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Old 07-15-2011, 07:43 AM   #1
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Thyroid mass cancer probability

Two months ago, I went to my doctor for a follow-up appointment for my high cholesterol reading. Sitting across the room, he asked if I'd noticed a lump in my throat. He ordered an ultrasound which showed an enlarged thyroid and two solid masses on the left lobe (one 1.5X1.4X1.3 cm and the other 6.6X3.4X4.8 cm). Both are solid and show blood flow. I was referred to an endocrinologist who diagnosed Hashimotos (although my TSH at 3.4 and my free T4 at .94 were normal, my Antithyroid peroxidase ab reading of 446 was very high). A FNA revealed one mass as being atypia of undetermined significance, the other showed as suspicious for follicular neoplasm. I've gone to a surgeon who wants to remove the left lobe of my thyroid. What is the increased chance of cancer for a solid mass with blood flow over a fluid filled mass? I was hoping for a definitive answer such as, "Your chances increase from 2% for a fluid filled mass to 20% for a solid mass with blood flow" but I've only been able to find an average (that a general mass has a less then 5% chance of being cancerous).
Thank you.

 
Old 07-15-2011, 08:18 AM   #2
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Re: Thyroid mass cancer probability

If I recall the statistics, a cold solid nodule (a hot nodule 95%), has an 85% chance of being benign. But these statistics have changed for you, because you have a "suspicious" follicular neoplasm. Now your statistics have changed. Most nodules are solid, most have blood flow (it's a very vascular area in general). Why are you concerned about fluid nodules when yours is solid? You have to look at things in your situation.

My surgeon knew the statistics, he's on the board of the thyroid cancer organization. You can email someone from their support site. I would personally go to a surgeon that would explain these things to me better. A teaching hospital or a cancer center is the best, especially where you personally want things explained. A thyroid specialist is what I would use in your case. This is going to be a challenging surgery.

The hashimotos patients tend to get these very overgrown nodules from thyroid disease, they are often benign. Either way, 6cm is tremendous, bigger than an entire thyroid, and obstructive and that thyroid has to go---if it were cancer, it would be a bit more serious though I doubt it is. I can't imagine why you would only take one lobe. That thyroid, even without cancer, is going to be a mess, and not going to provide you hormone in the long run.

Last edited by Reece; 07-15-2011 at 02:24 PM.

 
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Old 07-15-2011, 07:23 PM   #3
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Re: Thyroid mass cancer probability

I am in the exact same position as you are. My nodule is solid with blood flow and my FNA came back as a follicular lesion, suspicious for follicular neoplasm. Here's what I can tell you. My doctor said 85% of FNAs with such a result are benign. Most of the expert opinions online are 80%. My FNA report says 70-85%. So at the worst, your odds are 30% chance of cancer. That's the good news.

The bad news is your nodule is very large and should almost definitely come out regardless. I'm consulting with a surgeon this week for mine. Since yours are both on the same side, a lobectomy is a viable consideration. However, keep in mind that if the final pathology comes back positive for cancer, you'll have to have a second surgery to take out the other half. Only you and your doctor can make the decision that is right for you. You might also consider having the pathology slides looked at by a major teaching hospital for a second opinion. Good luck to you and keep me updated.

 
Old 07-15-2011, 08:57 PM   #4
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Re: Thyroid mass cancer probability

The nodule is too large to leave in. Suspicious for follicular neoplasm is a common diagnosis when they can't tell you if it's benign or malignant. A neoplasm can either be benign or malignant. Most times it's benign. I believe your chances of cancer are about 80/20. So, based on the inconclusive FNA and the size, I'd get it out. If it were me, and there are no nodules on the other side, I would only take half and wait for the frozen section during surgery or the biopsy to come back before deciding about the other side. That way, you have a chance that you might not need thyroid medicine. Do you have Hypo symptoms? I have hashi's, had a partial thyroidectomy due to a nodule with hurthle cells and "suspicious for follicular neoplasm" like yours, but I have no symptoms and I'm still not on meds because I only took half my thyroid out instead of it all. It's a very personal decision that you have to make. I elected to roll the dice and mine was benign and I saved half my thyroid.

But your question is about odds. And truly, you can be quoted all the odds in the world and end up being on the wrong side of the odds so it doesn't matter. The odds are in your favor though. Know that. And this type cancer (even if you did have it which I doubt) is highly curable.

Cysts can be cancerous too!

 
Old 07-16-2011, 06:56 PM   #5
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Re: Thyroid mass cancer probability

I'm scheduled for surgery on 8/9. It will be for a left thyroid lobectomy with a possible total thyroidectomy, depending on the lab results. My thyroid itself is enlarged: 5.8X1.5X1.8 and 9.3X4.5X3.6, but I believe my surgeon wants to leave the right lobe in, since my T3 and T4 levels are normal.

 
Old 07-17-2011, 06:04 PM   #6
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Re: Thyroid mass cancer probability

I think it's a good plan. That's what I did basically. It worked out well. I'm still not on meds and I've tested positive for Hashi antibodies as well. So, good luck. Also, mine was benign.

 
Old 07-18-2011, 04:12 AM   #7
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Re: Thyroid mass cancer probability

Best of luck to you with your surgery!

Please check back with us afterwards since your thyroid labs indicate hypothyroidism.

But, first things first.
__________________
Graves' 2007...remission 2009....hypo 2010

Last edited by sammy64; 07-18-2011 at 04:13 AM.

 
Old 08-16-2011, 05:45 PM   #8
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Re: Thyroid mass cancer probability

Hi all,

I have recently had a FNA on a 4.5cm nodule on the left lobe of my thyroid. The path report showed a hurthle cell neoplasm. I will be meeting with an ENT surgeon in two weeks to schedule surgery. My Endo is suggesting removal of the left lobe, then if it is cancer removal of the rest of the thyroid followed by RAI.

After reading what seems like thousands of reports, articles, board posts, textbooks, etc. over the last few days I am a little flummoxed. I have really learned a lot from reading threads, on this board in particular (there are some really great posters on here!), but I just felt the need to tell my story so far. I have read that my age (27) is very good for my prognosis but being male and having a fairly large nodule isn't so good. Just wondering if anybody has any idea how my 'stats' change the typical 80/20 chance for carcinoma. I am also somewhat struggling with the decision of whether or not to have a TT from the start to avoid a second surgery. I will absolutely discuss this with my surgeon. Thanks for any help. I have a 10 month old son at home and cant stop thinking about the 'what if's'.

 
Old 08-16-2011, 06:06 PM   #9
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Re: Thyroid mass cancer probability

Quote:
Originally Posted by iuguy View Post
Hi all,

I have recently had a FNA on a 4.5cm nodule on the left lobe of my thyroid. The path report showed a hurthle cell neoplasm. I will be meeting with an ENT surgeon in two weeks to schedule surgery. My Endo is suggesting removal of the left lobe, then if it is cancer removal of the rest of the thyroid followed by RAI.

After reading what seems like thousands of reports, articles, board posts, textbooks, etc. over the last few days I am a little flummoxed. I have really learned a lot from reading threads, on this board in particular (there are some really great posters on here!), but I just felt the need to tell my story so far. I have read that my age (27) is very good for my prognosis but being male and having a fairly large nodule isn't so good. Just wondering if anybody has any idea how my 'stats' change the typical 80/20 chance for carcinoma. I am also somewhat struggling with the decision of whether or not to have a TT from the start to avoid a second surgery. I will absolutely discuss this with my surgeon. Thanks for any help. I have a 10 month old son at home and cant stop thinking about the 'what if's'.


I completely understand how you feel. I was very scared too. Remember, thyroid cancer is the most curable cancer there is. Almost always. Having said that, I had hurthle cell nodule as well. All neoplasm means is that it could be either a non cancerous tumor or it could be malignant. They don't know until it's removed. That's the reason most doctors want you to have surgery when you have this type nodule. Yours though, is large. I had mine removed after watching it for over 4 years for signs of growth/changes and finally when it grew to 3.4 cm, I had the right lobe removed and it was benign. My diagnosis after FNA was "Suspicious for Follicular Neoplasm" and was a hurthe cell nodule. Also said could not rule out Hurthle Cell Neoplasm which again just means it could be malignant or benign. Having said all of this, yours is larger so in my opinion, it needs to be removed. Anything over 4 cm is no longer a question. It has to come out according to my Endo. That's why when it reached 3.4, he said it's time. Hopefully yours will turn out like mine. The chance is about 80/20 with this type nodule, but I am not sure if it is over 4 cm if that changes the odds or not. The odds are still very much in your favor I am quite sure. I would discuss this with your Doc ASAP to put your mind to rest. As far as a TT, if it were me, I'd get the left side removed with the understanding that a "frozen section" be done during your operation (which will probably be inconclusive because of the hurthle cells) but if it is cancer, then during the operation they can remove all of your thyroid. If it is inconclusive, they close you up. If when the pathology report comes back, it is cancer, unfortunately you will have to have the other side removed, but if it is benign (which is more likely) you will have saved half your thyroid. That could mean the difference between being on medicine for the rest of your life....or not. That's why I chose what I did. I didn't want to be on meds for the rest of my life and so far I haven't needed them. The half that's still there is doing the work for both sides.....so far, but it's early still. Also, the surgery was very easy and so was the recovery. After having it and never even taking a Tylenol, if I would have had to have the other side removed, I could have handled it easily I think. But again, that was my surgical experience. Others have other experiences.

Anyway, that's just my opinion based on what I did, how it turned out and the similarities in our cases. Remember though...the size could be the game changer. You need to talk about the odds based on the size with your doctor and/or your surgeon. Hope this helps. Good luck, try not to worry too much until there's a reason to (I know...much easier said than done) and please keep us informed.

Last edited by Terri880; 08-16-2011 at 06:10 PM.

 
Old 08-16-2011, 08:36 PM   #10
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Re: Thyroid mass cancer probability

As an update to my original post, I had my surgery last Tuesday and I'm doing fine as far as that went. However, I have another surgery scheduled for this Thursday (one of those rare cases where the original report by the pathologist while I was on the operating table came back benign, but the frozen sections came back positive for cancer). I had an appointment today with the surgeon. I was disappointed he couldn't tell me any details about the pathology report. I can assume its follicular cancer since my FNA show cells suspicious for follicular neoplasms, but I don't know if the 6 cm or the 1.5 cm nodule was the one that was cancerous. He didn't seem to think it mattered, but from what everything I've been reading, the size will make a difference as to whether it's stage II or stage III. I'll have to wait until I see my endocrinologist after surgery. There seems to be a lot of wait and see involved in this.

 
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Old 08-16-2011, 11:34 PM   #11
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Re: Thyroid mass cancer probability

so sorry for your diagnosis. i don't like that your surgeon didn't give you your path report and explain it in detail. If you are under 40, it's less important for staging, but you have every right to be informed. Call the office for a copy, and see your endo who will manage your cancer. Find a good one who will discuss the path report in detail.

I would consider another surgeon, someone with such a large tumor, should have the entire thing out, no matter what the fna said.

That being said, you will do well, just take this one yucky step at a time, and soon you will be clear and done!

 
Old 08-17-2011, 06:05 AM   #12
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Re: Thyroid mass cancer probability

Quote:
Originally Posted by CathyLou View Post
As an update to my original post, I had my surgery last Tuesday and I'm doing fine as far as that went. However, I have another surgery scheduled for this Thursday (one of those rare cases where the original report by the pathologist while I was on the operating table came back benign, but the frozen sections came back positive for cancer). I had an appointment today with the surgeon. I was disappointed he couldn't tell me any details about the pathology report. I can assume its follicular cancer since my FNA show cells suspicious for follicular neoplasms, but I don't know if the 6 cm or the 1.5 cm nodule was the one that was cancerous. He didn't seem to think it mattered, but from what everything I've been reading, the size will make a difference as to whether it's stage II or stage III. I'll have to wait until I see my endocrinologist after surgery. There seems to be a lot of wait and see involved in this.

Cathy, first let me say that the other poster who posted about his situation in here is new and probably didn't realize he should have started another thread so as not to take away from your situation. I should have mentioned it to him. Maybe we can get him to start a new thread.

Anyway, so sorry about your diagnosis. And I agree with Reece. Your doctor should have been able to go over your pathology report in detail. Just because your diagnosis was suspicious for follicular neoplasms, if I'm correct, it doesn't mean it's follicular cancer. It could be a follicular variation of papillary cancer. Papillary cancer is the most common. Than Follicular. The pathology report should have that. Again, ridiculous that you haven't seen it or at least been told everything that is in it. Yours if an atypical case where the second surgery is needed after examination while you were being operated on showed benignity. But we all know when we elect to have one side taken out, there is a chance that we will end up back on the table. Lucky for me, that did not happen, but I know that the surgery was so easy for me, I would have been o.k. had I had to have the second operation. And you will be too. Reece is right. Take baby steps and before you know it, you'll be cancer free and on your way to good health.

Keep your chin up and find out what was in that path report.


 
Old 08-17-2011, 07:19 AM   #13
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Re: Thyroid mass cancer probability

@LuckyTerri

Thanks so much for your quick response! It is good to hear from someone who has gone through a similar experience to mine. I meet w/a surgeon in 10 days, I will have plenty of questions for him to be sure. I also know the odds are definitely in my favor, but hearing 'cancer' w/your name attached makes the rational side of your brain disappear. If you don't mind me asking, what kind of follow-ups do you have done w/a benign hurthle cell neoplasm history? From what literature I could find, a benign hurtle cell growth rarely if ever turns into cancer. I am still hoping for the best (bengin) but preparing for the worst. I guess even the worst is still better than most other cancers worst . Thanks again for the reply, I will update when I can.

 
Old 08-17-2011, 07:26 AM   #14
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Re: Thyroid mass cancer probability

Quote:
Originally Posted by iuguy View Post
@LuckyTerri

Thanks so much for your quick response! It is good to hear from someone who has gone through a similar experience to mine. I meet w/a surgeon in 10 days, I will have plenty of questions for him to be sure. I also know the odds are definitely in my favor, but hearing 'cancer' w/your name attached makes the rational side of your brain disappear. If you don't mind me asking, what kind of follow-ups do you have done w/a benign hurthle cell neoplasm history? From what literature I could find, a benign hurtle cell growth rarely if ever turns into cancer. I am still hoping for the best (bengin) but preparing for the worst. I guess even the worst is still better than most other cancers worst . Thanks again for the reply, I will update when I can.

Iuguy, could I ask a favor. Could you start a new thread so as not to take away from Cathy's thread. Sometimes when someone else posts in a thread someone else started, the responses to them get lost in the shuffle. If we can start a new one for you and copy and paste our posts to each other in here onto the new thread, we can delete or edit them in here so Cathy can have her thread back. I know you're new and didn't know about this. At least, this is how it was explained to me.

Having said that, to know if a hurthle cell nodule is benign, you must go through surgery. If it is benign after surgery, there is nothing left to do. It is gone. You might have to go on meds for hypothyroidism (under active thyroid) but if only half is removed, you might be able to avoid that as the half of your thyroid you still have would do the work of the other side. If you have a Total Thyroidectomy, you would be on thyroid hormone replacement for the rest of your life. Other than that, there is no particular followup that I know of.

 
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