# Happened so fast! Can someone give insight?



## Catwalk1 (Jan 15, 2011)

Hello! I'm grateful to have found this board and searching the posts has been SO helpful. Can't find my particular situation, though... so I am hoping someone here can help me.

Last weekend, my friend (a doctor) noticed a lump on my neck and told me in no uncertain terms to see my PCP asap. I got an appointment Monday. Goiter! Sent for bloodwork/sonogram and referred to ENT (all Tuesday). ENT performed FNA.

Bloodwork: completely normal (I've had no symptoms other than the lump).

Sonogram (paraphrasing here): right lobe normal size, but has "small focal area of mixed echogenicity" at 4mm lobe. The left lobe "is replaced by a solid mass measuring 6.9 x 7.7 4.6 cm " biopsy suggested. As you can imagine, "replaced by a mass" (especially a HUGE mass) freaked me out. How could something grow that big, that fast, without me noticing?

So here are the results of the biopsy: 
Diagnosis: Negative for malignant cells (hooray!). Specimen consists of hurthle cells and lymphocytes in a background of blood. This pattern is suggestive of chronic thyroiditis. And the ENT's handwritten notes: "as expected. repreat ultrasound in 6 months."

Can anyone lend insight? I don't understand - if this is Hashimoto's, then it's an inflamed thyroid, but the sonogram suggested it was a mass. Also, if it's indicative of Hashimotos then wouldn't I see symptoms or bloodwork that supported that? The sonogram / bloodwork / FNA seem to disagree with one another. I'm grateful for the "no malignancy" but... repeat u/s in 6 months as a treatment plan seems a bit under-agressive to me...

help?


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## lainey (Aug 26, 2010)

>>Also, if it's indicative of Hashimotos then wouldn't I see symptoms or bloodwork that supported that? <<

The answer is, yes, and no. 
For the blood work, you should ask for the results, with ranges. I am also curious as to whether you had antibodies tests run. These likely would support the FNA with Hashimoto's.

You can function quite normally with "half" a thyroid, which is what it sounds like you have. As long as it is doing it's job (as shown by your blood work), you don't need replacement medication.
Some people go for quite a while with no symptoms/mild symptoms before they show signs of having a problem. It really is a matter of how long, if ever, it takes the thyroid to stop functioning properly.

If you have no symptoms, and your blood work is normal, the treatment is to watch and wait--ie, repeat ultrasound and blood work in 6 months as indicated. The exception here would be if the enlarged side of your thyroid continues to increase in size, or presses on neck structures. In addition, the potential nodule on the other side should be monitored. Did the doctor recommend a radioactive uptake scan to see how your thyroid is performing?

Do you have any follow up appointments scheduled to go over the results?


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## Catwalk1 (Jan 15, 2011)

Thank you for your quick reply. My ENT you are not. (after suggesting it might very well be cancer, he told me it was office policy to mail results. Ugh.)

Anyway. I will enter what I know of bloodwork. It's a copy of a copy of a fax, so I am doing my best to read it.

TSH 3rd Genner... 0.49....0.39- 4.19 (is that the range?)
T4...5.47 .... 1.87 - 11.72
T-uptake - .....34.45...25 - 35
?? hard to read PT1? ... 1.88 ... 1.22-4.10

Both PCP and ENT said "your bloodwork looks just fine." My concern is that the pathologist would have no knowledge of bloodwork, so I wonder if that would have factored in to the diagnosis of chronic thyroidosis. (which is the same as Hashimoto's, right?)

I can't stress enough that as of one week ago, I had no indication of any problem, thyroid or otherwise, so I am suddenly in over my head!

I have an appt. Tuesday with my PCP to discuss results but would like an idea of what to ask / what I should know... I disliked the ENT intensely and won't be going back to him! (not that he asked me to come back)


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## lainey (Aug 26, 2010)

My experience with doctors and "cancer" is that they always throw that out there when it is a possibility, because God forbid if it actually is, even if the chances are very small, they don't want to neglect to mention it.
Of course, there mere suggestion sends most people over the moon.

The FNA holds the answer to that, though, and that is good.

Those are outdated blood tests. You need TSH, Free T4 and Free T3, and also the thyroid antibodies.

See:

Thyroid Panel http://www.labtestsonline.org/understanding/analytes/thyroid_panel/glance.html

Thyroid antibodies http://www.labtestsonline.org/understanding/analytes/thyroid_antibodies/test.html

If the whole side of the thyroid is involved, I would venture that they can tell from the structure on the sonogram if it is a thyroid that has been damaged by thyroiditis. They don't need to know the results of the blood work to conclude that.

As for the PCP, I would ask for the full panel of tests for thyroid disease as described above. This should be part of your monitoring. I doubt he/she is going to suggest a different treatment plan at this point. You can also take your labs and other tests to an endocrinologist, or endocrine surgeon for another opinion if that makes your comfortable.


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## Catwalk1 (Jan 15, 2011)

Thanks again - based on what I'm seeing on this board, the results seemed out of date and that surprised me - but I will ask.

My concern stems from the fact that the sonogram said one thing (enormous mass, no left lobe at all), the blood tests showed another (no problem with hormones,no damaged thyroid), and the biopsy / pathology didn't confirm either (hurthle cells / thyroiditis, which suggests damaged thyroid (vs. mass) and assumes bloodwork that supports this diagnosis).

Anyway, seems like someone is wrong. At this point, I have no faith in the ENT, who (if I understand correctly, and I'm not sure I do) probably should have put all the results together and come up with a "something doesn't add up" vs. "take two aspirin and get an ultrasound in 6 months."


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## lainey (Aug 26, 2010)

Your thyroid has 2 lobes, and they work independently, and together.

In other words, if you have one lobe removed surgically (and this is done quite often actually, for patients removing a single nodule, that turns out benign on the operating table), the other lobe left behind will usually produce enough hormone on it's own to keep the patient's levels stable.

I am not a doctor, but I am inclined to think that perhaps your one lobe is very damaged, but the other is not and is working fine. That would explain what seems to be a discord between your sonogram and your blood results.

The problem, I think, is perhaps with your "definition" of the word "mass" and the pathologists'....are you assuming it means "tumor"? Consider the many definitions for "mass": http://dictionary.reference.com/browse/mass 
If the pathologist is using "mass" to mean "a collection of incoherent particles, parts, or objects regarded as forming one body" that would imply a thyroid destroyed--ie lacking the normal characteristics of a thyroid as in: "Specimen consists of hurthle cells and lymphocytes in a background of blood. This pattern is suggestive of chronic thyroiditis. And the ENT's handwritten notes: "as expected", then it makes sense, no?

I don't think that your results don't add up, but that you don't have a complete picture. Presence of antibodies would be consistent with the thyroiditis part of the diagnosis, but these haven't been tested yet. Why one side of your thyroid is so affected when the other is not is also yet to be answered.

As long as your blood work is normal and your thyroid is not cancerous, you wouldn't need medicine or surgery at this time. That is what the monitoring is for--if your blood work changes, or the repeat sonogram changes, then treatment may be necessary.

Ask the PCP. In the process, start asking around for an endocrinologist that specializes in thyroid disorders, so that you can get an opinion there. ENT's are not always the best first line for information on endocrine issues.


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## Andros (Aug 26, 2009)

Catwalk1 said:


> Hello! I'm grateful to have found this board and searching the posts has been SO helpful. Can't find my particular situation, though... so I am hoping someone here can help me.
> 
> Last weekend, my friend (a doctor) noticed a lump on my neck and told me in no uncertain terms to see my PCP asap. I got an appointment Monday. Goiter! Sent for bloodwork/sonogram and referred to ENT (all Tuesday). ENT performed FNA.
> 
> ...


Welcome to the board. Oh, dear! I will give my honest opinion. I think you should get a second opinion as there are 2 kinds (or maybe even more) of Hurthle cells. Those indigenous to Hashimoto's and those indigenous to cancer.

I would very definitely have a RAIU (radioactive uptake scan) for sonograms do have their limitations.

Did the goiter come up fast? I am thinking it did if "you" did not notice it? Are you coughing, having trouble swallowing and breathing when you lie down at night?


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## Catwalk1 (Jan 15, 2011)

Thanks so much, both of you, for your thoughtful replies. I feel much better prepared to speak to my doctor (I have an appointment on Tuesday). I'm thinking that I will talk to her about the tests you mentioned, as well as ask for a referral to an endrocrinologist (vs. an ENT) for a second opinion / more detailed follow up.

I've been very, very luck with my health thus far (frantically knocking on wood) so navigating these issues iscompletely new to me. Thank you again for your caring efforts to help educate others and point them in the right direction. It is sincerely appreciated.


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