# Possible Recurrence



## jen7724 (Jun 19, 2012)

For starters, I'm a new member and this is my first post. Thank you for taking the time to read and respond.

HISTORY
I was diagnosed as hypothyroid in 2005 at age 23. My doctor immediately noticed a large mass in my neck and an FNA was performed. I was told it showed cancer cells in the right lobe. In December, 2005 I had a partial thyroidectomy to remove my right lobe. I begged the doctor to remove all of it while he was in there but he said there was too much liability involved so he left the left lobe intact. Pathology came back on the right lobe (I was told it was malignant) and they scheduled me for a total thyroidectomy and removed the left lobe.

About 6 weeks later I had a scan which showed remaining tissue so I was treated with RAI. Follow up scan showed that there was still tissue remaining so I went through RAI treatment a second time. I believe it was 2007 by the time I finally got the all clear.

(Side note, I was diagnosed with Lupus in 2010).

So here it is now 2012 and my Tg levels have been undetectable all this time, until now. I believe they were .6. Being that they were undetectable for 5 years Endo was concerned and sent me for a neck ultrasound. Ultrasound showed "area of possible thyroid tissue regrowth or tumor recurrence in the right thyroid bed." Endo wants to give Thyrogen injections and do uptake scan next.

CAUSE FOR CONCERN
I have long forgotten about my thyroid and any diseases it carried and wanted to refresh my memory on my diagnosis since it was obviously still there so I pulled out my medical records and started reading. I found my pathology reports and was shocked at what is on them. I still can't interpret these reports completely and was hoping some of you would be able to help:

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"FINAL DIAGNOSIS:
A. "MASS OF THE INFERIOR NECK", BIOPSY:
-LYMPH NODE (ONE) SHOWING REACTIVE LYMPHOID HYPERPLASIA. NO METASTIC TUMOR SEEN.
B. THYROID, RIGHT LOBE:
-LYMPHOCYTIC THYROIDITIS CONSISTENT WITH HASHIMOTO'S THYROIDITIS.
-ATYPICAL NODULAR EPITHELIAL PROLIFERATION WITH FOLLICULAR PATTERN AT THE INFERIOR
POLE OF THE THYROID LOBE. SEE COMMENT 1.
-ATYPICAL NODULE WITH FOLLICULAR PATTERN. SEE COMMENT 2.

COMMENT:
1. The 1 cm nodule located in the inferior pole, well demarcated and incompletely
encapsulated has a follicular growth pattern arranged in microfollicles lined by
cells with eosinophilic cytoplasm, nuclei with fine granular chromatin and an
occasional groove. The nodule extends to the anterior inked margin. A nodule with
similar cytological features is noted in slide 9.

The differential diagnosis for this 1 cm nodule includes follicular/oncocytic
neoplasm, papillary carcinoma and component of nodular Hashimoto's thyroiditis.

2. Slide 7 shows a 0.6 cm nodule with follicular growth pattern and cytologic
features suspicious for papillary carcinoma. Slides 6 and 8 show a nodule with
similar features. Slide 5 shows a small focus suspicious for papillary carcinoma.

This case will be forwarded to the Armed Forces Institute of Pathology for Consult.

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Again, I was only told that I had Hashimoto's, Papillary Carcinoma and a multi-nodular goiter. My doctors never once told be any of what is mentioned on this report. It was so confusing that the pathologist couldn't even settle on a diagnosis so he sent it to AFIP for a second opinion. I have their report too so I can post their findings if requested but I've written a book so far so I don't want to totally overdo it. They used the word "interesting case" in their report however and it was seen in staff conference. The critical thing to note here is all of this was the Right lobe. The pathology on the Left lobe came back only as Hashimoto's Thyroiditis. The tissue the radiologist picked up the other day is on the Right side so obviously I'm concerned and now trying to dissect my initial reports to try to figure out why it came back. From what I've gathered it looks like I actually had a Follicular Varient of Papillary Carcinoma but also with Hurthle Cells. The Hurthle Cells would explain why it's still there. Again, I was never told any of this by my Doctor.

I have chosen to seek diagnoses and treatment at the Mayo Clinic instead of my Endo here simply because I don't feel like I can trust my Endo at this point. My apt at the Mayo Clinic is July 18. If anyone has any interpretation of my pathology report to give me some clue at what my initial diagnosis should have been that would be very helpful to me. If there's anyone who has has a similar diagnosis or experience I would love to hear about it!


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## Andros (Aug 26, 2009)

jen7724 said:


> For starters, I'm a new member and this is my first post. Thank you for taking the time to read and respond.
> 
> HISTORY
> I was diagnosed as hypothyroid in 2005 at age 23. My doctor immediately noticed a large mass in my neck and an FNA was performed. I was told it showed cancer cells in the right lobe. In December, 2005 I had a partial thyroidectomy to remove my right lobe. I begged the doctor to remove all of it while he was in there but he said there was too much liability involved so he left the left lobe intact. Pathology came back on the right lobe (I was told it was malignant) and they scheduled me for a total thyroidectomy and removed the left lobe.
> ...


Apparently, not all the thyroid tissue was zapped. However, there is such a thing as ectopic thyroid tissue and if i were in your situation, I would request a whole body scan.

I am sorry to hear this; it would have been so nice to put it aside as you say and get on w/your life.

The only good news I can think of is that they "found it" and once again you will go through treatment of some sort.

Your diagnosis is interesting in that Hashimoto's, Graves' and cancer are bed mates and there are Hurthle Cells indigenous to cancer and Hurthle Cells indigenous to Hashimoto's. Glad you got a second path opinion at the time.


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## webster2 (May 19, 2011)

I am sorry you have to go through this again. My hope that this will be your last time around with it. My knowledge is very limited so I don't understand the path report, but I wish you all the best. You'll find a lot of support here and a lovely place to vent. Welcome, but sorry for what brings you to the club.


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## jen7724 (Jun 19, 2012)

Andros said:


> Apparently, not all the thyroid tissue was zapped. However, there is such a thing as ectopic thyroid tissue and if i were in your situation, I would request a whole body scan.
> 
> I am sorry to hear this; it would have been so nice to put it aside as you say and get on w/your life.
> 
> ...


I looked up ectopic tissue, I found the information very interesting. I was not aware there was such a thing. I don't think it applies in my case but I'm still glad to have learned about it.

I don't have Graves though, I was hypothyroid, my understanding is that Graves Disease is an auto immune hyperthyroid trait. My diagnoses was Hashimoto's, Hypothyroidism, a Multi Nudular Goiter, Follicular Variant of Papillary Carcinoma w Hurthle Cells.

I see that you have Lupus too. I was diagnosed w Lupus about 2 years ago. Were you diagnosed before or after your thyroid cancer? I swear there's a relation to my Lupus diagnoses and my thyroid disease considering they're both auto-immune. Do you have any insight on that theory?


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