# Atypical Hurthle cells found in biopsy - Hashi's?



## sunvsmoon (Mar 17, 2018)

I am 28 years old and female. My biopsy results came back. Upon ultrasound, 4 nodules were found, 2 were biopsied, one on each side. I've posted results below. Just the mention of Hurthle cells is really, really freaking me out!  My doctor didn't go over the results either, so I'm not sure if the terms being used are indicative of malignancy. However, I've read that Hurtheloid cells can be found in someone with Hashi's and aren't necessarily indicative of Hurthle cancer. Is this the case? Did anyone else have this experience? I am meeting with an endo in a couple of weeks to discuss whether or not they think I should take my entire thyroid out so am trying to learn as much as I can about my own report and others' personal experiences before discussing such a huge decision. Some of my lab work history is also below.

TSH: March 2018 - 2.3, Dec 2016 -1.51, June 2015 - 1.68

Thyroid peroxidase antibodies: March 2018 - 94

T3, free: March 2018 - 3.2

T4, free, direct dialysis: March 2018 - 1.6, August 2017 - 2.2

Ultrasound: 
RIGHT LOBE: Normal size with very heterogeneous parenchyma. Subtle hyperechoic nodule centrally is 1.3 x 1.1 x 1.1 cm. Subtle hypoechoic region with ill-defined margins measures 1.0 x 0.9 x 0.9 cm. 
LEFT LOBE: Normal size, slightly heterogeneous. Anteriorly in the left lobe there is a 1.0 x 0.5 x 0.6 cm slightly hypoechoic nodule that appears somewhat 
exophytic at the superior pole. At the inferior pole there is a heterogeneous nodule 1.6 x 1.2 x 1.1 cm with isoechoic and hypoechoic regions, and small 
echogenic foci.
ISTHMUS: Normal. No visible mass, cyst, calcification, enlargement, or abnormal echotexture.

Microscopic Description:

Diagnosis:
A: Thyroid, right middle lobe, FNA:
Atypical Hurthleoid cells and lymphocytes 
Atypical cells of uncertain significance, Bethesda class III

B: Thyroid, left lower pole, FNA:
Follicular and atypical Hürthleoid cells with reduced colloid
Atypical cells of uncertain significance, Bethesda class III

A: SurePath concentration prep, cell block sections, and direct smears are examined. Overall specimen is hypocellular. One smear shows several clusters of Hürthleoid cells with mild nuclear enlargement and irregular contour. Rare intranuclear inclusions are noted. No longitudinal nuclear grooves are seen. No papillary or microfollicular architecture is recognized. Colloid is essentially absent. On one slide, a dense mixed lymphoid infiltrate is well demonstrated. Staff review. 
B: SurePath concentration prep, cell block sections, and aspirate smears are examined. Specimen is adequately cellular. Follicular epithelium with and without Hürthleoid change is arranged in irregular small sheets. Rare microfollicular structures are noted. No papillary architecture is seen. No intranuclear cytoplasmic inclusions or longitudinal nuclear grooves are seen. Colloid is sparse. No background lymphoid component is recognized.

Diagnosis:
A: Thyroid, right middle lobe, FNA:
Atypical Hurthleoid cells and lymphocytes 
Atypical cells of uncertain significance, Bethesda class III

B: Thyroid, left lower pole, FNA:
Follicular and atypical Hürthleoid cells with reduced colloid
Atypical cells of uncertain significance, Bethesda class III


----------



## Lovlkn (Dec 20, 2009)

I'm not experienced with ultrasound results and never had one during my journey prior to surgery.

Have they run a thyroglobulin antibody test on you yet?

What "doctor" would not speak with you about these results?

If it were me - I would consult a surgeon, unless you need to wait for your endo to refer. Look for a surgeon who performs 3-4 thyroid surgeries per week. This could be an ENT or a general surgeon who specializes in endocrine surgeries


----------



## sunvsmoon (Mar 17, 2018)

Lovlkn said:


> I'm not experienced with ultrasound results and never had one during my journey prior to surgery.
> 
> Have they run a thyroglobulin antibody test on you yet?
> 
> ...


I have not had a TgAB test run on yet. My doctor who didn't explain the results in detail to me was my PCP. My concern over my swollen lymph nodes and hoarse voice was also blown off, so I've now started making appointments with ENTs and endocrinologists on my own as I have a PPO. Can a surgeon discuss everything with me that an endocrinologist can? I haven't made an appointment with a surgeon yet because I thought I would only meet with them if I decided to have it taken out. I was pretty much thrown in to all of this about 3 weeks ago when I went in complaining of a swollen neck, so am still trying to figure out who I should be meeting with, what information I need, etc.

Thanks!


----------



## Lovlkn (Dec 20, 2009)

An ENT or a Surgeon who specializes in thyroid surgeries could both explain your results to you.

Joplin1975 is a mod and regular poster who has experience with ultrasound results - she hopefully will drop in shortly and can give you the explanation of your results.


----------



## joplin1975 (Jul 21, 2011)

Hurthle cells (atypical ones, too!) are very, very, very common in people with Hashi's. A lot of people consider them a telltale sign of autoimmune disease.

Hurthle cell carcinoma is very, very rare and accounts for only about 3% of all thyroid cancer cases. When you consider the large number of thyroid cancers being diagnosed these days, its a TEENY TINY number.

Which is a long way of saying that, yes, you need to get some clarification from your doctor, but I wouldn't spend an inordinate amount of time worrying about hurthle cell carcinoma. It would be especially rare to find hurthle cell carcinoma in someone so young. It usually doesn't pop up until someone's late 50s and 60s. (All said with the acknowledgement that I get it, I've been there, and I totally appreciate your concern!).

How large are your nodules? Your results are basically undetermined. Depending on the size of the nodules and any other characteristics they may have, surgery might be a good option. But, thyroid cancer grows really, really, really slowly. My surgeon's best guess was that I was growing mine for "at least a decade." So a lot of people choose to re-do the biopsy in six months. Treatment protocols for thyroid cancer have gotten a bit less aggressive since 2015. You have to weight you biopsy results, ultrasound results, and overall quality of life (i.e., are you symptomatic) before definitive decisions are made.

As always, we're happy to help you make that decision and think about things to consider.


----------



## sunvsmoon (Mar 17, 2018)

That is very reassuring to know about the Hurthle, even atypical, cells being common! I had a pretty bad day when I started researching what Hurthle cells were after the biopsy results came back. I've had trouble finding personal experiences on this online, just a lot of medical studies and papers.

The two nodules they biopsied out of the 4 were 1.6 x 1.2 x 1.1 cm and 1.3 x 1.1 x 1.1 cm. I went in to the doctor about a month ago because I noticed my neck seemed swollen and I had developed a double chin (without any weight gain) very quickly, within a week or two. This occurred just weeks after a miscarriage I had, so can only assume it's all connected. I was having lots of ear pressure, headaches, and brain fog, especially forgetfulness in the moment. That's when he sent in the thyroid ultrasound which led to the FNA. I think (and hope) the thyroid findings are incidental in relation to the symptoms I've been having. For the past month, along with the neck swelling, my voice has been hoarse and I've been clearing my throat a lot. My larynx seems swollen. The double chin that appeared out of nowhere remains even though I've lost about 5 - 6 pounds from changing my diet per direction from an ENT I saw last week. He said he thinks I have a viral salivary gland infection along with LPR/silent reflux. The low acid diet is supposed to help with the LPR. He is sending an additional ultrasound in for my swollen lymph nodes on the right side (even though I thought the thyroid ultrasound covered that? better to be sure though). I've noticed quite an increase in hair loss in the shower over the past year and a lot of eyelashes falling out within the past couple of months. My skin has been very dry as well. However, I never noticed any symptoms in the neck area/discomfort like what I've been having the past month.

At this point, I have no clue what symptoms are actually related to Hashi's (assuming that diagnose is confirmed via my blood work), LPR, salivary gland infection, stress (there has been a LOT of that and I know it can significantly exacerbate symptoms), and/or maybe something else. I am comforting myself by understanding that thyroid cancer grows very slowly, and the chance of it being related to my voice hoarseness, etc. that came on within the past month is probably close to zero. And, if it were really bad, it probably would have shown up as truly malignant in the pathology report and not atypical. To say the least, I am very much looking forward to the results of this new ultrasound, follow up with my ENT on the infection and LPR, and appointment with the endocrinologist!


----------



## joplin1975 (Jul 21, 2011)

There are thyroid ultrasounds and then lymph node mapping ultrasounds. Same area, different focus. 

Actually, the symptoms you mention are often things that people with thyroid disorders deal with. A swollen thyroid and large-ish nodules can cause hoarseness and a fullness feeling. The hairloss is also likely related. If you have a minute, give us the reference ranges for your blood work results. They are usually included in ( ) just next to your result. Different labs use different methods which use different ranges. Based on your symptoms, my guess would be that you are hypo with Hashi's.

I've never been pregnant (by choice) so I can't speak from personal experience, but many, many, many posters discover thyroid disorders after a pregnancy. Thyroid disorders occur so slowly that people rarely notice them (that's how I had a good decade of symptoms, but chalked it all up to getting older or other life changes). This showing up after a miscarriage -- and please know I'm sorry for your loss -- is not unusual. I would still assume you have Hashi's.


----------



## sunvsmoon (Mar 17, 2018)

I excluded the T3 & T4 Total numbers as I've read those aren't very telling?

T4, Free
March 2018 Free T4 (EIA) - .86, range 0.76 - 1.46 ng/dL
March 2018 - "T4, Free, Direct Dialysis" - 1.6, range 0.9-2.2 ng/dL
December 2016 - "T4, Free, Direct Dialysis" - 2.2, range 1.3-2.7 ng/dL

TSH
March 2018 - 2.300, range 0.358 - 3.800 mcIU/mL
December 2016 - 1.51, no ref range given
June 2015 - 1.680, range 0.358 - 3.800 mcIU/mL

T3, Free
March 2018 - 3.2, range 2.3-4.2 pg/mL
December 2016 - 3.2, range 2.3-4.2 pg/mL


----------



## joplin1975 (Jul 21, 2011)

Well you are definitely trending hypo. You free t4 result is really, really low and your free t3 is just barely at the 50% mark. So, that explains your symptoms.

It would be a good idea to have your thyroid antibodies tested: TPO, TSI, and Tg/TgAB.


----------



## sunvsmoon (Mar 17, 2018)

I had my Thyroid peroxidase antibodies tested in March of this year as well and they came back at 94 with the range of <9 being normal. I have another appointment for some blood work prior to meeting with the endocrinologist, so will have to get the other two done as well (TSI & TgAB). With those numbers, once they're able to determine what's going on, are chances pretty high that they will suggest some medication to balance things out?

I am nervous with everything else going on and what that may result in (lymph node ultrasound, swollen neck, atypical cells, etc.) but also excited if everything does turn out okay and all I need for the time being is some medication to make me feel better. I was chalking all of this up to getting older and being stressed!


----------



## joplin1975 (Jul 21, 2011)

A good doctor will put you on a low dose medication. It *may* (emphasis on may) lower the antibodies, which may reduce symptoms. In some people, it can help shrink nodules.


----------



## sunvsmoon (Mar 17, 2018)

That's exciting! Are there other things that have been proven helpful in lowering antibodies? I've already read up quite a bit on AIP, but am not sure if others have had success going this route or doing something else. Also, what is considered a low dose?


----------



## joplin1975 (Jul 21, 2011)

Low dose is usually 25 or 50 mcgs. Then you adjust from there, depending on what your labs look like.

I'm sure there are others who will jump in, but if you were to ask me, I don't think diet has a significant impact on thyroid disease.


----------

