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Does My Thyroid FNA Sound Worisome? Some Hurthle Cells Found

mhc4165
Posts: 46
Joined: Dec 2008

Hi I'm new on here,

On June 24th I had an FNA of 3 very small thyroid nodules that were found by accident In the Fall of 2006 when I was 41 and a half, because I have a very slow metabolism and my thyroid blood tests have always been normal and I gained weight for the first time at age 34 and had to go on a diet for the first time in my life. So I asked my internist for a prescription for a thyroid ultrasound.

The sizes of my nodules are one on the right lobe, 0.5 x 0.7x 0.7 cm on the left lobe,1.3 x 1.3 x 4.5 cm and on my isthmus a 0.3 x 0.6 x 0.7 cm, biopsied by a very good endocrinologist with a good reputation, Dr.Anthony Jennings and the first pathologist at Quest Diagnostics described them as unremarkable follicular cells with colloid and are diagnosed as colloid nodules. She didn't even mention I had any Hurthle cells. I have normal TSH and all other thyroid blood tests. Dr.Jennings also biopsied my largest 1 cm predominately solid nodule twice that day because first fluid came out.

I also asked my endo to please send my report and slides from Quest Diagnostics to a top thyroid pathologist that Dr.Mandel uses Dr.Zubair Baloch at University of Penn for a second opinion.

Dr.Baloch says in his report of my nodules, that in his opinion based on cytomorphology he will favor a diagnosis of hyperplastic/adenomatoid nodule for both specimens. He says interestingly the specimen from the right thyroid nodule shows oncocytic cells and few lymphocytes percolating among the follicuar groups suggesting an element of chronic lymphocytic thryoiditis. He says he does recommend clinical follow up and repeat FNA if there is an increase in the size of any of these nodules.

He says in summary then, my diagnoses are :1. Thyroid, right lobe nodule (size not indicated) FNA:Hyperplastic/adenomatoid nodule with oncocytic change. Focal chronic lymphocytic thryoiditis. 2. Thyroid left lobe (size not indicated) FNA: Hyperplastic/adenomatoid nodule.

Dr.Baloch called me and he said when I told him my concerns about the Hurthle cells ,he said I don't have a lot of them ( my endo said only when there is sheets of them can they be cancer) ,and that he could have Hurthle cells , children could have Hurthle cells in their thyroids and that it's not abnormal only when there is a large amount. But because my nodules are so small, isn't possible that the needle missed more of the Hurthle cells ( and other cancer cells!) present?

Also how accuarate are thyroid FNA's especially when my other 2 nodules are pretty small? My endo used ultrasound guided FNA though. Also I had asked Dr.Jennings when he looked at my ultrasound report if any of my nodules are taller than wide because the other endo at University of Penn Hospital Dr.Kolin Hoff kept insisting this feature as suspicious for thyroid cancer is outdated, and Dr.Jennings pointed to 1 of my nodules on his computer screen and said this one is slightly taller than wide does this count as suspicious then?

And none of my 3 nodules has a halo around them ,and one of my small nodules is on my isthmus and is hypoechoic and my largest nodule is predominately solid and isoechoic the other two are mixed but more cystic than solid.

I have the excellent report by the AACE, Task Force On Thyroid Nodules and they mention that nodules that are taller than wider, hypoechoic and have an absent halo are ultrasound features that are commonly found with thyroid cancer and I have these features and this still concerns me. My former endo at The University of Pennsylvania Hospital sent me a letter telling me my nodules were read as officially non-suspicious.

Two radiologists from the university of Maryland,Dr. Fauzia Vandermeer, and Jade Wong-You-Cheong wrote in an excellent article called,Thyroid Nodules:When To Biopsy? in Applied Radiology Journal online March 2007, that although with 80% of thyroid cancers the halo is absent ,it may also be absent in more than 50% of benign nodules. So I was wondering since I have some of these ultrasound features can a benign biopsy result of all 3 of my really small nodules, be truly accurate anyway? I don't have any calification and not a lot of blood flow. And I know that as The American Cancer Society writes in their report on thyroid cancer,most benign and cancerous nodules look the same on ultrasound and they said thats why you can't tell by ultrasound alone if they are benign or cancer. And I also know that the benign and cancerous nodules can have features of each other.

My father who is 75 recently found out he has four small thyroid nodules some on each lobe and he had X-Ray therapy to treat acne as a teenager. He had a biopsy on just one of his small nodules in January and it came back a benign colloid nodule. One of my father's sister's daughter's at age 41 nine years ago had a thyroid nodule found by accident on an MRI she had because of head aches she was getting from a diet pill she was taking to lose weight after her second daughter was born. She had no thyroid conditions and her nodule was cold on a scan, she had an inconclusive biopsy and then half her thyroid removed and it was benign!

I know that benign thyroid nodules can run in families but so can papillary thyroid cancer sometimes, so if my father's biopsy of his nodule is inaccurate or if it was accurate but his other nodules he didn't have biopsied are cancer, it would increase my chances and likelihood of having it too. And is it true that starting at age 45 thyroid cancer isn't as treatable? I'll be 44 in April and I'm concerned since most thyroid cancers grow so slowly that I'll be older than 45 by the time I'm diagnosed.

I have spoken with 5 thyroid cancer survivors, and had emails back from about 5 and I communicated with survivors on thyroid health boards and many of them were older than me when they were diagnosed and are OK now but everyone is different and thats what worries me. I didn't want to wait until I was 45 or 50 to have a biopsy and my nodules if they are cancer could stay this same size for the next 5 or 8 years and then I would be stage 2 !

I would really appreciate your reply.

Thank You.

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mhc4165
Posts: 46
Joined: Dec 2008

Also I had spoken in May with university of Maryland radiologist Dr.Jade Wong-You-Cheong and when I told her that my endo at Unniversity of Penn hospital kept insisting that a taller than wide shape of thyroid nodules is suspicious, she said she thinks it still holds true. And she mentioned that there was a recent study about it in the online journal Radiology.

I asked her was it from Korea because I found a recent study about this too on an online radiology journal and she yes and she said it was by a Dr.Moon. So after I spoke with her I looked it up again on google and sure enough it was the same study I had found and was by a Dr. Moon!

mhc4165
Posts: 46
Joined: Dec 2008

I came on here and posted this question back in December and I hadn't checked back here until recently and I'm really disapointed and let down that *nobody* replied!

I just had a year follow up thyroid ultrasound and 2 of my smallest nodules out of my 3 did grow about 2mm. Does anybody know if this is considered a significant increase in six and should I be concerned?

Many benign thyroid thyroid nodules do grow slowly over time and recent research found that many small papillary thyroid cancers didn't grow in 8 years! So growth or no growth isn't really that helpful of a sign.

If someone who knows about this would respond I would really appreciate it.

Thank You.

usljh10
Posts: 85
Joined: Apr 2009

My FNA came back inconclusive. Only when I had my 1st surgery to remove my right lobe did it show I had Papillary Cancer. Both my nodules were in my Thyroid gland. Sounds like you have very good Doctors that keep you well imformed. I too would be concern if the nodules had changed in 6 months. Sorry I don't have the answers to your questions.

mhc4165
Posts: 46
Joined: Dec 2008

Thank you for your response usljh10. But I just had a year follow up ultrasound that my 2 out of 3 small nodules grew. My last thyroid follow up I only waited 9 months and at that time these 2 nodules had only very slightly grew.

Also this is the first time that Upenn's ultrasound report describes my thyroid echotexture as heterogeneous when every other time which was 2 follow ups before it was described as homogeneous.

It was also described as homogeneous when my nodules were originally found by accident at Einstein Center One. It also says that my thyroid is small which was also never said before.

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