# Ultrasound Findings [Hurthle Cell Nodule]



## MamaFox512 (May 15, 2016)

I'm a 25 year old mother of 2 - no history of cancer, completely normal thyroid levels. I do have a history of craniofacial fibrous dysplasia (I had it as a child, it was a bony growth on my jaw bone that was removed at age 8 with no recurrence). I also have Beau's Lines on my fingernails, which my GP did not have an answer for either..

I have had an ultrasound every 6 months - and I've had 2 FNA biopsies, both which determined Hurthle Cells. But obviously you cannot tell the difference between benign and malignant.

1st ultrasound = approx 2cm, mostly cystic.

2nd ultrasound = approx 2cm, becoming more solid.

3rd ultrasound = approx 2cm, even MORE solid with microcalcification and blood flow to the inside of the nodule.

I haven't heard from my doctor yet, as my ultrasound was just today.. I waited 1 1/2 hours in the waiting room, but luckily the technician was GREAT and although they are not supposed to discuss findings during the ultrasound, he did.. he was a great guy. I knew by watching as he did the ultrasound, that it has changed A LOT, although it hasn't grown from what we could tell.

I complained to my GP that I have pain under my jaw bone, he told me it was probably a swollen lymph node.. well, I come home and start doing research to find out that Hurthle cells can spread to your lymph nodes. There is no reason for me to have a swollen lymph node - I'm not sick and haven't been and I have now had the pain for a whole week. But my GP didn't listen to my concerns, so I will express them when I hear from the ENT (hopefully soon).

Any other people with Hurthle cells? Can you share your story please? I am just worried sick. I have a 3 and 5 year old who need their mama.

I haven't seen any other "young" people with Hurthle cell nodules.. and it isn't very reassuring.


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## Lovlkn (Dec 20, 2009)

> 3rd ultrasound = approx 2cm, even MORE solid with microcalcification and blood flow to the inside of the nodule.


Has anyone ordered a FNA of this nodule?


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## MamaFox512 (May 15, 2016)

Lovlkn said:


> Has anyone ordered a FNA of this nodule?


Yes - my GP did, and an Endocrinologist also did one - they both came back as Hurthle cells. But they didn't come back benign or malignant I guess. But that was a year ago or more. He hasn't wanted to do any bloodwork or testing since, other than the ultrasounds every 6 months.


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## MamaFox512 (May 15, 2016)

I dug up some more stats - this is all I could find on my patient portal. I am requesting the rest, because I've had 2 FNA biopsies and more than 3 ultrasounds - but here is what I have:

The Hurthle cell is located in the right thyroid nodule, which is why it is larger?

*April 11th, 2016: *

RIGHT LOBE: 4.9 cm x 2.1 cm 
LEFT LOBE: 4.1 cm x 1.4 cm

THYROID NODULE: 2 cm x 1.8 cm

DOCTOR'S NOTE:

Both lobes of the thyroid are normal in size. The complex solid (last cystic) mass in the inferior pole of the right thyroid lobe is overall unchanged in size. It should be noted that the posterior one half of the lesion was entirely cystic on the previous stuedy and now appears to be predominantly solid. Given the change in the lesion and the young age of the patient, suggest ENT referral for surgical resection.

*November 11th, 2016*

RIGHT LOBE: 5 cm x 1.5 cm 
LEFT LOBE: 4 cm x 1.3 cm 
NODULE: 2.4 cm x 2 cm

DOCTOR'S NOTE:

Both lobes of the thyroid are normal in size and unchanged. The right is 5 cm x 1.5 cm and the left is 4 x 1.3 cm. The isthmus is normal. Complex solid/cystic nodule in the inferior right thyroid lobe is slightly larger. Previously it measured 2 x 1.8 cm and today's measures 2.4 x 2 cm. Complex solid/cystic nodule in the inferior right thyroid lobe has increased in size. While this is still likely benign, suggest ultrasound guided biopsy for tissue to exclude malignancy.

*January 12th, 2018*

RIGHT LOBE: 5.9 cm x 1.5 cm 
LEFT LOBE: 4.4 cm x 1.7 cm 
NODULE: 2 cm x 1.8 cm

DOCTOR'S NOTE

Right lobe of the thyroid measures 5.9 cm x 1.5 cm x 1.6 cm. There is a complex right lower pole nodule. This measures 2.2 x 1.7 x 1.5 cm. This has cystic and solid complement as well as small calcifications. This lesion is vascular. This lesion is cirumscribed. TI-RADS score equals 5. This lesion is stable for 2 years and 2 prior biopsies have been performed. The left lobe measures 4.4 x 1.3 x 1.4 cm. Normal homogeneous echotexture. No thyroid nodules. Thyroid isthmus is negative. No new abnormality.


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## jenny v (May 6, 2012)

When was your last biopsy? Seeing how the ultrasound is still showing solid aspects and small calcifications, I would push for another biopsy if it's been over 6 months.


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## MamaFox512 (May 15, 2016)

I think the last biopsy was probably over a year ago - I don't remember. I am trying to request all of those records.

I am honestly really freaked out about the TI-RADS rating system.. and that they said it was a 5 on the chart.


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## MamaFox512 (May 15, 2016)

I called myself and made an appointment with the ENT doctor who I've been seeing.


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## MamaFox512 (May 15, 2016)

They claimed both of my biopsies are: HURTHLE CELLS - BENIGN.

Even though we know that Hurthle cells cannot be defined as benign or malignant via FNA biopsy... so how can they tell me it's benign if they don't know? Especially when it has many characteristics of being malignant..


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## Lovlkn (Dec 20, 2009)

MamaFox512 said:


> They claimed both of my biopsies are: HURTHLE CELLS - BENIGN.
> 
> Even though we know that Hurthle cells cannot be defined as benign or malignant via FNA biopsy... so how can they tell me it's benign if they don't know? Especially when it has many characteristics of being malignant..


Keep pushing your doctors to answer this question for you.


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## joplin1975 (Jul 21, 2011)

I think an ENT surgical consult is a really good idea.

You should be able to tell hurthle benign vs. malignant with an FNA but it is crazy unreliable. I'm thinking you might want to seriously consider surgery.

Also, a lymph node mapping ultrasound would be a really good idea.


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## MamaFox512 (May 15, 2016)

My doctor's office lied to me - they haven't sent my report or my ultrasound to the ENT yet. So I requested a copy of ALL of my ultrasounds on a disc, and I forwarded them a PDF of my report.

I complained to my doctor of the jaw pain, which I still have.. I've been having it for almost 2 weeks. We ruled out TMJ - he says swollen lymph node. If the incompetent ass knew ANYTHING about Hurthle cell nodules, he would have requested they ultrasound the lymph node(s) too.. you'd think.

Thank you for the recommendations - I am doing my best to advocate for myself and my health.


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## MamaFox512 (May 15, 2016)

The ENT did discuss surgery - he said because I'm young (25) that it would be better to wait and monitor it every 6 months.

Speaking of which, they only have 3 reports and 3 ultrasounds for me.. and I've probably had 6+, so I am trying to get those as well to compare findings myself.


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## joplin1975 (Jul 21, 2011)

Can you share the exact language of the u/s? Please...


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## MamaFox512 (May 15, 2016)

I have attached it if you'd like to look at the report.


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## MamaFox512 (May 15, 2016)

ENT said there have been no changes. Which I know isn't true because my first ultrasound, it was about 90% cystic with a tiny amount of solidification. Now it's predominantly solid 

Why are they blatantly lying to me?


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## MamaFox512 (May 15, 2016)

Here is what I was able to come up with - only 3 ultrasounds.. I am still missing 2-3.

I know that they look similar.. but obviously it be coming more and more solid.

When comparing ultrasounds of other nodules, it resembles Cystic Papillary Carcinoma - but obviously pictures can't diagnose anything.

I haven't had an FNA in 2 years - should I request one? I am seeking a second opinion from a new ENT in the area as well.


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## MamaFox512 (May 15, 2016)

Here.


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## joplin1975 (Jul 21, 2011)

So...your ENT is going by the radiologists report. Very few doctors can and do actually look at images. The radiology report states that the nodule is stable, which more or less says there haven't been any changes.

Why would the radiologist read the images as stable? Well, because ultrasounds have a wide margin of error. My pre-surgery ultrasounds listed one of my nodules as 2.5cms and complex while the other listed it as something like 2.9cms and solid (btw, it was actually 3.2cms and solid, pre my post-op path report).

Which is a long way of saying that I don't think they are blatantly lying to you so much as they aren't seeing drastic enough changes.

People have surgery all the time for discomfort from thyroid nodules. I think maybe your best bet would be to see if you can get another surgical consult.

I have no experience in reading actual u/s pictures - I'm sorry!


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## MamaFox512 (May 15, 2016)

Thank you for your response - my midwife referred me to a new ENT. We'll see.

I didn't know how to read ultrasounds either - but I've spent the last few weeks studying thyroid sonography so I could learn to read them myself.

Since my thyroid levels are fine and I'm having no actual symptoms of having problems with it, it just makes me more suspicious.

One minute they are telling me to take it out ASAP, then "watch and wait" - and apparently going from a cystic nodule to a complex nodule means "no change".

I appreciate your responses - I'm just not feeling much at ease. And I don't think I will until this is removed and I know for 100% sure.


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## Ktaylor0104 (Apr 22, 2018)

Hi. Wondering what happened with all of this.
I am 31 and have hurthle cells in my nodules.


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