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Old 04-21-2010, 02:15 PM   #1
Librarian2010 Librarian2010 is offline
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Subtotal Thyroidectomy Then Regenerated Tissue and Possible Repeat Thyroid Surgery??

Hi Everyone!

I am new to HealthBoards and have searched through the message boards and the index, but I do not see anyone in a similar situation...

I had a subtotal thyroidectomy (right lobe and isthmus removed) in 2005. Surgery took 5 hours, and there was thyroid tissue attached to structures in the neck that could not be removed. The nodule turned out to be benign, but incidental papillary carcinoma 2mm was found near it. I have been on suppression therapy since the surgery. Four years later the tissue that was removed had almost completely regenerated. The next year's ultrasound found that the new tissue also has more nodules. My endocrinologist referred me to surgery. The surgeon ordered FNA Biopsy, Thyroid Scan and Uptake, and a CT scan. I started the low-iodine diet and stopped taking synthroid on April 1, 2010. The FNA Biopsy was done on April 12, 2010. The report is as follows:

Ultrasound Examination: Current ultrasound examination demonstrates a nearly intact, enlarged thyroid gland, with only a portion of the right isthmus missing. There are no discrete nodules. An area of vague nodularity in the right thyroid lobe, measuring up to 0.7 cm, is selected for biopsy. Fine needle aspiration (x1) under ultrasound guidance of the area of vague nodularity in the right thyroid lobe yields adequate material for cytologic evaluation.

Microscopic: Two air-dried, Diff-Quick stained smears are examined. Seen are lymphocytes in various stages of maturation, lymphoid tangles, multinucleated giant cells and sheets and clusters of follicular cells, most with oncocytic metaplasia. The oncocytic metaplasia is characterized by abundant, granular cytoplasm and enlarged, pleomorphic nuclei. There are rare microfollicles.

Diagnosis: Hurthle cell nodule in a background of thyroiditis.

Comment: The Hurthle cell change is felt to be metaplastic rather than neoplastic. This process can be followed with periodic ultrasound examination, with reaspiration if a discrete nodule develops.

My questions for the board: Has anyone had regenerated thyroid tissue after thyroid surgery with a Hurthle cell nodule in the new growth? Why would a Hurthle cell nodule be monitored rather than removed?

I still have to do the thyroid scan and uptake and the ct scan before I meet with the surgeon again to discuss the results of all the tests. I was hoping to find someone else who has been in this situation who might have some information to share. It will be a while before I find out what happens next and the wait is agonizing!

I look forward to hearing from you very soon and wish you all the best of luck with your treatment.