# Results of FNA



## kgriess

I'm new here and wanted to find out your opinion regarding the results of the fine needle biopsy I had in April.

I have been diagnosed with subclinical hypothyroidism, and I'm being treated for that, but my endo also sent me for an ultrasound and then a biopsy of a small (6mm), calcified nodule that was found on one side of my thyroid. I'm told calcification raises cancer risk, as does having only one nodule.

Here's what the inconclusive report says (I'm typing it as it's written):

"The specimen consists of fragments of follicular epithelium, which exhibit focal microfollicular architecture. *Mild nuclear atypia including nuclear elongation, enlargement and overlap are noted. No nuclear inclusions are identified. Focal Hurthle cell change is noted. The features are most suggestive of the presence of a follicular lesion (hyperplastic versus neoplastic), with possible focal Hurthle cell features.* Clinical correlation and further evaluation are recommended, as clinically indicated."

The bolded part is the section my doc underlined after reading the report.

Basically, he said it isn't conclusive as to whether or not it's cancer. They can't say for sure. He said I could have my thyroid removed, or the nodule could be monitored.

Because they can't tell me for sure it IS cancer, I have so far chosen the monitor route and I'm supposed to have another ultrasound in a couple of weeks to see if the nodule has changed (grown).

Meanwhile, he wants to get me towards the "hyper" side of the TSH normal range so that the nodule isn't stimulated at all TO GROW.

I'm wondering if any of you understand the report and whether I am taking a big risk by not just having my thyroid out, which is not my desired route, obviously. I know none of us are doctors, so I will take any advice in that manner.

Thanks for reading and commenting!

P.S. Before I started taking my meds, I didn't fully realize just how bad I felt. How "old" my body was acting - it's like someone took an oil can to every joint/muscle in my body.


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## hillaryedrn

Ok, the only reason I'm going to say this is because my FNA results were very similar to yours. My Endo also suggested I wait and watch. I opted for surgery because I have such a strong family history of thyroid cancer. When I went to my consultation with the surgeon, he told me that with follicular lesions, you can't tell if it is cancerous by the FNA. You have to look at encapsulation, vascularity and other things like that. Trust me, I'm not trying to "stir the pot" or make something out of nothing, but I just wanted to make you aware. I sure hope it's nothing!!!!


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## kgriess

Hillary - thanks so much for the reply.

Was yours cancerous?

I'm going to see my endo in a couple of weeks and I'm supposed to have the ultrasound follow-up next week (just realized I need to call for the script that they were supposed to mail me to have it done) so I will discuss it again with him.

I suppose that looking at those other things (encapsulation/vascularity) is impossible to do WITHOUT surgery?

I have no history of thyroid cancer in the family, at least.

I feel lucky that the endo even found this because if my primary doc had just given me synthroid way back when, I never even would have gone to see the endo and found the nodule. I still don't know why he even had me get an ultrasound to begin with since the nodule is so small...I doubt he could have felt it, but who knows. Guess I should just ask him!


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## Andros

kgriess said:


> I'm new here and wanted to find out your opinion regarding the results of the fine needle biopsy I had in April.
> 
> I have been diagnosed with subclinical hypothyroidism, and I'm being treated for that, but my endo also sent me for an ultrasound and then a biopsy of a small (6mm), calcified nodule that was found on one side of my thyroid. I'm told calcification raises cancer risk, as does having only one nodule.
> 
> Here's what the inconclusive report says (I'm typing it as it's written):
> 
> "The specimen consists of fragments of follicular epithelium, which exhibit focal microfollicular architecture. *Mild nuclear atypia including nuclear elongation, enlargement and overlap are noted. No nuclear inclusions are identified. Focal Hurthle cell change is noted. The features are most suggestive of the presence of a follicular lesion (hyperplastic versus neoplastic), with possible focal Hurthle cell features.* Clinical correlation and further evaluation are recommended, as clinically indicated."
> 
> The bolded part is the section my doc underlined after reading the report.
> 
> Basically, he said it isn't conclusive as to whether or not it's cancer. They can't say for sure. He said I could have my thyroid removed, or the nodule could be monitored.
> 
> Because they can't tell me for sure it IS cancer, I have so far chosen the monitor route and I'm supposed to have another ultrasound in a couple of weeks to see if the nodule has changed (grown).
> 
> Meanwhile, he wants to get me towards the "hyper" side of the TSH normal range so that the nodule isn't stimulated at all TO GROW.
> 
> I'm wondering if any of you understand the report and whether I am taking a big risk by not just having my thyroid out, which is not my desired route, obviously. I know none of us are doctors, so I will take any advice in that manner.
> 
> Thanks for reading and commenting!
> 
> P.S. Before I started taking my meds, I didn't fully realize just how bad I felt. How "old" my body was acting - it's like someone took an oil can to every joint/muscle in my body.


Hi there and welcome! Follicular is not a good thing.

Follicular lesion of undetermined significance/atypia of undetermined significance 
FNA specimens in this category include cases that partly display features of both hyperplastic/adenomatoid nodules and follicular neoplasm i.e. cellular specimen showing follicular cells arranged in cohesive groups and microfollicles with focal nuclear crowding and overlapping and monolayer sheets in a background of watery colloid admixed with thick colloid and few macrophages. The question arises as to how useful it may be to divide non-papillary follicular lesions into two separate categories; should all be diagnosed as indeterminate follicular lesions with the decision of how to manage being left to the clinician via either clinical follow-up and repeat FNA or surgical excision. Repeat FNA has been shown to play an important role in the management of thyroid nodules. Published experiences have shown that by repeating the FNA >50% of nodules which are non-diagnostic or indeterminate on initial cytologic diagnosis can latter be placed into definite diagnostic categories with repeat FNA etc. (there is much much more)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2365970/

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

As you say, none of us are doctors here but if it were my decision to make, I would have it yanked. I would not want it to metathisize into the lymphs and so on.

The second link really puts it in plain english.

I hate this for you; making permanent decisions are tough but I would not want the cancer making the decision for me.


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## hillaryedrn

Mine was "precancerous" in that there were cancerous changes, but it wasn't fully "malignant" if that makes any sense. In other words, I caught it in time. Yes, you really can't tell if those changes are present without surgery. That's my vote, but it's a very personal decision that only you can make.


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