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Old 04-21-2010, 01:15 PM   #1
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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.

 
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Old 04-21-2010, 01:33 PM   #2
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Re: Subtotal Thyroidectomy Then Regenerated Tissue and Possible Repeat Thyroid Surger

Sorry you are going through this. I think if you had cancer, this is sort of considered a "recurrence"---but you already kept half your thyroid----and didn't ablate the remaining tissue with RAI, so I guess it's a bit difference. What level was your tsh kept at?

In my case, when I had thyroid cancer, the entire thyroid was removed, and then I had RAI to ablate and destroy all remaining thyroid tissue, and then I keep my tsh suppressed (at about .04). If they find any tissue, they will treat it as cancer, as a "recurrence"---even if they tested the tissue they still consider it a cancer recurrence.

You could consider surgery again, and/or RAI to destroy all tissue. The only way to know if hurthle is cancer, is if it's encapsulated in the nodule or not, so you would have to remove the whole lobe.

Let us know what the surgeon says----and get a good one, go to a cancer center or university hospital if possible.

 
Old 04-22-2010, 06:05 AM   #3
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Re: Subtotal Thyroidectomy Then Regenerated Tissue and Possible Repeat Thyroid Surger

Hi Reece!

Thank you for your quick reply. I am so sorry to see that you have had thyroid cancer. I hope you had great doctors and that your treatment was successful. I am with Kaiser now and have to use their specialists, so I don't think I can go to a specialized cancer treatment facility. They are still keeping me suppressed at .03 but it doesn't seem to keep the tissue from growing back. The right lobe that was removed has regenerated and is now larger than the left lobe that was left intact. I also had a vertebral compression fracture and was diagnosed with osteoporosis (before Kaiser) then Kaiser took me off the Boniva telling me that adjusting for my age my z score was in the normal range. I think that the suppression therapy is affecting my bones even though I'm taking Oscal w/ vitamin D. Could the bone issues mean cancer has metastasized??

Last edited by Librarian2010; 04-22-2010 at 07:00 AM.

 
Old 04-22-2010, 10:22 AM   #4
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Re: Subtotal Thyroidectomy Then Regenerated Tissue and Possible Repeat Thyroid Surger

Yes, I have what seems to be a little bone loss too, you might want to smidgen up your meds. if you are after menopause. But from what I've been researching on bone loss, it doesn't seem that there's concrete protocol until you get to osteoperosis level.

Good luck managing your care---I hope everything works out successful.

 
Old 04-23-2010, 03:00 PM   #5
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Re: Subtotal Thyroidectomy Then Regenerated Tissue and Possible Repeat Thyroid Surger

Thanks for letting me know about the bone loss issue. I will do some checking into this as well...

I think might have to start the wonderful (ahem NOT) low-iodine diet over... heavy sigh... the store I buy the unsalted peanut butter from just informed me that they use the SAME machine for making their salted and unsalted peanut butter! The machine is in the back of the store where only employees are allowed... so I was unable to see it for myself. I called the surgeon's office yesterday to find out if I will need to reschedule the thyroid scan and uptake and start the diet over. They told me that the surgeon is out for six weeks due to a personal emergency. His nurse told me she would ask another thyroid surgeon and let me know. I only have 5 days left of the four week diet... I never in my lifetime thought that I would be SOOOO UPSET over PEANUT BUTTER

 
Old 04-24-2010, 05:42 PM   #6
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Re: Subtotal Thyroidectomy Then Regenerated Tissue and Possible Repeat Thyroid Surger

It's not a no iodine diet, it's a low iodine diet, so don't worry if you ate some, it shouldn't effect anything that much, just don't keep eating it now, you have a few days left for this to be out of your system by then.

Also, if you are still really concerned (but I believe you are fine) you don't have to speak to the surgeon, just the nuclear med facility where you are having the test done. Many only tell you not to eat seafood----most people don't stick to the diet, so you are ahead of the game, so I really believe you are fine.

 
Old 04-27-2010, 04:52 PM   #7
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Re: Subtotal Thyroidectomy Then Regenerated Tissue and Possible Repeat Thyroid Surger

Thanks Reece! I did take your advice... stopped eating the pb and called the nuclear med facility, but they referred me back to the surgeon because he ordered the diet and the test. I finally heard from the nurse and she said I didn't need to reschdule. I am so relieved... This is one diet I hope I NEVER have to do again!

 
Old 05-02-2010, 06:40 PM   #8
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Re: Subtotal Thyroidectomy Then Regenerated Tissue and Possible Repeat Thyroid Surger

Hi Again,

I am finished with the Thyroid Scan and Uptake. I went to the Nuclear Medicine facility on April 29th and took the radioactive iodine pill at 9:00 am and then was instructed to return at 1:00. So, I did... We came back at 1 and they took me to the back and did the scan and uptake. The scan showed both lobes that looked about the same and the Hurthle cell nodule was not visible (because it was less than 1 cm). The measurement taken while seated with the camera at the neck then at the leg showed higher than normal readings. We met with the Dr. after both tests and he said I have Graves Disease. If the readings go even higher on the next day, it will confirm the diagnosis. So we were instructed to return on the 30th between 7 and 10 am. Sure enough the readings on the next day were higher. The Graves diagnosis was confirmed! They told me that due to the Graves, Hashimotos, and Hurthle cell nodule I need a total thyroidectomy followed by radioactive iodine ablation. I never knew it was possible to have both Graves AND Hashis??? Now I know why I never felt any better on Synthroid, but nobody would believe me! I will receive a copy of the report and recommendation and will add the percentages then. The next step for me is the CT scan on May 20th...

 
Old 05-03-2010, 01:36 PM   #9
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Re: Subtotal Thyroidectomy Then Regenerated Tissue and Possible Repeat Thyroid Surger

Yes, it is possible, but do you have antibodies for both---or is it from the scan only this diagnosis? Either way, you do have a good explanation for feeling poorly.

Be careful, as if someone has graves, and had thyroid cancer, it can be more aggressive if it is cancer.

Good luck with the ct scan, I'm thinking you may want the surgery with what's going on here---although not fun!

 
Old 05-03-2010, 03:13 PM   #10
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Re: Subtotal Thyroidectomy Then Regenerated Tissue and Possible Repeat Thyroid Surger

The Graves diagnosis was made only from the results of the thyroid scan and uptake. No testing for antibodies has been done at this time. But I have been tested for the Hashimotos antibodies after the subtotal thyroidectomy, which were positive. Do I need confirmation via bloodwork or is the thyroid scan enough for a diagnosis?

I also want to say thank you, Reece, for your advice, for keeping in touch, and for sending me good wishes . I have two wonderful sisters who have been with me for these appointments and I am so thankful for their love and support. At home, not so much... My husband still thinks this is all in my head and that I can simply will it away...

 
Old 05-03-2010, 03:58 PM   #11
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Re: Subtotal Thyroidectomy Then Regenerated Tissue and Possible Repeat Thyroid Surger

I had a very high uptake prior to my surgery---when I was evaluating my nodule originally, but no antibodies or anything, my endo just decided to say I was "subclinical hyperthyroid" (we didn't discuss it further than that, maybe because I was scared it would mean my cancer would be more aggressive). I didn't have anti-bodies, and my free t's were fine, it was just the scan that was high in uptake, and I sometimes think it was the cancer itself in my case. You should discuss in more detail with your doctor.

I have a great sister---that's so nice that yours support you thru. all this junk. Fortunately, my hubby is helpful----it could just be yours is scared and doesn't want to think too much on it or ramifications-----it's important that you have people to talk to when you go thru. testing and waiting and worrying. Go sisters!

Let us know what happens!

 
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