# Do I have to request an FNA??



## shellebean (Oct 12, 2011)

Hello everyone, I have a question about having an FNA. I am scheduled Wednesday for an Endo appointment (waited weeks to get in with her). I have already met with an ENT, but they are now setting me up with Endo. I have two complicated cysts (1cm oval and 0.7 cm round) and two solid hypoechoic nodules (0.6 and 0.4cm) in the isthmus. Highly suggested Hashi's because of TPO 698.6 and entire thyroid is heterogeneous with increased vascularity. I really feel that I should have an FNA at the least (I don't want to "watch" these cysts/nodules since they are fairly small. That is what I am afraid they will suggest. Not sure. When I see the Endo Wed. should I ask for an FNA? Do they have to plan that ahead of time, or can they decide and do it on the spot? Does the Endo even usually do the FNA?? I am not sure if I should call ahead and ask or just wait until the appointment. I don't want to wait for another month to get some other determination.
Help?


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## lainey (Aug 26, 2010)

With nodules of that small size, it is very unlikely that they would get a good sample. The whole reason for "watch and wait" is because thyroid cancer is generally slow growing (odds are against having it with multiple small nodules) , and the chance that you would get an "indeterminate" sample on such nodules/cysts is very high. The net result is an unnecessary procedure and unnecessary anxiety.

Do they have copies of the ultrasound images? If so, if you were to ask, they can tell you if they are likely to do it at the appointment.

Generally the way it works is, if they can look at those images and see anything that arouses their suspicion, they hurry things along. If they are not hurrying up the appointment, etc, they probably haven't observed anything very abnormal.


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## shellebean (Oct 12, 2011)

Thanks, Lainey. I understand your point about not getting good readings with small nodules. I am just concerned about some of the other characteristics; they lean towards questionable. At least, would like them to do FNA on the 1cm complicated cyst. We'll see tomorrow what they suggest. Just hate waiting for ANOTHER appointment if they don't do them without planning for it.


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## Andros (Aug 26, 2009)

shellebean said:


> Hello everyone, I have a question about having an FNA. I am scheduled Wednesday for an Endo appointment (waited weeks to get in with her). I have already met with an ENT, but they are now setting me up with Endo. I have two complicated cysts (1cm oval and 0.7 cm round) and two solid hypoechoic nodules (0.6 and 0.4cm) in the isthmus. Highly suggested Hashi's because of TPO 698.6 and entire thyroid is heterogeneous with increased vascularity. I really feel that I should have an FNA at the least (I don't want to "watch" these cysts/nodules since they are fairly small. That is what I am afraid they will suggest. Not sure. When I see the Endo Wed. should I ask for an FNA? Do they have to plan that ahead of time, or can they decide and do it on the spot? Does the Endo even usually do the FNA?? I am not sure if I should call ahead and ask or just wait until the appointment. I don't want to wait for another month to get some other determination.
> Help?


I would insist on it and soon. They may never even mention it to you; especially if it is under insurance. They have orders from on high to "save money" and then they get a bonus at the end of the year.

Hey, the patient be damned!!

Push and push some more. So far as I know ENT would be your best bet for FNA.

I found this:

Typically, FNAs are done by by endocrinologists, cytopathologists, or surgeons. The cells are studied and assessed by a cytopathologist.

Make sure that the practitioner has extensive experience in doing fine needle aspirations. Ask how many aspirations the practitioner does each month, and ask their "unsatisfactory" or "inconclusive" specimens rate. Don't always assume an endocrinologist is particularly skilled in this technique - he or she may not regularly perform this procedure.

http://thyroid.about.com/cs/nodulesgoiters/a/fna.htm


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## joplin1975 (Jul 21, 2011)

I think we all understand the frustration of waiting for yet another appointment!!!

Hopefully they can answer your question. They may be able to get a FNA on the 1cm one, which can give you some answers...

Hang in there.


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## shellebean (Oct 12, 2011)

Thanks, Andros. I can definately be persistant! Just need to know when to turn it on and off!! Ha. I will f"eel it out" tomorrow at Endo appt. They already have me scheduled for follow up with ENT next week so I'm curious why they would already plan to follow up so soon. I appreciate the info!!


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## shellebean (Oct 12, 2011)

Thanks Joplin. I think you may be the one that said my situation was similar to yours. Sorry to hear about all the post surgery challenges you are going thru. I've read online about all these results of nodules that are small and end up cancerous. How did they know that if they didn't do an FNA on them or just take the whole dang thing out and test them?? I'd say in those cases, they were lucky they didn't wait and see...allowing them to get bigger before proceding.


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## Andros (Aug 26, 2009)

shellebean said:


> Thanks, Andros. I can definately be persistant! Just need to know when to turn it on and off!! Ha. I will f"eel it out" tomorrow at Endo appt. They already have me scheduled for follow up with ENT next week so I'm curious why they would already plan to follow up so soon. I appreciate the info!!


Aaaaaaaaaaaaaaaah; if you are being scheduled w/ENT, you are on track.

Complicated and solid are 2 words that raise suspicion for cancer as you well know.

Keep us informed of your progress!


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## shellebean (Oct 12, 2011)

Yes, have met with ENT twice (first time explained my ultrasound and took more blood for additional tests-second to give results of blood tests which suggested Hashi's). Then set me up with Endo for next step and scheduled another ENT appt to follow. At least I feel on track!


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## joplin1975 (Jul 21, 2011)

shellebean said:


> Thanks Joplin. I think you may be the one that said my situation was similar to yours. Sorry to hear about all the post surgery challenges you are going thru. I've read online about all these results of nodules that are small and end up cancerous. How did they know that if they didn't do an FNA on them or just take the whole dang thing out and test them?? I'd say in those cases, they were lucky they didn't wait and see...allowing them to get bigger before proceding.


Yup -- my GYN found mine too and started this whole process. When we originally conversed, I had forgotten that some doctors don't FNA nodules smaller than 1cm. Mine were 3cms, so once I got in touch with a surgeon, he biopsied them right away.

I forget if I am repeating myself (apologies if I am), but another approach would be to inquire about a radioactive iodine uptake study/scan. They'll give up a trace amount of radioactive iodine to see how "active" your thyroid is..."cold" nodules or those nodules that don't uptake iodine are generally of concern (when we are discussing cancer -- mine were all cold) and it might push a wait-and-see doc into agreeing to a FNA sooner rather than later.

Just a thought!


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## shellebean (Oct 12, 2011)

THANKS, this all is very helpful!


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## shellebean (Oct 12, 2011)

Well, met with Endo today. Kinda non-eventful. I guess that is good.
No medication at this point- even with the Hashi's, my Thyroid is "working within the ranges" so I'm not Hypo yet. When I asked about the complex cysts/solid nodules, she said that they were all small and that I shouldn't worry. She set up an appt for more blood work in 6 months. I asked about biopsy and she said the largest complex cyst was 1cm so they could do that. She said thao 50% of Dr's would say to do and other 50% would say let it go for now. I said let's do the FNA for MY piece of mind. Have that scheduled for 11/15.


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## Andros (Aug 26, 2009)

shellebean said:


> Well, met with Endo today. Kinda non-eventful. I guess that is good.
> No medication at this point- even with the Hashi's, my Thyroid is "working within the ranges" so I'm not Hypo yet. When I asked about the complex cysts/solid nodules, she said that they were all small and that I shouldn't worry. She set up an appt for more blood work in 6 months. I asked about biopsy and she said the largest complex cyst was 1cm so they could do that. She said thao 50% of Dr's would say to do and other 50% would say let it go for now. I said let's do the FNA for MY piece of mind. Have that scheduled for 11/15.


I am glad you are getting the FNA. One step at a time here. Very good news!


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## joplin1975 (Jul 21, 2011)

Glad to hear you are getting that FNA.


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## shellebean (Oct 12, 2011)

Me too. Sad that I had to ask to have it though. I know it's pushing the size that is recommended to perform FNA on, but knowing there are complex cysts and hypoechoic solids in there and with Hashi's...I didn't think it should be blown off.


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## webster2 (May 19, 2011)

I am glad you asked, and are getting one. Piece of mind is never a bad thing!


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## webster2 (May 19, 2011)

Ugh, peace...can you tell I am wiped out.


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## shellebean (Oct 12, 2011)

I'm with ya, Webster..."Piece Out"!


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## lainey (Aug 26, 2010)

shellebean said:


> Me too. Sad that I had to ask to have it though. I know it's pushing the size that is recommended to perform FNA on, but knowing there are complex cysts and hypoechoic solids in there and with Hashi's...I didn't think it should be blown off.


This really isn't about "blowing it off". It's about statistics, sample size and the possibility of unnecessary stress and procedures for the patient.

The problem is that because of it's small size you could very well end up with the opposite of what you think you want--no peace of mind at all because of an indeterminate result.

Be prepared for that possibility, because then you will be faced with another watch-and-wait-or-further-consult decision.


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## shellebean (Oct 12, 2011)

Thanks Lainey, I do understand that. It's frustrating though when I've had the Gyno, Ultrasound Dr and the ENT all tell me I have a very unhealthy thyroid, but there's little to do until it gets worst. It is what it is I guess. I'll "chill out".


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## shellebean (Oct 12, 2011)

Interesting, just when I've been telling the Dr.'s that there are no thyroid issues in my family, my aunt (paternal) tells me that she has been on synthetic thyroid medicatiojn after a pituitary adenoma, tumor bled in 2001. She also tested positive for Sjrogen's syndrom 2 years ago. Based on symptoms, she thinks that her mom (my gma) and her gma had thyroid (or autoimmune) issues but were scared of Dr.s and wasn't diagnosed/treated directly for the issues. They were treated for diabetes. 
Is my aunt's pituitary issues/Sjrogens related to my possible thyroid/hashi/nodules issues?? Or are these totally separate issues that are not hereditary?


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## Andros (Aug 26, 2009)

shellebean said:


> Interesting, just when I've been telling the Dr.'s that there are no thyroid issues in my family, my aunt (paternal) tells me that she has been on synthetic thyroid medicatiojn after a pituitary adenoma, tumor bled in 2001. She also tested positive for Sjrogen's syndrom 2 years ago. Based on symptoms, she thinks that her mom (my gma) and her gma had thyroid (or autoimmune) issues but were scared of Dr.s and wasn't diagnosed/treated directly for the issues. They were treated for diabetes.
> Is my aunt's pituitary issues/Sjrogens related to my possible thyroid/hashi/nodules issues?? Or are these totally separate issues that are not hereditary?


The propensity for autoimmune is genetic (familial) and could take any pathway once it rears it's ugly head.

How about that; you must be surprised to find there is a familial leaning towards autoimmune diseases?

Bless your heart. Keep on asking questions, you may find out a lot more. The thing is though, back in the day, sometimes folks did not even know what they had much less kept any medical records.


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## shellebean (Oct 12, 2011)

Thanks Andros! I am sure everyone gets tired of all the questions, but I'm full of them!!


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## Andros (Aug 26, 2009)

shellebean said:


> Thanks Andros! I am sure everyone gets tired of all the questions, but I'm full of them!!


I have always thought that if you ask questions, it makes the folks who answer those questions feel important!! Ha, ha!


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