nuclear grooves, and open homogenous choromatin are features suggestive of papillary carcinoma.The lesion lacks distict papillary architecture, intranuclear inclusions, and firm cytoplasm often noterd with papillary carcinoma. reapeat aspiration in 3 months or sergical excision is suggested." My physician thinks we should not wait and remove it and follow it with radiated I-131.my TSH result is 1.21(range:0.35 to 4.94 ). I just read an article in cancer journal of clinician, suggesting sodium iodide I-123 scan.
I am not a Physician, so I am really confused of what to do? . What is your oponion?,I live in Stat college,pa and i can't find a Thyroid specialist(Endo...). I have called my physician about the scan and waiting for his answer. But I would like to get as many recomendation as possible before jumping to surgical removal. I am in good physical shape with sligthly elevated glucose(105) in the last blood work on 1/24/2011. I am not taking any medication. Your assistance in this matter is greatly appriciated. Please let me know if you need any additional information  thank you

[ThyroidHunter]

A general physician, which you may have already, can help treat, order biopsy, and push through appointments with specialist's and surgeons. I do not use a endo regularly, although I know 2 well, even personally. I know the facts, and I know my body. That's enough for a GP to handle almost all my medical needs.

The "timeliness" of appointments these days is an issue that many on this Board are very concerned with, and that many requests for help are made about - every day. I know this for a fact through our Foundation work, but it is worldwide in it's scope. You may have to drive a bit, but don't wait any longer for biopsy. Also - go in to docs appointments now with a written "list", just like a grocery list. Get the questions on the list answered, and the symptoms treated - & don't leave until you do. It's your health, fight for it!

Thanks so much for the kind words, my best to you in health

[sha170]

Dear ThyroidHunter,
Thank god for people like you who dedicate their time to help others in crisis.Not only your response was helpful it is also comforting at the time of my confusion.As you recomended I should find an Endo to explore my condition further.Unfortunately with new system of health care on these days The physicians are very so busy that they see you for 15 minutes max to disscuss your condition and option. I even called them back and spoke to a nurse to leave a note with my physician to be reffered to an endo., but two bussiness day passed and i didnot recieve any call yet. I do not blame my physician(he is a good man and i believe he had the same concern as you mentioned, even the surgeon that he reffered me to which is in his group gave me a appoitment for 30 days later which makes me wonder how urgent it is). I am going to call the 2 endo that we have available in this town(state college,pa) to see if I can get appoitment. Again please accept my appriciation and I hope someday I'll be able to help others as you do. I even tried to get in touch with barb135 or goolara, but I am new with this system and having some difficulty, I will try try again.Thank you and God bless you and people like you.My best wishes to you........sha170

[ThyroidHunter]

You're very welcome for the response, let's just hope it was useful!

I am not as familiar with the sodium 123 scan as many on this board are. My only feelings are until confirmation (or atypical, or inconclusive) results are returned from a biopsy. You should be prepared for surgery - not necessarily Iodine radiation. They are 2 different ballparks.

Also, I am reading the whole report, as a total picture. Atypia of undetermined signifigance,in my opinion, reads as an order for a biopsy. I am more concerned with the sentence "Findings of nuclear Nuclear ventriculography overlap, and open homogenous choromatin are features suggestive of papillary carcinoma." This is a strong statement the radiologist believes the possiblility of cancer must be explored aggressively.

Let's get a biopsy, and if it's negative, you've got plenty of time then to study your options on further treatment, especially because you have little to no symptoms.

[sha170]

Thank you for your response,
How abot the sodiom I-123 scan? AsI read in the Cancer Journal for clinician, thare is a 20% chance of cancer when the findings are Atypia of Undetermined Significance?do you have any input on that?again thank you for response and caring answer

[ThyroidHunter]

I agree strongly that a total thyroidectomy is in order. Anytime a radiological report suggest the architecture of papillary carcinoma, it's time to get the gland removed ASAP. You may only want to delay to have a fine needle biopsy done, but even those can be fooled if the cancer is still in the microscopic stage - as this very well may be.

I would strongly suggest you research a great deal about post operative radiation. Thyroid carcinoma's are the easier cancer to treat and overcome, you only need monitor by radiological means twice a year to make sure there is no new gland and/or carcinoma growth. However, there is a great deal of clinical and patient argument regarding iodine uptake with both 131 and 132, so you need to see MORE than 1 endo, and do some research on your own before you allow this procedure.

If you are not taking and meds, you have few to no symptoms. Can I suggest you begin a strong vitamin program which includes Vitamins A, B6, C, E, and Zinc? These will benefit your autoimmune and metabolic systems regardless of the manner of treatment(s) you decide on.

Reach out ot Board Members Barb135, and goolara to name a couple for additional opinions. Stay strong, as you can overcome this, especially if you keep doing the research you're doing now.

The Best in Health.