# Help Needed in Deciphering Medical Gobledy-****



## mysarojane (Sep 11, 2010)

I had my FNA on 9/27 of this year and just got a copy of my results today. That, in and of itself, is a long story.

I was told the results were inconclusive and need to follow up with an endocrinologist.

GROSS DESCRIPTION:
SPECIMEN ADEQUACY: INADEQUATE (DED)

MICROSCOPIC DESCRIPTION:
Moderately cellular aspirate with enlarged follicular cells present as microfollicles, crowded sheets and naked nuclei. No colloid or macrophages seen. The follicular cells are enlarged with fine chromatin and micronucleoli. No intracytoplasmic inclusions identified.

FINAL DIAGNOSIS:
SATISFACTORY FOR EVALUATION.
Follicular lesion with atypical nuclear features. Considered in the differential diagnosis is follicular variant of papillary thyroid carcinoma, follicular neoplasm, and adenomatoid nodule.

Can someone who's been through this help me figure out what this means? Thanks!!


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## mysarojane (Sep 11, 2010)

Anyone? 54 views an no responses?

Can someone at least explain to me the last part about the differential diagnosis - no idea what that means but I certainly do know what carcinoma means.

Starting to freak out here...


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## tina (Sep 17, 2010)

I am so sorry you are going through all of this! Unfortunately, I don't know what the results mean either, but, I would definately be calling and getting into an Endo asap! One thing I have learned through my own experiences is to TRY not to worry about the unknown. That is the most difficult thing in the world in my opinion. The unknown is the most horrific thing in our minds. I am sure that there will be lots of responses in time. There are some very knowledgable people here. Welcome to the boards and good luck in your new journey. That is the way I have chosen to feel about this today...This is just another journey in my long and wonderful life!


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## GD Women (Mar 5, 2007)

mysarojane said:


> Anyone? 54 views an no responses?
> 
> Can someone at least explain to me the last part about the differential diagnosis - no idea what that means but I certainly do know what carcinoma means.
> 
> Starting to freak out here...


If no one answers its probably because no one know the answer. After all we are only laypersons not doctors and we certainly don't know or have all the answers. So its nothing against you.

If you were told that "results were inconclusive and need to follow up with an endocrinologist" then go with that.

Perhaps you should have asked for it all to be explained to you before leaving the doctors or Lab with your copies, whatever.

FNA is not a 100%. Surgery to take out the nodules for biopsy is the only true and safe way to tell if its cancer or not.

Sorry you are not getting your answer.


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## Cheracup (Sep 23, 2010)

I know how hard it is to wait for some kind of explanation about what is going on. From my understanding, a 'differential diagnosis' means they figure things out by looking at everything they know and then by the process of elimination. So, without definite evidence that points directly at one specific thing, they say - what we know fits into the following diagnoses. Not that I think Googling until you are dizzy and scared is a good idea, but you might want to do a bit of research on each of the 3 possibilities so that when you meet with your Doctor, you have a basic understanding of what he is talking about.

Definitely get into an endocrinologist as soon as you can so that you can get a few answers and can rest easier!

Take gentle care of yourself!!


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## Andros (Aug 26, 2009)

mysarojane said:


> I had my FNA on 9/27 of this year and just got a copy of my results today. That, in and of itself, is a long story.
> 
> I was told the results were inconclusive and need to follow up with an endocrinologist.
> 
> ...


Boy, that is a horrifically long time to wait for a pathology report! I am worried. I do think that this warrants further attention. Perhaps even another FNA.

Here is some info.

http://www.springerlink.com/content/v153475040w361u8/

Please read this one carefully, it is very very informative.

http://www.uscap.org/site~/98th/pdf/companion14h06.pdf

Keep us posted on this, please? Did you make appt. with the endo? Have you had Thyroglobulin antibodies' labs done?

I also think a radioactive uptake scan would be warranted at this time.

The above is a humble layperson's opinion only.

Welcome to the board. We have many here who will be able to provide experienced input.


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## mysarojane (Sep 11, 2010)

Hi, long time for me to respond, I know!

Anyway, I did not follow up as I had planned with my outcome. Lots of things interrupted life and....you know how that happens.

So, today, saw a new Internal Med Dr who was great! He is referring me both to Endo and ENT at my Hospital for follow up.

In the last 1-2 months I have started having a type of pain on my left side when I swallow. Not every swallow but most. Not an internal "sore throat" kind of pain, but more of the feeling like something's stuck in your throat. My right thyroid is still swollen more than average size.

Here's to hoping we go somewhere and figure it all out. Thanks for all your help and encouragement!

Sarah


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## Andros (Aug 26, 2009)

mysarojane said:


> Hi, long time for me to respond, I know!
> 
> Anyway, I did not follow up as I had planned with my outcome. Lots of things interrupted life and....you know how that happens.
> 
> ...


Wow, Sarah!! It's been a long time and I am distressed to hear that you are just now getting around to you and your needs.

Things w/your thyroid did not sound so good way back in December!

Here is some reading material.

http://www.uscap.org/site~/98th/pdf/companion14h06.pdf

http://www.cumc.columbia.edu/dept/thyroid/papillary.html

I presume your new doc has seen your pathology report from Dec. 2010?

Will you let us know when your appts. are set up?


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## mysarojane (Sep 11, 2010)

Will do! Blood for new labs were taken yesterday and follow up with my Dr. to review them is on August 2nd.


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## Andros (Aug 26, 2009)

mysarojane said:


> Will do! Blood for new labs were taken yesterday and follow up with my Dr. to review them is on August 2nd.


Very excellent! If you want to, please post the results of those labs and the ranges. I am sure we all would like to have a look see.


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## mysarojane (Sep 11, 2010)

Got a call today for the ENT referral; scheduled for August 11.


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## Suburban (Jun 12, 2011)

At least things are moving along now - fingers crossed it goes well for you : )


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## mysarojane (Sep 11, 2010)

Thanks for your support! :hugs: Got a call for the Endo consult today - scheduled it for the same day, August 11, but 5 hours apart!!! Looks like I'll spend the day at the hospital....or shopping!!

I'm not feeling nervous. I've learned enough to know what the signs are pointing to. And if it's not cancer, great! But if it is, I'm reading about what I need to know, ask, and be prepared for. I feel really good mentally. Very empowered.


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## Andros (Aug 26, 2009)

mysarojane said:


> Thanks for your support! :hugs: Got a call for the Endo consult today - scheduled it for the same day, August 11, but 5 hours apart!!! Looks like I'll spend the day at the hospital....or shopping!!
> 
> I'm not feeling nervous. I've learned enough to know what the signs are pointing to. And if it's not cancer, great! But if it is, I'm reading about what I need to know, ask, and be prepared for. I feel really good mentally. Very empowered.


I am so glad to hear things are set into motion for you. You have a very good attitude.

You know of course we all wish for good news! If not, it is far better to know than to not know so the proper medical intervention can take place.










We are here for you.


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## mysarojane (Sep 11, 2010)

Got my lab results today and was discouraged that my new Dr. did not run a full thyroid panel.  Here's what he got...

Thyroxine Free = 1.81
TSH = 2.910

Both of which he said were fine.

I left, and then returned to ask the nurse if it were possible to run the Pero AB test since that was the one last year that was abnormal and she got the head nurse to ok it and put it in. I also had them run the Triiodothyronine test which I think is the T3???

Just goes to show, you and your Dr. cannot read each other's minds and you have to be pro-active about what you want and need in health care. 

The nurse said I can call him for the results in a few days, and I'll post them up here...

On another note, he did say that my thyroid was still significantly swollen on both lobes and my lymph nodes were quite swollen as well (and tender!)


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## northernlite (Oct 28, 2010)

Except for the symptoms from your swollen thryroid how do you feel? Without ranges it is tough to tell where your FT4 is. Your TSH is at a level that is fine for some people but symptomatic for a lot of us.


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## Andros (Aug 26, 2009)

mysarojane said:


> Got my lab results today and was discouraged that my new Dr. did not run a full thyroid panel.  Here's what he got...
> 
> Thyroxine Free = 1.81
> TSH = 2.910
> ...


Geez; it's like pulling teeth.

Honey bunny! In the future we need the ranges with your lab results as different labs use different ranges.

I will say that if "my" TSH was 2.910, I would be quite quite symptomatic, I kid you not.


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## mysarojane (Sep 11, 2010)

Well, that's all they wrote (literally) on the report. I'll try to dig up some more information when I call later this week for my new lab results...


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## Andros (Aug 26, 2009)

mysarojane said:


> Well, that's all they wrote (literally) on the report. I'll try to dig up some more information when I call later this week for my new lab results...


Maybe you could call the lab to get the ranges if your doctor won't furnish them? Giving you results w/o the ranges is the same as not complying with your right to have your labs at all.

I see no difference.


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## mysarojane (Sep 11, 2010)

Ok, I got my lab results today AND got the ranges for all the current lab work. Here we go...

July/August 2011
FT4 1.81 (.78-2.19)
TSH 2.910 (.465-4.68)
T3 1.63 (.97-1.61)
Thyroid Pero AB 384

September 2011
FT4 1.38
TSH 2.580
T3 1.13
Thyroid Pero AB 290

Can't find the paperwork from the original labs (copied the numbers from my original post) but would assume the ranges are the same as it was the same lab.

Alrighty then, input anyone? I see ENT and Endo on Thursday. From what I think I know, it's pointing to Graves and/or cancer based on this and my FNA results.


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## Andros (Aug 26, 2009)

mysarojane said:


> Ok, I got my lab results today AND got the ranges for all the current lab work. Here we go...
> 
> July/August 2011
> FT4 1.81 (.78-2.19)
> ...


We sure do appreciate you getting your ranges.

Free T4 is quite below the mid-range of 1.98 as per the range provided by your lab. That is not good.

Total 3 is above the mid-range 1.29 of the range provided by your lab but one must bear in mind this is not a FREE test. Total is bound, unbound and rT3 (reverse hormone) so it is hard to know where you really stand on that one.

Not sure you have the dates right though; Sept. is near but not quite here yet. Bless your heart!

I don't think it is pointing to Graves' but cancer is a strong possibility based on your FNA. You are in my prayers for this.

You know we will all be with you in spririt on Thursday when you see the ENT and Endo.


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## mysarojane (Sep 11, 2010)

Had my 2 appointments today: ENT and Endo.

ENT I actually met with a thyroid surgeon and really liked him a lot. Got the scope up my nose and down my throat. Not fun, but I liked being able to see all my throat parts - very cool! Doc said my tonsil tissue was a little inflamed and thought I might have some mild acid reflux for which he suggested Nexium. Everything else internally looked ok. I had him decipher my FNA results and he said that he didn't like that the cells were atypical, but that they could not tell whether they were cancerous or benign. He recommended surgical removal of the right lobe for a more thorough biopsy.

On to Endo...

Met with Endo who was the Chief of the Dept. He did another u/s of my thyroid area and showed me all the pics he took. The larger nodule was of a darker color and showed possible microcalcifications, both of which he said were not ideal. He also agreed that as the results were inconclusive he recommended a surgical biopsy of the right lobe. He said the percentage of nodules that were cancerous was about 5% but since the results were neither here nor there and not definitive it increased those odds to 25-30%. So we agreed on surgery.

Back downstairs to ENT...

Called my BF and he met me at the elevators to go back down to ENT (he works at the hospital.) Went on down and were lucky to get not only the same surgeon as I saw that morning, but his last appointment for August - August 23.

As soon as I left ENT the first time, I started getting woozy and lightheaded. Just spacey. I think I was getting overwhelmed by being at the hospital and the reality of things setting in. No matter how mentally prepared you thing you are...you just aren't. By the time I got to ENT to schedule my surgery I had to put my head between my legs. I guess I was just overwhelmed.

Went to work tonight and my boss and the HR lady were not there, but I did go online and put in for a Leave of Absence. Surgery is scheduled for the day after my new semester starts too - geeze!


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## Suburban (Jun 12, 2011)

Well done you for getting those two opinions from the two docs/surgeon! At least you can be sure you are making an informed decision now. Let us know how it all goes. :hugs:


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## Andros (Aug 26, 2009)

mysarojane said:


> Had my 2 appointments today: ENT and Endo.
> 
> ENT I actually met with a thyroid surgeon and really liked him a lot. Got the scope up my nose and down my throat. Not fun, but I liked being able to see all my throat parts - very cool! Doc said my tonsil tissue was a little inflamed and thought I might have some mild acid reflux for which he suggested Nexium. Everything else internally looked ok. I had him decipher my FNA results and he said that he didn't like that the cells were atypical, but that they could not tell whether they were cancerous or benign. He recommended surgical removal of the right lobe for a more thorough biopsy.
> 
> ...


I am sorry you have to have the surgery but ever so glad they are going to do it and the best part is that it sounds like you are in very very competent hands.

Very excellent. Let us know the date of your surgery!


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## mysarojane (Sep 11, 2010)

Thanks for the support! These boards, and our members, have been an invaluable resource for me! Thank you, again!

Surgery is August 23rd.

And, I have Hashi's.


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## Andros (Aug 26, 2009)

mysarojane said:


> Thanks for the support! These boards, and our members, have been an invaluable resource for me! Thank you, again!
> 
> Surgery is August 23rd.
> 
> And, I have Hashi's.


Glad it is all set up. Good deal!


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## mysarojane (Sep 11, 2010)

Ok, I think I'm as ready as I'll ever be. Surgical pre-op is tomorrow morning 7am and I should find out the time of surgery tomorrow. Got all kinds of yummies at the grocery store: pudding, jello, ice cream, cottage cheese, juices, straws and ice packs. Got 2 new pairs of comfy jammies to wear. And hit Borders for 5 really cheap books!

I also start school tomorrow, so have to go straight from my pre-op appointment to class (I'll be late) and then have classes straight through til 3pm.

I'll probably spend the day at the hospital Tuesday no matter what time my appointment cuz my boyfriend has a class for work all day, so he'll drop me and my daughter off at the hospital. Julie will be with me before and after the surgery (she's 18) and he'll come by when his class is done. I won't be able to go home until Wednesday night tho cuz he has class again.

So here begins the fun!


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## Andros (Aug 26, 2009)

mysarojane said:


> Ok, I think I'm as ready as I'll ever be. Surgical pre-op is tomorrow morning 7am and I should find out the time of surgery tomorrow. Got all kinds of yummies at the grocery store: pudding, jello, ice cream, cottage cheese, juices, straws and ice packs. Got 2 new pairs of comfy jammies to wear. And hit Borders for 5 really cheap books!
> 
> I also start school tomorrow, so have to go straight from my pre-op appointment to class (I'll be late) and then have classes straight through til 3pm.
> 
> ...


Wishing you all the best today and tomorrow!! Keeping you in my thoughts and prayers.


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## Suburban (Jun 12, 2011)

Good luck with the surgery - hope it all goes well x


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## mysarojane (Sep 11, 2010)

Thanks for all the well wishes and support! Surgery is scheduled for 730am...I have to be there at 550am - YIKES!


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## mysarojane (Sep 11, 2010)

Had my surgery Tuesday, August 23rd and I've lived to tell the tale!

First and foremost, I DO NOT HAVE CANCER!!!!!!!! arty0049:

And now...for the REST of the story....

Checked in to the hospital at 550am for a 730 surgery. Surgery should take 2.5 hours approximately and I was supposed to be in recovery sometime around 10 or 1030 that morning. My BF had a class he had to be at and would be by afte that but my youngest daughter was going to stay and tough it out with me. I remember going into the operating room and requesting my "happy juice".....arty0036:

When I woke up it seemed dark and I asked what time it was. They said 6pm at night. I had been in surgery for nearly 9 hours! My BF and daughter were there and explained it to me what happened and immediately after my surgeon appeared for the same.

They removed my right thyroid lobe as planned but found a cyst up underneath my chin which had to be removed. Apparently, when we are in an embryonic stage, the tissue which becomes the thyroid detatches from the back of the tongue and slides down a duct in the neck called the thyroglossal duct. On most people this duct eventually closes off and/or is absorbed. In some it remain open (called a persistant thyroglossal duct) and a cyst can form, a thryglossal duct cyst. That is what happened to me. This also probably explains the swelling the ENT doctor saw inside my lower throat when he put the scope down there.

So I had two incisions instead of one, as well as a drain coming out of the right side of the lower incision. Plus an IV on my hand. And I'm on oxygen

I also had these great leg thingies on which massaged my calves off and on all the time. I was mobile from the first day so it was kinda a pain to have to unattach them all the time and then reattach them again. The one nurse would always for get to turn them back on after she attached them and I'd have to call.

Wednesday morning the docs came in and explained what happened again and started prepping me for discharge. They said I'd go home with the drain in my neck but could come back to have it removed when it was draining less than 30ml a day.

Then the nurse comes in to take my BP and stats. BP is a little high (LOL) 167/108. And my O2 is low. Nurse keeps coming in to check it. I start hating to see her cuz it's like she wants me to take a test I know I'm going to fail. She puts me back on oxygen. Tells me to stay in bed. Docs come back in and say my O2 is too low to go home, they'd like to keep me one more day and just monitor me as a precaution. I tell them I'd never had a HBP problem, only sporadic high readings associated with anxiety. So, I'm in for another day of yummy hospital food (everything is covered in gravy, I think, to make you poop!) Turkey and gravy, yankee pot roast and gravy, roast beef and gravy...etc. I start a collection of cold cereals, jam and fruit cups in my take home bag. I stay on oxygen off and on all night.

Both my roommate and I have requested (and got) fans on our sides of the room cuz it is so freakin hot! We are on the afternoon sun side of the building and geeze!!! Even the nurses are sweating! And of course the pillows and mattresses are vinyl-covered for cleaning and then have sheets on top, so they make you sweat even more.

The muscles in my arms and back are all siezed up. Probably, they tell me, from being in the one position for the entire surgery. I can barely move my arms. So, when I can, I do small lifting exercised and work on rotation movements to stretch them out. Minimal improvement.

Oh, also on Wednesday. I pooped! :sick0019:

Thursday morning I wake up. Not that I slept at all well during this whole time. Everytime I did, it felt like I had slept for 6 hours but I'd ask about them time and find I was only out for 1/2 hour or 1 hour or the like. Frustrating. Off and on like this the whole time.

Evil BP nurse comes to check me and my O2 is better but my BP and pulse are still so high she says she's going to do a quick EKG before they talk about discharging me again. She puts those sticky-thingies all over my chest and shoulders and runs the test. I can tell from her face she's not reading happy news. She goes away and comes back a little while later and runs it again. I'm happy and mentally clear and joking with the whole staff the entire visit so far. Walking around, going to the bathroom, etc. My throat doesn't hurt internally. I haven't taken pain meds for over 12 hours. I'm ready to go home.

She looks at the results again, not happy. She says I'm not totally sure but you may have had a heart attack.

This is getting long and my BF needs his computer so I'll finish on my laptop in another post.


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## mysarojane (Sep 11, 2010)

...and she says, I'm not totally sure but you may have had a heart attack. :confused0068: I ask her now? When? She asks about chest pains which I've had none. She said they'll have to run some blood tests to determine when this event occurred.

I immediately text my BF and get him on the phone. So wierd, I was *feeling* fine!

Doc comes in and says they are moving me to Telemetry (which I had no idea what that was) to monitor my heart and make sure nothing else happens and no, I'm not going home again!

Sheesh, it's ALWAYS something!!! ROFL! 

Immediately they put me in a wheelchair and away we go to the other end of the floor to Telemetry. My nurse, who I actually really liked, hugged me and wished me the best of luck. She said she'd miss me and my humourous and positive attitude. :anim_63:

As least this room was on the cooler side of the hospital! But, I had a roommate again, and older woman with severe gout, ulcers and a multitude of things. She was in a lot of pain and had a lot of carepeople there so it was a little distracting (not to be rude about it) and disheartening. There is a family sitting room next door tho, so when I can I go there to give her some privacy as well as I know it's not easy to be miserable in front of strangers and have yourself poked and prodded. The first night she was quite loud.

About 830pm they wheeled me out for a CAT scan to see if they could identify the problem. That was pretty easy. Went back to my room and back to sleep by 1030.

Got a phone call to my room from my ENT doctor who told me they found 3 blood clots in my lungs on the CAT scan. To be woken out of a dead sleep to *that* phone call was not fun. No one came in person to tell me. I started to cry. :sad0007:

I had researched everything about my surgery but not the complications. It wasn't going to happen to me, complications are rare. So, for once, I was terrified. I was unprepared. I thought I was going to die. They only thing I knew about blood clots was that they can kill you. Only what I'd seen on medical TV shows. They were S E R I O U S! And D A N G E R O U S! I didn't know what to do! Should I move? Breathe? And I had to pee!

I texted my BF and he talked me down a bit. He offered to come back but I didn't want him to have to drive all the way back to the hospital and get NO sleep before his class. He was already burning at both ends (class, work, me, my daughter AND working on a paper for his 2nd Masters')

I called a nurse to help me up and started to cry again. :sad0004:He agreed that someone should have come and told me in person; the doc was shitty to do that. He reassured me that I wouldn't die and that they were there to help me. They started me on an aggressive heparain drip in my IV to help prevent any further blood clots. The ones I had would just be absorbed into the lung tissue and dissolve on their own.

My BP continued to remain high (duh!) but my O2 levels and pulse were now within normal ranges. Needless to say, I would not be going home Thursday! And, I had NOT had a heart attack, my EKG was indicative of the blood clots.

Thursday they inform me that I'll have to give myself shots twice a day in the stomach for a week or so with an anti-coagulant. I am NOT psyched about this!

Getting a little tired. Will post more later...


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## Suburban (Jun 12, 2011)

Hey there! So glad you made it through and boy, have you been through alot!

I really admire your positive attitude!

Those bloodclots sounded scary but good job they found them while you are at the hospital and are treating you for them.

Thanks for posting your story - its good to know the details of what possibly to expect should I (and others) go through such surgery.

Hope you get all sorted soon and can then recover at home. hugs3


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## webster2 (May 19, 2011)

Wow, what an unexpected turn of events, but you have handled it admirably! I am glad the blood clots were found, and they cyst. Hope you will begin to feel much better very soon. Thanks for sharing your story.  Please come back & let us know how you are doing.


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