# Need FNA Advice/Opinions Please



## vg7707

I am seeking opinions from anyone who can offer guidance. I'm a little worried about a recent FNA that I had. I have a large non-palpable solid nodule in the right lobe of my thyroid that was discovered on ultrasound and was referred to an ENT for consult. The ENT ordered an FNA biopsy. Here are the results of my US and FNA:

*Ultasound:*

Impression:

Dominant solid midpole nodule 2.0 x 1.3 x 1.2 cm on the right. Clinical correlation and follow-up could be of benefit. Nodules are indeterminate by ultrasound.

REASON FOR EXAM: HYPOTHYROIDISM, ENLARGED THYROID

FINDINGS:

Right lobe thyroid measures 2.5 x 1.2 x 1.4 cm.
Dominant solid midpole nodule 2.0 x 1.1 x 1.2 cm on the right.
Hypoechoic 4 x 2 mm lateral nodule.

Left lobe thyroid measures 2.6 x 1.1 x 1.2 cm
Upper pole nodule 6 x 5 x 3 mm and lower pole 8 x 8 x6 mm nodule.
Isthmus measures 3 mm.

*FNA:*

Clinical History: 2 cm solid right thyroid nodue with possible rare smaller lesions as per radiology.

GROSS EXAMINATION:
Two FNA passes are performed by radiology consisting of a few bloody droplets of fluid from which two H&E smears and two DQ smears are generated.

MICROSCOPIC DIAGNOSIS:
RIGHT THYROID, ULTRASOUND-GUIDED FNA: BENIGN-APPEARING FOLLICULAR EPITHELIAL ELEMENTS.

COMMENTS: The FNA smears consist of a mild to moderately cellular population of benign-appearing epithelial cells. These show some monolayered sheets as well as a focal microfollicular component without a prominent background colloid deposition or histocyte accumulation. There are no features of papillary thyroid carcinoma.

In summary, these findings may very well represent a cellular hyperplastic nodule (goiter); however, the possibility of a small follicular neoplasm cannot be completely ruled out. Continued close ENT and radiologic follow-up is advised. If the lesion should enlarge significantly over time, then further work-up to include re-biopsy/FNA is warranted.

My ENT wants to do another US in three months. If the nodule hasn't grown, he then wants to do another US in 6 months. My problem is that this sounds like an inconclusive diagnosis&#8230; which I thought usually resulted in surgery just to be safe. I read a study online that is suggesting that if the words "follicular neoplasm" are anywhere in the diagnosis, then the diagnosis should be "follicular neoplasm". I don't want to wait for this to grow and move somewhere else in my body before they take it out.

Your thoughts and opinions are appreciated.

Vg7707


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## Octavia

If you aren't in any pain or discomfort (such as weith swallowing or talking), then I think your ENT's plan is a good one. These things are generally pretty slow-growing, and once in a while, they disappear on their own-you might get lucky. Definitely keep an eye on it yourself to see if it becomes visible and/or palpable, or if it starts to cause pain or discomfort. If that happens, call your doctor.


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## vg7707

Octavia said:


> If you aren't in any pain or discomfort (such as weith swallowing or talking), then I think your ENT's plan is a good one. These things are generally pretty slow-growing, and once in a while, they disappear on their own-you might get lucky. Definitely keep an eye on it yourself to see if it becomes visible and/or palpable, or if it starts to cause pain or discomfort. If that happens, call your doctor.


Thank you so much for your advice. I've never been through this before and I guess I just want some reassurance that this is the right way to go.

I'm not in any pain, but I'm having some difficulty swallowing, which is why we did the US in the first place. However, my ENT thinks that the swallowing problem is from acid reflux, but I'm glad that I had an issue, or would never know that the nodule is there.


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## Octavia

vg7707 said:


> However, my ENT thinks that the swallowing problem is from acid reflux, but I'm glad that I had an issue, or would never know that the nodule is there.


Reminds me of a good friend of mine who was carrying his daughter on his shoulders, and she accidentally kicked him in the front of his neck. His neck never started to feel better, so he finally went to a doctor about it...turns out that he had a very rare form of cancer in there (not thyroid). After some pretty harsh surgeries and treatments, he's doing very well now...pretty much back to normal. Thank goodness for that little kick from his daughter!


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## angel1976

The ultrasound report is contrardicting itself on terms of the thyroid lobe sizes!! 
_Right lobe thyroid measures *2.5* x 1.2 x 1.4 cm_
based on the dimensions provided the thyroid *lobes* are very *small*.
(average size is *3.5* X 1.2 X 1.4)
if nodule has a capsule it more likely to be adenoma/neoplsm, but second opinion may be needed.
Sometimes Afirma test could be used to evaluate possibilities of cancer mutations.


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## vg7707

angel1976 said:


> The ultrasound report is contrardicting itself on terms of the thyroid lobe sizes!!
> _Right lobe thyroid measures *2.5* x 1.2 x 1.4 cm_
> based on the dimensions provided the thyroid *lobes* are very *small*.
> (average size is *3.5* X 1.2 X 1.4)
> if nodule has a capsule it more likely to be adenoma/neoplsm, but second opinion may be needed.
> Sometimes Afirma test could be used to evaluate possibilities of cancer mutations.


Yes, I thought that was a small size, also. I asked the US tech that was assisting during the FNA if she thought that was small for a thyroid. She said that if I was hypo, that could explain it. She also said that she had done US on people that she could barely find thier thyroid because they were so small! That was one reason for my concern with the nodule as it appears to be almost as big as the right lobe of my thyroid.

I am not familiar with Afirma test, but I will inquire about it. Thanks for your sharing your thoughts.


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## vg7707

Octavia said:


> Reminds me of a good friend of mine who was carrying his daughter on his shoulders, and she accidentally kicked him in the front of his neck. His neck never started to feel better, so he finally went to a doctor about it...turns out that he had a very rare form of cancer in there (not thyroid). After some pretty harsh surgeries and treatments, he's doing very well now...pretty much back to normal. Thank goodness for that little kick from his daughter!


Yes, thank goodness for that kick. Sometimes the oddest things can turn out to be blessings. So glad your friend is doing well.


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## Andros

vg7707 said:


> I am seeking opinions from anyone who can offer guidance. I'm a little worried about a recent FNA that I had. I have a large non-palpable solid nodule in the right lobe of my thyroid that was discovered on ultrasound and was referred to an ENT for consult. The ENT ordered an FNA biopsy. Here are the results of my US and FNA:
> 
> *Ultasound:*
> 
> Impression:
> 
> Dominant solid midpole nodule 2.0 x 1.3 x 1.2 cm on the right. Clinical correlation and follow-up could be of benefit. Nodules are indeterminate by ultrasound.
> 
> REASON FOR EXAM: HYPOTHYROIDISM, ENLARGED THYROID
> 
> FINDINGS:
> 
> Right lobe thyroid measures 2.5 x 1.2 x 1.4 cm.
> Dominant solid midpole nodule 2.0 x 1.1 x 1.2 cm on the right.
> Hypoechoic 4 x 2 mm lateral nodule.
> 
> Left lobe thyroid measures 2.6 x 1.1 x 1.2 cm
> Upper pole nodule 6 x 5 x 3 mm and lower pole 8 x 8 x6 mm nodule.
> Isthmus measures 3 mm.
> 
> *FNA:*
> 
> Clinical History: 2 cm solid right thyroid nodue with possible rare smaller lesions as per radiology.
> 
> GROSS EXAMINATION:
> Two FNA passes are performed by radiology consisting of a few bloody droplets of fluid from which two H&E smears and two DQ smears are generated.
> 
> MICROSCOPIC DIAGNOSIS:
> RIGHT THYROID, ULTRASOUND-GUIDED FNA: BENIGN-APPEARING FOLLICULAR EPITHELIAL ELEMENTS.
> 
> COMMENTS: The FNA smears consist of a mild to moderately cellular population of benign-appearing epithelial cells. These show some monolayered sheets as well as a focal microfollicular component without a prominent background colloid deposition or histocyte accumulation. There are no features of papillary thyroid carcinoma.
> 
> In summary, these findings may very well represent a cellular hyperplastic nodule (goiter); however, the possibility of a small follicular neoplasm cannot be completely ruled out. Continued close ENT and radiologic follow-up is advised. If the lesion should enlarge significantly over time, then further work-up to include re-biopsy/FNA is warranted.
> 
> My ENT wants to do another US in three months. If the nodule hasn't grown, he then wants to do another US in 6 months. My problem is that this sounds like an inconclusive diagnosis&#8230; which I thought usually resulted in surgery just to be safe. I read a study online that is suggesting that if the words "follicular neoplasm" are anywhere in the diagnosis, then the diagnosis should be "follicular neoplasm". I don't want to wait for this to grow and move somewhere else in my body before they take it out.
> 
> Your thoughts and opinions are appreciated.
> 
> Vg7707


I agree w/you 100%. The whole thing is indeterminate, iffy and inconclusive. They cannot say with certainty such as the "benign appearing" and so forth.

Why should you have to live on pins and needles here (is that a pun?); I would encourage you to have it out.

It is not always about what they do see but more about what they don't see. Ultra-sounds leave a lot to be desired and sometimes, so do FNAs.


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## vg7707

Andros said:


> I agree w/you 100%. The whole thing is indeterminate, iffy and inconclusive. They cannot say with certainty such as the "benign appearing" and so forth.
> 
> Why should you have to live on pins and needles here (is that a pun?); I would encourage you to have it out.
> 
> It is not always about what they do see but more about what they don't see. Ultra-sounds leave a lot to be desired and sometimes, so do FNAs.


When I first saw my ENT he told me that this could go one of three ways; 1) it's benign and we monitor it; 2) it's malignant and we remove it; or 3) it's inconclusive and we remove it. However, when we got the results he went to option 4) inconclusive and we just watch it... but we didn't discuss that one in the beginning so it caught me completely off guard.

I am seeing my GP in two weeks for a follow-up on my thyroid meds and I plan to talk to her in depth about this. She's been my doctor for a very long time and I can discuss anything with her and she listens. I may have her get in touch with my ENT (which she referred me to in the first place) to convince him that we don't need to wait. I'm still trying to get my head around this. I have had several first degree relatives that have died from cancer (colon, bladder, lymphoma) and I don't want to take any chances.

I have also read post after post of people with "benign" or "inconclusive" FNAs that later found out that they did indeed have thyroid cancer.

Thanks for your advice, Andros.

vg7707


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## Andros

vg7707 said:


> When I first saw my ENT he told me that this could go one of three ways; 1) it's benign and we monitor it; 2) it's malignant and we remove it; or 3) it's inconclusive and we remove it. However, when we got the results he went to option 4) inconclusive and we just watch it... but we didn't discuss that one in the beginning so it caught me completely off guard.
> 
> I am seeing my GP in two weeks for a follow-up on my thyroid meds and I plan to talk to her in depth about this. She's been my doctor for a very long time and I can discuss anything with her and she listens. I may have her get in touch with my ENT (which she referred me to in the first place) to convince him that we don't need to wait. I'm still trying to get my head around this. I have had several first degree relatives that have died from cancer (colon, bladder, lymphoma) and I don't want to take any chances.
> 
> I have also read post after post of people with "benign" or "inconclusive" FNAs that later found out that they did indeed have thyroid cancer.
> 
> Thanks for your advice, Andros.
> 
> vg7707


You are welcome and that is correct. FNA and ultra-sounds are limited. Many found out they had cancer "after" the TT! And thank God for that!

Please let us know what your wonderful doctor has to say.


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## vg7707

Andros said:


> You are welcome and that is correct. FNA and ultra-sounds are limited. Many found out they had cancer "after" the TT! And thank God for that!
> 
> Please let us know what your wonderful doctor has to say.


Hi Andros.

I wanted to let you know that I saw my GP today. The most concerning thing about today's visit was the letter that my ENT had sent over to her about my biopsy. He stated that my diagnosis was a "benign neoplasm". Did I miss something?! Nowhere on the original biopsy report did it say definitively that it was benign. I showed her my copy of the biopsy report and expressed my concerns. She thinks that I should just go ahead and have it taken out. Even if it turns out to be nothing, at least I won't be worried about it all the time.

I have nodules on both lobes even though they only biopsied one, so she even said that I should just go ahead and have the whole thyroid removed. We have had so many problems regulating my thyroid meds that she said it would probably be easier for us to get me regulated without it. Sometimes it works and sometimes it doesn't.

I also posted a new thread about this info, but wanted to also let you know since you had asked. 

Thanks for your advice.
vg7707


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## Andros

vg7707 said:


> Hi Andros.
> 
> I wanted to let you know that I saw my GP today. The most concerning thing about today's visit was the letter that my ENT had sent over to her about my biopsy. He stated that my diagnosis was a "benign neoplasm". Did I miss something?! Nowhere on the original biopsy report did it say definitively that it was benign. I showed her my copy of the biopsy report and expressed my concerns. She thinks that I should just go ahead and have it taken out. Even if it turns out to be nothing, at least I won't be worried about it all the time.
> 
> I have nodules on both lobes even though they only biopsied one, so she even said that I should just go ahead and have the whole thyroid removed. We have had so many problems regulating my thyroid meds that she said it would probably be easier for us to get me regulated without it. Sometimes it works and sometimes it doesn't.
> 
> I also posted a new thread about this info, but wanted to also let you know since you had asked.
> 
> Thanks for your advice.
> vg7707


Your GP is absolutely correct and she may in fact be saving your life. She is also right about thyroxine titration difficulties going by the wayside.

Not to mention, "Why should you have to angst for years to come over this!"

Do it to it!!!

Please let us know what you decide! Whatever you chose to do, we will respect that and support you one way or the other.


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## oceanmist

Just a question....how long did it take to get results for your FNA?

Thank you 
Oceanmist


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## sa103

It took at most 3 days, but, I go to a large hospital here in Chicago. That may make a difference, I'm not sure. Good Luck!


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## joplin1975

Three days for me, too. Medium-sized hospital in a medium-sized city.


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## Andros

vg7707 said:


> I am seeking opinions from anyone who can offer guidance. I'm a little worried about a recent FNA that I had. I have a large non-palpable solid nodule in the right lobe of my thyroid that was discovered on ultrasound and was referred to an ENT for consult. The ENT ordered an FNA biopsy. Here are the results of my US and FNA:
> 
> *Ultasound:*
> 
> Impression:
> 
> Dominant solid midpole nodule 2.0 x 1.3 x 1.2 cm on the right. Clinical correlation and follow-up could be of benefit. Nodules are indeterminate by ultrasound.
> 
> REASON FOR EXAM: HYPOTHYROIDISM, ENLARGED THYROID
> 
> FINDINGS:
> 
> Right lobe thyroid measures 2.5 x 1.2 x 1.4 cm.
> Dominant solid midpole nodule 2.0 x 1.1 x 1.2 cm on the right.
> Hypoechoic 4 x 2 mm lateral nodule.
> 
> Left lobe thyroid measures 2.6 x 1.1 x 1.2 cm
> Upper pole nodule 6 x 5 x 3 mm and lower pole 8 x 8 x6 mm nodule.
> Isthmus measures 3 mm.
> 
> *FNA:*
> 
> Clinical History: 2 cm solid right thyroid nodue with possible rare smaller lesions as per radiology.
> 
> GROSS EXAMINATION:
> Two FNA passes are performed by radiology consisting of a few bloody droplets of fluid from which two H&E smears and two DQ smears are generated.
> 
> MICROSCOPIC DIAGNOSIS:
> RIGHT THYROID, ULTRASOUND-GUIDED FNA: BENIGN-APPEARING FOLLICULAR EPITHELIAL ELEMENTS.
> 
> COMMENTS: The FNA smears consist of a mild to moderately cellular population of benign-appearing epithelial cells. These show some monolayered sheets as well as a focal microfollicular component without a prominent background colloid deposition or histocyte accumulation. There are no features of papillary thyroid carcinoma.
> 
> In summary, these findings may very well represent a cellular hyperplastic nodule (goiter); however, the possibility of a small follicular neoplasm cannot be completely ruled out. Continued close ENT and radiologic follow-up is advised. If the lesion should enlarge significantly over time, then further work-up to include re-biopsy/FNA is warranted.
> 
> My ENT wants to do another US in three months. If the nodule hasn't grown, he then wants to do another US in 6 months. My problem is that this sounds like an inconclusive diagnosis&#8230; which I thought usually resulted in surgery just to be safe. I read a study online that is suggesting that if the words "follicular neoplasm" are anywhere in the diagnosis, then the diagnosis should be "follicular neoplasm". I don't want to wait for this to grow and move somewhere else in my body before they take it out.
> 
> Your thoughts and opinions are appreciated.
> 
> Vg7707


I agree w/you!! There are too many "iffables" as I call them. Solid, indeterminate, benign-appearing, rare smaller lesions etc..

If I were you, I would consult w/another ENT. If you have insurance, they may be pulling the strings here.

Have you had Thyroglobulin and Thyroglobulin Ab lab tests?

Also, why should you live in worry every day? Makes no sense to me. I think that your thyroid should wave bye bye!


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## vg7707

Andros said:


> I agree w/you!! There are too many "iffables" as I call them. Solid, indeterminate, benign-appearing, rare smaller lesions etc..
> 
> If I were you, I would consult w/another ENT. If you have insurance, they may be pulling the strings here.
> 
> Have you had Thyroglobulin and Thyroglobulin Ab lab tests?
> 
> Also, why should you live in worry every day? Makes no sense to me. I think that your thyroid should wave bye bye!


To the others above: it took about a week to get my results simply because that is when my follow-up with my ENT was scheduled.

Newest developments on my situation:
I called my ENT back and spoke with him over the phone. He did say that surgery was an option, but that because there is a risk of paralysis to the vocal nerve, he wanted to be sure it was needed. He said let's wait and do another U/S in 3 months, if it's grown, we'll take it out anyway. He also said that if I have thought about it everyday for three months, we'll take it out. However, he only wants to take out one lobe. I want the whole thing taken out because I have two nodules on the other side. I agreed to wait simply because I want to know if they are all growing.

I have had additional blood tests since this time. Thyroid AB was 33, range is <40. I also had a T3 uptake with was low 20.6 range 24.3 -39. My GP has now referred me to an Endocrinologist because she thinks I may have a pituitary problem. I see the Endo on the 22nd of this month. I have read, however, that the T3 uptake is an outdated test. Anyone have any thoughts on this?

vg7707


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