# Confused



## ScaredAJ (Jun 3, 2011)

Okay, quick question. After my FNA it said that my smear contained blood many lympocytes macropahges including multinucleated macrophages, follicular cell groups , and some of those have Hurthle cell appearance.

Then I have a cell block of blood lymphocytes and macrophases.

I'm reading that FNA results can not tell the difference between Hurthle cells being cancer or not? Is this correct? If so are their other factors in the FNA that says hashi and not cancer? If this is the case shouldn't other tests be given? From what I read is after finding the Hurthle cell inside a growth that the thyroid should be removed? Or am I reading the wrong sites?

I don't understand that at all, and I'm quite confused. Can anyone clarify this a bit for me?

"Is the Hurthle Cell Tumor Benign or Malignant?
Like follicular tumors, there are benign Hurthle cell tumors and malignant Hurthle cell tumors, and the pathologist tells the difference between them based on invasion of the capsule and the blood vessels. Benign Hurthle cell tumors are not a threat at all and should not come back once they are removed"

http://emedicine.medscape.com/article/279462-overview


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## lainey (Aug 26, 2010)

Re: The Results are IN!
>>FNA results

5 spray fixed smears for pap stain 5 air dried smears for dq stain. fluid for cell block

No malignant cells identified 
Cellular aspirate containing blood, many lymphocytes, macrophages including multinucleated macrophages and follicular cell groups, some of which have a hurthle cell appearance.

Cell Block 
blood lymphocytes and occasional macrophage.

Comment: Cytologic findings suggest chronic lymphocytic thyroiditis, please correlate with clinical laboratory and imaging findings<<

This is the original report, no?

Don't you think the pathologist who read the slides, along with the other findings, would raise the doubt of cancer instead of thyroiditis if they thought it were so?

Personally, I like to think that these people will hedge on the side of caution.

If you have any doubts, get a second opinion. Repeat the FNA in a short period--3 months.

However, if the pathologist thought that they were Hurthle cells indigenous to cancer, I think they would have said so.


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## ScaredAJ (Jun 3, 2011)

thats what has me confused, if the FNA can't tell the difference how do they? Lab results? what helps them decide Hashi or cancer?


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## bigfoot (May 13, 2011)

lainey said:


> Personally, I like to think that these people will hedge on the side of caution.


That's been my experience with other imaging / diagnostic tests, too. Finding a good doctor or endocrinologist is one thing, but the folks sitting in the lab coats at the microscope or computer screen know what they're doing and are very professional.


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## ScaredAJ (Jun 3, 2011)

I guess my confusion is because I've never had but the t3 t4 and TSH blood work until this week when I asked for it (those results arn't in yet they didn't even know what the TBII TPO or the Thyroglobulin Ab were ). I do think the pathologist knew what they were looking at, but i think he recommended follow up testing that was never done. My PCP said Hashi and left it at that. I asked to see a surgeon and I was referred to one who wanted to do a ultrasound and biopsy every 3 months. He did say he wanted to speak to the pathologist and if anything changed he would call.

Since the Hurthle cells are not 100% positive for Hashi what else should have been done?


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## lainey (Aug 26, 2010)

Now, am I correct that you are diagnosed and treated for hypo, correct?

So I guess I am confused as to what direction you are trying to take this. The tests that should have been run have pretty much been done.

Once you are diagnosed and treated, what exactly is the need to run antibodies? There really isn't any, unless you are having conflicting symptoms for hyperthyroidism. Antibodies are useful in making a diagnosis, but their presence or absence doesn't affect the treatment--it remains the same.

So far, everything you have posted re: your sonogram, including the FNA, is consistent with a multinodular goiter associated with thyroid disease. I had to look in several posts, but hopefully I am summarizing that correctly. You did post TSH and T4 blood work from the past. Am I correct also that you are on T4 replacement at 137 mcg? If your TSH is still near 3, perhaps a low dose increase is the place to start to address some of your symptoms.

Typically, after the diagnosis is made, antibodies are not run on a regular basis. Most doctors do not run the free T3 either unless the patient is taking T3 medications. Yes, in your case it may be helpful to see if your symptoms are caused by lingering low T3, so knowing where you are may be helpful in making medication and dosage choices.

If you are looking for a concrete reason to have surgery, IMHO you are really not there yet. Your nodules are small, they found no malignant cells in the FNA. Running the antibodies tests may tell you definitively that you have autoimmune thyroid disease, but that will not really change the present course of your replacement medication nor necessarily support surgery.


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## Andros (Aug 26, 2009)

ScaredAJ said:


> Okay, quick question. After my FNA it said that my smear contained blood many lympocytes macropahges including multinucleated macrophages, follicular cell groups , and some of those have Hurthle cell appearance.
> 
> Then I have a cell block of blood lymphocytes and macrophases.
> 
> ...


The report says no malignant cells found and it also says that,

```
Cytologic findings suggest chronic lymphocytic thyroiditis
```
 which means the pathologist thinks the Hurthle cells are indigenous to Hashimoto's. Thyroiditis is another word for Hashimoto's.

I would breathe easy if I were you for now. But, this is something that should be kept an eye on.

Here is a chapter for you........

http://www.thyroidmanager.org/Chapter8/8-frame.htm

And another............

http://www.thyroidmanager.org/Chapter18/18-cancerframe.htm


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## ScaredAJ (Jun 3, 2011)

I know it must seem like I an being a huge baby about all of this, and frankly, I kind of am. I'm sorry.

I feel that a lot was lost with my care, things overlooked, and not treated as they should be. Part of it being my insurance. Not being on medicaid does make a difference in the quality of treatment. Having medicaid here is a free ticket to all the diagnostic testing you can throw a stick at. Having a point of service insurance like I do means a lot of people don't want to deal with the red tape and paperwork. So they tend to make me "wait it out"

It took 6 years of being hypo with a vast list of symptoms to even have an ultrasound of the thyroid mentioned. No other blood drawn than the TSH and T4. Each symptom was it's own little issue and treated as such. No one ever said maybe its the thyroid, until I was assigned a new doctor. She listened to my current list of symptoms and ordered the sonogram and got this train wreck rolling. I still as of yet have gotten a definite answer of whats causing me to feel like this. The doctor never said "you have Hashi's" but instead said "They think you have Hashi's" after reading the pathologist report. I feel they should have said, "they think you have hashi's, lets do some more tests and make sure that's what it is", or is that over reacting? They also seem to think all of my ranges are okay.

I slept 19.5 hours yesterday, and went back to bed at midnight and slept another 6 hours. I am desperate and miss my family. I'm sure they miss me too. I want my life back, and the power to answer all of these things going wrong with my body. I'm losing my marriage, and family, and I want to arm myself with everything I can to keep them, and make things they way should be. My family needs me, I need them.

So I am sorry I seem so whiny and paranoid, part of me is being whiny and paranoid, the other part is just trying to understand whats happening to me and where to start looking to fix it. :hugs:


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## lainey (Aug 26, 2010)

Regardless, some doctors do better follow up care than others.

Once the hypo diagnosis is made, Hashi's or not, with or without antibodies, the treatment is the same and that is how doctors see it. The antibodies tests as part of the thyroid panel, as well as the free T3 are very expensive, so if they really don't need them, they generally don't run them--so once again, unless there are glaring problems, often they won't be run unless the patient asks. Again, if the results don't affect the treatment, it's not necessary to repeat them regularly once the patient has been diagnosed.

The sonogram is usually routine, why it took so long after diagnosis to do it is anyone's guess, but an annual or biannual (every 2 years) sonogram in a thyroid patient is good maintenance, so in that area your doc definately fell off the wagon.

Your sonogram and FNA are consistent with your diagnosis. I am not a doctor, however if you have doubts, talk to another doc, but from here it looks okay.

Don't be fooled--on medicare, they restrict the # and type of thyroid testing you can have annually. Most of us get a lot more without it than with.

If your levels are clearly off, as doctors see it, the hypo diagnosis is fairly easy to make and treat with replacement. Some docs manage their patients better in the sense that they are more responsive to symptoms than they are to labs, and adjust the dosage to get the best relief of symptoms. Others only focus on treating you until your numbers are "in range". Is this the source of dissatisfaction for you regarding your doc? I think you need to examine your levels, especially free T3 and consider asking your doc for a dose increase, or even a change in brand of medication. People respond differently to the branded medications, and you may get better results from a different med. Your TSH is still a little high, and it's likely that you might benefit from some T3 also in the form of cytomel--depending on those free T3 results.


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## Andros (Aug 26, 2009)

ScaredAJ said:


> I know it must seem like I an being a huge baby about all of this, and frankly, I kind of am. I'm sorry.
> 
> I feel that a lot was lost with my care, things overlooked, and not treated as they should be. Part of it being my insurance. Not being on medicaid does make a difference in the quality of treatment. Having medicaid here is a free ticket to all the diagnostic testing you can throw a stick at. Having a point of service insurance like I do means a lot of people don't want to deal with the red tape and paperwork. So they tend to make me "wait it out"
> 
> ...


Okay..............let's review here. I could not find the thread w/your medical history.

What are your most recent lab numbers like? Can you post them and the RANGES here?

Are you on thyroxine replacement at this time? If so,what and how much?

I realize there is a play on words here. Suggests chronic lympocytic thyroiditis is the same as saying that it also "suggests" it is not cancer.

Neither is definitive. I hear you loud and clear on this issue.

The only way to know for sure seems to be ablation (removal of the thyroid) or constant and timely follow-up w/scans and FNA.


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## ScaredAJ (Jun 3, 2011)

Last two sets of blood work done. (still waiting for June 21ish  results) 
Free T4- 0.8 (Range .6-1.6)
TSH 3rd Gen 3.07 (range .34-3.0)

End of May/June 
TSH #rd Gen 3.08 (range .34-3.0)

This is all they have ever tested me for as far as my thyroid has gone. I did have the list you gave me ran on the 21st-ish (I can't remember when I just know it was done) I just spoke to my doctors nurse and she is still reviewing my results.

I just feel like the pathologist said "Please correlate with lab, clinical, and imaging findings". Meaning something else needed done. My doctor did send me to a surgeon after me asking her to, and the surgeon just wants to do an FNA and sonogram until it stops growing or finally shows cancer. Every 3 months. I just can't feel this bad until then, someones gotta fix me. Right? They can't leave me like this?


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## Andros (Aug 26, 2009)

ScaredAJ said:


> Last two sets of blood work done. (still waiting for June 21ish results)
> Free T4- 0.8 (Range .6-1.6)
> TSH 3rd Gen 3.07 (range .34-3.0)
> 
> ...


You are right. With FT4 in the basement like that, at the very least, you should be on thyroxine replacement. Why are you not on thyroxine replacement?

You have to feel exhausted. I would start raising some heck. I would demand FREE T3 because I am wondering why your FT4 is so low. Either it is because you "need" thyroxine replacement or the FREE T4 is converting fast to FREE T3. We have to find out.

You cannot go on like this. I could not agree more.


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## ScaredAJ (Jun 3, 2011)

I do take 137 mcg (was moved to this dose in May due to the 3.07) of levothyroxine and it has the affect of taking M & M's apparently because they aren't doing anything for my fatigue.


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## lainey (Aug 26, 2010)

>>"Please correlate with lab, clinical, and imaging findings". Meaning something else needed done.<<

In this case, correlate means "to compare with" which in your case, would be to the blood work and sonogram results that you already have. The pathologist wouldn't necessarily have that information. As long as they are in agreement, the determination that your samples are consistent with Hashi's is correct. By saying that, the pathologist is leaving room for the possibility that you don't have Hashi's--which, if true, could change the picture (but the pathologist wouldn't necessarily know that when looking at your slides, see?).

Your labs, even on 137mcg, still leave room for improvement. With your T4 so low in the range, your free T3 could very well be low out of the range. Hopefully the new labs you asked for will be in soon. A dose increase is your first best bet to improve your symptoms.


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