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Old 01-26-2013, 02:03 PM   #1
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So scared -- FNB is "Suspicious for Hurthle Cell Neoplasm". Advice appreciated.

I've done a lot of research, but I'm afraid a lot of it is still confusing to me. I would really appreciate any help in getting an honest picture of what this means and my odds. I'm sorry in advance this is so long.

Background: 39 yo female. No health problems or symptoms. Mother had Graves, older sister has Hashimotos w/ benign nodules (haven't been tested in a while though).

2001 (age 28): Dx with mild Hypo. 2 small nodules found and biopsied, told they were benign. No other info, and was too clueless to ask. Moved away that year, never saw an Endo again.

2006: Regular doctor couldn't get old Endo to send records, so had be do a sonogram. Found just one nodule: .8 x .9 cm. Report said: "rounded hypoechoic nodule." No repeat FNA done.

2008: Thyroid hormone levels suddenly normalize, and have been off meds since. No symptoms, just occasionally heart palpitations out of the blue and infrequently.

Oct 2012 (age 39): missed miscarriage at 8 weeks of first pregnancy, no reason known.

Dec 2012: pregnant again. Some concern because my progesterone level is testing at "low normal". Go to our family doctor just to make sure my thyroid is still fine, since I know it can contribute to fertility and miscarriage issues.

TSH: 2.9
T4 (not sure why they didn't tell me T3): 10

Also, since my last sonogram on thyroid was 2006, doctor wants me to get an updated one.

Jan 2012: Sonogram shows changes -- original nodule has grown, I have a new even larger nodule on the same side (right), and now a small nodule on the left side. They send me to an ENT, who sends me to have an FNA. I was stunned to find that the results were considered Inconclusive, but Suspicious for Hurthle Cell Carcinoma. Here are what the tests said, combined:

US report: "Thyroid gland is slightly prominent overall and mildly assymetrical. Overall size has not changed significantly [...] Color flow Doppler imaging shows increased vascularity throughout the thyroid gland with diffusely heterogenous echotexture. Ultrasound appearance of the nodules is nonspecific with regards to etiology.

Nodule 1 (the original one that tested benign in 2001):
US -- Measures 1.3 x 1.4 x 1.3. Rounded nodule is fairly well-circumcised and nearly isoechoic.
FNA -- Suspicious for Hurthle Cell Neoplasm (Bethesda Classification). The cytologic preparations are moderately to abundantly cellular and show numerous sheets and clusters of Hurthle cells. Many of the clusters are crowded with nuclear enlargement and there is a subset of microfollicular arrangements. There is a background suggestive of chronic lymphocytic thyroiditis with numerous lymphocytes and lymphoid tangles seen. However, not much colloid is appreciated and the architectural arrangements raise the possibility of a neoplasm. Only very rare single Hurthle cells are seen.

According to the Bethesda consensus statement and outcome studies, the suspicious for neoplasm category carries a malignancy risk of 30%.

Nodule 2 (new, larger one):
US: 1.8 x 2.0 x 1.5 cm, slightly less well-defined and nearly isoechoic
FNA: The cytologic preparations are mildly cellular and show sheets and clusters of bland follicular cells, some microphages, lubricant and blood; only scant colloid is appreciated.

Nodule 3 (also new):
.4 x .6 x .3, left thyroid lobe. Hypoechoic. No FNA done.

All the literature I've read is so confusing. Sometimes I think my results on the suspicious nodule look like I just have Hashimotos Thryoiditis (my antibodies have never been tested), considering all the lymphocytes. But then I read stats about how the lack of colloid in my sample, combined with the abundant Hurthle Cells in clusters and microfollicular arrangement means my odds are a lot higher that I do have a neoplasm/cancer. Frankly, I'm just terrified. Add in an "at risk" pregnancy, and all the emotions that come with that, and my brain and nerves are so tangled up I'm really struggling. I know this is a rare cancer, and it's typically dx'd for people a few decades older than me, but I also know that someone always falls on the bad side of the odds.

The only good news I have is that the lab who did my FNA prepped some slides for the Veracyte test, so at least I don't have to go straight to diagnostic thyroid surgery. Now I have to wait 2 weeks to either hear benign or still suspicious.

Has anyone been in my shoes before? Any advice?

 
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Old 05-23-2013, 12:34 PM   #2
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Re: So scared -- FNB is "Suspicious for Hurthle Cell Neoplasm". Advice appreciated.

yes, I'm in the *exact* same terrible scary situation and I'm too *PETRIFIED* to have the thyroid surgery! So I'm terrified either way,of the possibility that my nodule could cancerous! I had a benign FNA of all 3 of my nodules in June 2008,but my isthmus nodule has grown 50% in 3 years since my last thyroid ultrasound and a small amount of oncocytic (hurthle cells) were noted when I got a second opinion by a top university of Pensylvania thyroid pathologist but he thought that it suggested an element of chronic lymphotic thyroiditis(he called me back in July 2008 and assured me that hurthle cells are a normal cell to have in the thyroid,he said he could have themchildren have them,it's only when you have a whole lot of them is it a concern for cancer,and now I find out I do have a majority of them!),but I don't have Hashimotos and all of my thyroid tests have always been normal through the years.

My recent FNA on April 18th of just this isthmus nodule is an inderminate follicular neoplasm with oncoytic features,and I have been told that I now have a majority of Hurthle cells!I don't think lymphocytes were mentioned in my recent FNA but there were a few mentioned by the second opinion thyroid pathologist in July 2008.

Last edited by MerleR; 05-23-2013 at 12:41 PM.

 
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Old 05-23-2013, 01:22 PM   #3
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Re: So scared -- FNB is "Suspicious for Hurthle Cell Neoplasm". Advice appreciated.

Hurthle cell cancer, thyroid cancer in general, is usually diagnosed in women of child bearing age---are you mixing it up with anaplastic cancer, which is a bit more deadly, and diagnosed mostly in older people? This is not like that at all.

You might want to see a top knotch thyroid surgeon and consider getting rid of this thyroid, even if this is benign, as it may mean the cells are mutating and can become something in the future. Wait for your results, there's nothing you need to do until then. You can still live a long healthy wonderful life even if it were your worst case scenario.

 
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Old 05-23-2013, 01:43 PM   #4
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Re: So scared -- FNB is "Suspicious for Hurthle Cell Neoplasm". Advice appreciated.

please don't worry, my guess is that you have a multi-nodular goiter and hashi's.....they go hand in hand, and for some reason hurthle cells show up with hashi's. If you got your antibodies tested, I'd be willing to bet you will test positive for hashis

 
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