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Old 11-15-2008, 09:12 PM   #16
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

Here are some fast facts that I learned last night:

1.) FNB's : Pathologists can't tell the difference between follicular nodules (adenoma), follicular cancer, & non-toxic goiter from a
fine needle biopsy.

2.) The Dr. must see the entire capsule in the thyroid gland to see if there is a follicular cancer that has gone beyond the capsule which surrounds the nodule. The FNB only shows cells not the entire nodule with the capsule.

3.) The coarse needle biopsy is more accurate than a fine needle biopsy- 40 % of the time it can tell the difference between follicular neoplasm, thyroid cancer, & non-toxic goiter.

4.) Hurtle cell is a type of follicular nodule

5.) 80% of pts will have a benign nodule

6.) Very Aggressive Folicular cancers can usually be recognized during surgery but not always.

7.) May take a week for Pathology to make a diagnosis. My older daughter's OR biopsy was negative but the final a week later was positive for Papillary with a follicular variant.

8.) This is important in those who have tried suppression with thyroid hormone for our nodules: 15 - 20 % of malignant nodules are suppressible which may lead our Dr's into thinking that they are benign.

9.) Cancer cells are autonomous & don't require TSH for growth

10.) In contrast, benign nodules require TSH for growth.

11.) So if there is cancer in the thyroid, giving high doses of thyroid hormone to suppress the thyroid gland are likely to cause the cancer cells to grow more.

12.) Reason for a total thyroidectomy

a.) pts. older than 40yrs old with follicular thyroid cancer

b.) pts. with bilateral disease

c.) pts. with nodule & history of radiation (example radiation treatments for acne.)

Complete thyroidectomy does not improve long term prognosis.

My older daughter had two separate operations. The 2nd lobe did not have cancer. She wishes she had done only one surgery & followed the other side with Ultrasounds. All of her parathyroids were destroyed & her Dr. did not follow up with prompt attention to her calcium levels. By the time, he got on the ball her calcium levels were very low so she had to be loaded with calcium. This messed up her kidneys. Then she had to be given a b/p med to protect her kidneys which lowered her already low b/p.

There is a 99% cure rate if the cancer is confined to microscopic capsular or venous capsular invasion.

Gathered this info from NY Thyroid Center & Emedicine. Fam

 
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Old 11-15-2008, 09:44 PM   #17
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

Here are some fast facts that I learned last night:

1.) FNB's : Pathologists can't tell the difference between follicular nodules (adenoma), follicular cancer, & non-toxic goiter from a
fine needle biopsy.

2.) The Dr. must see the entire capsule in the thyroid gland to see if there is a follicular cancer that has gone beyond the capsule which surrounds the nodule. The FNB only shows cells not the entire nodule with the capsule.

3.) The coarse needle biopsy is more accurate than a fine needle biopsy- 40 % of the time it can tell the difference between follicular neoplasm, thyroid cancer, & non-toxic goiter.

4.) Hurtle cell is a type of follicular nodule

5.) 80% of pts will have a benign nodule

6.) Very Aggressive Folicular cancers can usually be recognized during surgery but not always.

7.) May take a week for Pathology to make a diagnosis. My older daughter's OR biopsy was negative but the final a week later was positive for Papillary with a follicular variant.

8.) This is important in those who have tried suppression with thyroid hormone for our nodules: 15 - 20 % of malignant nodules are suppressible which may lead our Dr's into thinking that they are benign.

9.) Cancer cells are autonomous & don't require TSH for growth

10.) In contrast, benign nodules require TSH for growth.

11.) So if there is cancer in the thyroid, giving high doses of thyroid hormone to suppress the thyroid gland are likely to cause the cancer cells to grow more.

12.) Reason for a total thyroidectomy

a.) pts. older than 40yrs old with follicular thyroid cancer

b.) pts. with bilateral disease

c.) pts. with nodule & history of radiation (example radiation treatments for acne.)

Complete thyroidectomy does not improve long term prognosis.

My older daughter had two separate operations. The 2nd lobe did not have cancer. She wishes she had done only one surgery & followed the other side with Ultrasounds. All of her parathyroids were destroyed & her Dr. did not follow up with prompt attention to her calcium levels. By the time, he got on the ball her calcium levels were very low so she had to be loaded with calcium. This messed up her kidneys. Then she had to be given a b/p med to protect her kidneys which lowered her already low b/p.

There is a 99% cure rate if the cancer is confined to microscopic capsular or venous capsular invasion.

Gathered this info from NY Thyroid Center & Emedicine. Fam

 
Old 11-15-2008, 10:06 PM   #18
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

Famnd-Thank you for posting that information. I appreciate it!
I am so sorry to hear that your daughter had trouble with her surgery. Damage to the parathyroids is something that gives one pause. Was her surgeon very experienced with thyroid surgery? Was it the same surgeon that did both sides? I hope your daughter is doing better. What is the status of her parathyroid situation now?

Last edited by osteoblast; 11-15-2008 at 10:11 PM.

 
Old 11-16-2008, 06:46 AM   #19
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

In terms of parathyroids and damage, it all depends upon where your parathyroids are---not everyone has them in the same location. Sometimes the surgeon has to move them when removing the thyroid, and then there's a risk they will either be temporarily "stunned" or even possibly permanently damaged.

In my case, the surgeon didn't have to touch mine, and I had no issue with them or my calcium level.

The woman next to me who had her second surgery (my surgeon did it, and he believes in both sides being removed no matter what), which was much trickier because scar tissue had grown, did have some calcium issue while we were in the hospital, but she was carefully monitored, and I don't know what happened later.

And many surgeons use drains, to monitor your output overnight, and it's good, this way you don't have a fluid buildup lump in your neck, and they take it out the next morning, and it's really not a big deal, it doesn't hurt, I put the drain in the pocket of my shirt while it was in and I walked around after surgery.

Last edited by Reece; 11-16-2008 at 06:49 AM.

 
Old 11-16-2008, 10:01 AM   #20
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

Hi Osteo, sorry your going thru this! Sounds similar to my biopsy last April, now I'm back to wondering??? here is mine:

Two out of seven smears show many small clusters of reactive follicular cells with Hurthle cell metaplasia and crushed lymphocytes in a hemorrhagic background. There is no papillary configuration or specific nuclear atypia.

Comment: Suggest erologic work-up for Hashimoto's thyroiditis.

Two endo's sd no surgery needed. Said this is typical for Hashimoto's. First endo claimed a 1cm nodule and biopsied. 2nd endo 5 months later, sd no nodule? claims other endo biopsied the thyroid...confused? now wonder if the whole thyroid has these cells not good?

I've read a couple others' here had surgery and no cancer while some others went in and only found it after pathology.

Wishing you the best at Mayo! keep posting.
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Old 11-16-2008, 11:07 AM   #21
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

Hello again Osteoblast. I apologize for being away yesterday. I see that a lot can happen on these threads in a short amount of time.

Well as far as your question whether I was offered a total or hemi...after hearing all the pros and cons I think I decided I would go hemi, hoping of course that it is an adenoma. Not to scare anyone but apparently this whole loss of your voice box can happen and does somewhat. The same is also true for some bleeding. I guess with all that at least with a hemi I reduce my risk by 50% right? If it is a carcinoma then at least I will have weighed the right of loss of voice against loss of.... well you know.

So in the end I am cautiously optimistic that the hemi is all I will have to have in the end.

what about you? were you offered either or?

jenn

P.S. not sure why I used to many smiles today.....it's a good day I guess.

 
Old 11-16-2008, 12:30 PM   #22
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

Jenn-the ENT that I first saw for surgery said she would only do one side while in surgery and get the path report while I was on the table and then do other side if warranted. Because I have hashi's and a sestamibi scan showed virtually no functioning thyroid tissue AND because besides the 3 cm mass with hurthle cells, I have 7 nodules sub centimeter divided between the two sides---I wanted both sides done. She wouldn't budge. I have heard so many stories of people who had one side done and then have to have second done soon thereafter or later find they should have done the other side. It is all very confusing, I just want it all to be done. Then.......there is the little thing about parathyroids and your laryngeal nerve. Of course these weigh on me and that is why I want to go to a surgeon who does this surgery all the time.
You are sooo right about the risks involved--damage to laryngeal nerve and parathyroids happens. And, loss or damage of voice can be devastating. I spoke with a woman locally who had this happen after she had a partial thyroidectomy. For the next 2 yrs. she was hyper focussed on her voice--understandably. Unfortunately, during that time she did not have follow up appts. to see if cancer was spreading and then when her new endo said where are your follow up scans etc-she had nothing. Now she has cancer found on the other side. This is a tough situation! And, her voice after 2 yrs. did mostly come back with voice exercises.
So,thus far I was not given a choice by the surgeon I consulted with. My endo and pcp then set me up with another surgeon who they said would likely do total but I decided against seeing him because he is the one at a teaching univ. and you must agree that he can be assisted by a resident. And, I was told by a woman radiologist who is a member of the local thyroid cancer assn. that she had surgery with that dr. at the univ, who has an excellent reputation but that in her case the resident destroyed her parathyroid on the side he operated on. Apparently they split the job. So..I am not going to the univ. hosp surgeon.
I am glad you are having a good day and thank you so much for responding. Jenn, be sure to let us know how your surgery goes. I am hoping the best for you!

 
Old 11-16-2008, 12:35 PM   #23
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

Reece-Thanks for the addtl info. You said your surgeon believes in having both sides done . When he explained this to you , what did he say??
I sure hope you see this because this is the first I have heard of such a stance being taken by a dr.
As you explained it the drain tube sounds like a very good idea. I am here on the west coast and I was told it is generally not done here. It is more of an east coast thing---this is what someone on this board said. She was having surgery done out here in Washington state.

RMB- In an earlier message, I addressed it to Jenn when I meant it for you. OOOPS . Anyway, I wondered did they give you the option of a total thyroidectomy at Mayo. Also, did you have a drainage tube after surgery?

Last edited by osteoblast; 11-16-2008 at 12:54 PM.

 
Old 11-16-2008, 01:25 PM   #24
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

Nope, I actually was referring to my room mate in the hospital who my surgeon did the second side the same day as my procedure---she had one side out a month earlier, it turned out to have a small cancer, and he then took out the rest when she was my room mate---and believed if there was cancer on the first side, it was important to get the other side out---not to randomly take the whole thing.

In my case, my fna was positive for pappillary. I begged him to take the entire thing out---he said he would take out as much as safely possible, and he did end up getting the whole thing. He is a thyroid specialist here in NY, and I knew I would trust whatever he did once he was in there.

Your case is more like my mother in law, she had a diseased thyroid, a suspicious nodule, and her thyroid was so diseased that the surgeon took out the entire thing, once he was in there. Hers was benign.

You can express your desire to get the whole thing out, it doesn't sound like your thyroid is very healthy at this point, a good surgeon will do what is safe and best with minimal damage.

The typical rate for vocal chord damage is 1%, it's not that common, just find a surgeon you trust and that is the best you can do.

Last edited by Reece; 11-16-2008 at 01:27 PM.

 
Old 11-16-2008, 04:59 PM   #25
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

Quote:
Originally Posted by osteoblast View Post
Reece-Thanks for the addtl info. You said your surgeon believes in having both sides done . When he explained this to you , what did he say??
I sure hope you see this because this is the first I have heard of such a stance being taken by a dr.
As you explained it the drain tube sounds like a very good idea. I am here on the west coast and I was told it is generally not done here. It is more of an east coast thing---this is what someone on this board said. She was having surgery done out here in Washington state.

RMB- In an earlier message, I addressed it to Jenn when I meant it for you. OOOPS . Anyway, I wondered did they give you the option of a total thyroidectomy at Mayo. Also, did you have a drainage tube after surgery?

I was only given the option of a TT if there was cancer in the nodule. They were very hopeful that the remaining thyroid was going to kick in and work on it's own, which it did not. They did not give me the option to go back in to surgery the following day to have the rest removed. I'm not sure if I would have...I guess hindsight is 20/20. My endo did call the following day to say I should not be be overly upset about the path report because the spot was so small and that we would continue to monitor the remaining thyroid. The spot was .5mm x .5mm.

No, I did not have a drainage tube. I'm not for sure if there would have been one if it had been a TT.

I think you also asked about a follow up visit and stitches? I did not have to go back to the surgeon for a follow up and I did not have stitches to remove. I had a follow up with my endo after 8 weeks.

 
Old 11-16-2008, 07:26 PM   #26
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

reece-thanks again for your response. I hope they would do with me as the surgeon did with your mil. From what I can gather here on the boards, it seems drs. will not generally do a TT unless there is cancer found.
Doing some research last night though it seems that it is hard for the pathologist to determine if hurthle cells are cancerous. I know it probably sounds odd but I read this in several places.
RMB-I am glad you caught that message. I was hoping to hear back from you. Thanks for the info about no stitches, no drainage tube , no surgeon follow up. I see though you had an endo follow up. At that time did you have your own endo where you lived? I wonder if I would just follow up with my own endo, or whether I would need to go back to Mayo. How did your scar turn out? Did you mention it to the Mayo endo that you wished they would have taken the whole thing as they did find cancer-though so small?
If so, what did the Endo say?
How did your timeframe at Mayo go? I am travelling a great distance to get there.On Mon. at 6:45am I have the endo appt. I am wondering if they will do the surgery on that trip or if I will have to come back. The asst. said that for those travelling long distances they try to make things happen , but they can't guarantee that surgery will happen on that visit. So there are alot of unknowns and it's getting me tensed up.
I really appreciate everybody who responded this weekend! It was a time for me to get my questions out. I still do not understand hurthle cells though. It is weird when I have been in the grips of some medical issues--I notice that it is hard for me to grasp the questions that I need to ask . It seems it takes me quite some time to understand what is going on. My endo is good generally, but has really dropped the ball on this project. She is pregnant and going to now be off for 4 months-during this time I will see one of her colleagues , so sometime in Dec. I hope to get some more info from the other endo.

 
Old 11-16-2008, 10:31 PM   #27
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

Hi Osteo,

My friend had two of her parathyroids removed at the end of Oct. She has had 3 follow ups with her surgeon. She stayed one day total in the hospital. She said that it hurt a lot getting the drain out.

She had said that she would call me when she got home. I didn't want to call her as I knew her voice would probably be weak & she might not feel like talking. By the 4th day, I finally gave her a call. I'm glad I did. She was not feeling well. She had numbness, tingling, & a feeling that her nerves were vibrating all over her body. She hadn't called the DR. She had been taking an over the counter calcium supplement. It wasn't enough.

I told her she needed to call the Dr. She waited until the next day. He ordered a blood test at our nearby hospital so she wouldn't have to travel. Her calcium was low so he ordered a prescription calcium supplement.

It is important to drink plenty of fluids throughout the day when taking these calcium supplements so that one doesn't get constipated & to protect the kidneys.

You need to plan what foods to have on hand because your throat will probably be sore. You will want soft foods that go down easily. You need to chew well so you don't start to choke as my friend started to do.

Another thing to consider is what meds you are on. If you are on a diuretic then you will need to have some potassium rich foods available after you get home. Potassium is not stored in the body although it can get by for a few days. Food is the safest way to provide potassium to the body. My friend hands were starting to shake & her legs were cramping up. I suspect her potassium was getting low from her diuretic. I find orange juice & milk the fastest way to get my potassium up when I am sick & don't want to eat.

The bottom line is you need to have a Dr. who you can call if you have a problem. Low Calcium & potassium can lead to serious problems. Hopefully, there is someone who can help you during this period to remind you to call your Dr. if you aren't feeling well

Preparing for your appointment will actually help ease your fears because it will make you feel in control of the situation. You are very lucky to be able to go to Mayo. Fam

 
Old 11-17-2008, 09:11 AM   #28
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

Quote:
Originally Posted by osteoblast View Post
RMB-I am glad you caught that message. I was hoping to hear back from you. Thanks for the info about no stitches, no drainage tube , no surgeon follow up. I see though you had an endo follow up. At that time did you have your own endo where you lived? I wonder if I would just follow up with my own endo, or whether I would need to go back to Mayo. How did your scar turn out? Did you mention it to the Mayo endo that you wished they would have taken the whole thing as they did find cancer-though so small?
If so, what did the Endo say?
How did your timeframe at Mayo go? I am travelling a great distance to get there.On Mon. at 6:45am I have the endo appt. I am wondering if they will do the surgery on that trip or if I will have to come back. The asst. said that for those travelling long distances they try to make things happen , but they can't guarantee that surgery will happen on that visit. So there are alot of unknowns and it's getting me tensed up.
I really appreciate everybody who responded this weekend! It was a time for me to get my questions out. I still do not understand hurthle cells though. It is weird when I have been in the grips of some medical issues--I notice that it is hard for me to grasp the questions that I need to ask . It seems it takes me quite some time to understand what is going on. My endo is good generally, but has really dropped the ball on this project. She is pregnant and going to now be off for 4 months-during this time I will see one of her colleagues , so sometime in Dec. I hope to get some more info from the other endo.
I am lucky enough to live close to Mayo..in fact my home clinic is a mayo affiliate. The endo I see visits our specialty clinic here in town, so that is who I followed up with locally. The surgeon did send a letter both to my endo and to my family doctor. I got to choose who I wanted to follow up with.

My timeframe was really drawn out but I think it is because I do live close to Rochester. I had my surgery consult on April 29th with surgery on May 8th. My surgery was sceduled at the beginning of April and that was the soonest they were able to get me in. I'm sure it was scheduled out so far because it was not considered an emergency. My endo was really hoping I could have had the consult on the 29th with surgery the next day but it did not work out that way. Just an FYI...my surgery was done at St. Marys...not sure where your hand surgery was done at.

People say my scar looks good. To me it seems like it is healing slow. I am very fair skinned so the area is still a little pink around the scar. The scar itself is relatively flat...it is raised just tiny bit on my right side. They say it will take a full year before it will look like it will for the rest of my life. I was very suprised at how long it took before the swelling really went away from the surgery area. I still at times feel tightness in my throat.

I did tell my endo that in a way I wish I had had a TT...he said it is really hard to know what the right plan of action is. I'm sure had I asked I'm sure I could have went back in right away.

I'm sure you wish your appointment was tomorrow so you can get on with life. Don't get too tensed up! Just keep asking questions and I will do my best to answer as many as I can....that was the hardest for me...the unknowns and worrying about them.

 
Old 11-18-2008, 09:51 AM   #29
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Re: Experts--Hurthle cells in FNA biopsy , what to think/what to do?

RMB-Once again a big thanks. Now I know a bit more. It seems like so many people pop up saying that they wish they had a total instead of a partial. I will express my concern but I do not believe that I will convince them of anything. And, probably that is a good thing. I think it is better that they are in charge of the project than me. Though here locally I just didn't feel good about the surgeon that said a partial--the bottom line was that I didn't trust her.
My hand surgery was not done at Mayo --I had it done locally. I think the surgeon was good, he was very helpful--it was just the Op. Room demeanor-it was a little wild. I know that must sound odd but it did happen on two occassions. It was sort of boisterous, rowdy a lot of joking around like your "get the lady a margarita" .
Thanks for telling me one whole yr. on healing of the scar. That is a long time. I too am very fair skinned .
Famnd-Thanks too for your addtl info. Very helpful about the calcium, potassium and soft foods. Luckily dh will be there to help me.

 
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