# Pathology report



## hillaryedrn (Dec 14, 2009)

My pathology report states, "Colloid, follicular cells with hurthle cell changes
consistent with nodular goiter."

The MD who did the biopsy says it is benign, but I'm still wondering with my
history of father AND grandfather with thyroid cancer and me having
multi-nodular disease, should I press for them to remove it anyway or am I
overreacting?


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## Andros (Aug 26, 2009)

hillaryedrn said:


> My pathology report states, "Colloid, follicular cells with hurthle cell changes
> consistent with nodular goiter."
> 
> The MD who did the biopsy says it is benign, but I'm still wondering with my
> ...


What kind of Hurthle cells are these?

Given your family history, I would urge you to get a second opinion re pathology.

Causes of False Diagnoses 
Interpretive or sampling errors account for false diagnoses (13,14,27,28). Hashimoto's thyroiditis probably is the most common cause of false‑positive cytology. Misclassification of follicular and Hürthle cell adenomas as papillary carcinomas accounts for other errors. FNA biopsy of thyroid lymphomas may produce lymphocytes that can be interpreted as Hashimoto's thyroiditis, accounting for a false‑negative diagnosis. Inadequate or improper sampling accounts for some false-negative errors. For example, nodules smaller than 1 cm may be too small for accurate needle placement, and nodules larger than 4 cm are too large to allow proper sampling from all areas, thereby increasing the likelihood of misdiagnosis. Finally, the cytopathologist should establish and observe criteria to exclude a diagnosis of malignancy (2,6,10,25).

I also urge you to read this in it's entirety.........

http://www.thyroidmanager.org/Chapter6a/fnabiopsy-frame.htm

I am certainly hoping and praying there is not cause for concern but as I said, "Given your family medical history......................."; and at the very least you would have to stay on top of this from time to time with future FNA's.


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## hillaryedrn (Dec 14, 2009)

I'm definitely going to speak with my Endo about this. I'm just wondering what could be causing the Hurthle cell changes. My thyroid hormone levels have always been within norms, so I'm thinking that doesn't go towards Hashimoto's. If not Hashi, then what would cause the Hurthle cells?


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## Andros (Aug 26, 2009)

hillaryedrn said:


> I'm definitely going to speak with my Endo about this. I'm just wondering what could be causing the Hurthle cell changes. My thyroid hormone levels have always been within norms, so I'm thinking that doesn't go towards Hashimoto's. If not Hashi, then what would cause the Hurthle cells?


Absolutely; I was left wondering which kind of Hurthle cells. There are those indigenous to Hashi's and those that are indigenous to cancer. 'Nuff said.

You probably won't get anywhere over the holidays but please do keep us informed. I for one am a very interested party.


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## hillaryedrn (Dec 14, 2009)

Ok, I can't get in to my Endo for a couple weeks, so I'm going to speak to my internist and get his opinion on the whole thing. My Endo apparently has a "wait and see" approach that just makes me uncomfortable. Upon doing my own research, my fna results don't lean towards Hashi. So that, again, makes me uncomfortable. *sigh* I'm just super nervous about all of this, especially with my family history. Am I being paranoid?? The clinical history provided to the lab was "nontoxic uninodular goiter" which is incorrect!! There are 3 nodules, two on the left and one on the right. I read (http://knowcancer.com/oncology/hurthle-call-adenoma/) that "hurthle cell adenomas and carcinomas have a higher incidence in people who have other, non-malignant thyroid problems like. . . colloid nodular disease. . ." and "Regardless of whether or not the tumor is malignant, Hurthle cell adenomas and carcinomas are both removed promptly to prevent the disease from progressing further." Do I just need to stop researching or what?


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## Andros (Aug 26, 2009)

hillaryedrn said:


> Ok, I can't get in to my Endo for a couple weeks, so I'm going to speak to my internist and get his opinion on the whole thing. My Endo apparently has a "wait and see" approach that just makes me uncomfortable. Upon doing my own research, my fna results don't lean towards Hashi. So that, again, makes me uncomfortable. *sigh* I'm just super nervous about all of this, especially with my family history. Am I being paranoid?? The clinical history provided to the lab was "nontoxic uninodular goiter" which is incorrect!! There are 3 nodules, two on the left and one on the right. I read (http://knowcancer.com/oncology/hurthle-call-adenoma/) that "hurthle cell adenomas and carcinomas have a higher incidence in people who have other, non-malignant thyroid problems like. . . colloid nodular disease. . ." and "Regardless of whether or not the tumor is malignant, Hurthle cell adenomas and carcinomas are both removed promptly to prevent the disease from progressing further." Do I just need to stop researching or what?


No, don't stop researching and advocating for yourself. I know many who were told that they could not possibly have cancer of the thyroid but there it was when they had the organ removed and it was sent out to path.

Trust your instincts; always. No one knows their body better than the owner. That's you!

I will help you all I can.


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## hillaryedrn (Dec 14, 2009)

Oh well, put off by another doctor as well. I'm going to get a second opinion thru another endocrinologist then I guess I'll let it go. Maybe I am just worrying for no reason. I just can't believe that no one sees my concern. Oh well.


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## Andros (Aug 26, 2009)

hillaryedrn said:


> Oh well, put off by another doctor as well. I'm going to get a second opinion thru another endocrinologist then I guess I'll let it go. Maybe I am just worrying for no reason. I just can't believe that no one sees my concern. Oh well.


I see your concern. I am here to validate you. Don't give up;your life may depend on it. I was fluffed off by the medical establishment for 20 years and almost died because of it.

Advocate for yourself; I will help you. Others here will help you also.

Do you have a copy of the pathology report in your possession? If you do, there should be a recommendation by the pathologist based on his/her findings right on that report.


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## hillaryedrn (Dec 14, 2009)

I have the report right here. These are the boxes listed: tests ordered, diagnosis, clinical provided history, clinician provided cytology information, and gross description. Unfortunately, I don't see a recommendation. It makes me feel SO much better to have just one person understand where I'm coming from. I've felt for a while that "something" was off, but my labs were always fine, so basically I was told it was all in my head. Even my internist dismissed me. I'm still trying to get that second opinion. My internist thinks that even an ENT wouldn't take out my thyroid at this point. Of course, I'm not necessarily wanting it out, just something. I don't know. I'll let you know if I get another appointment.


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## Andros (Aug 26, 2009)

hillaryedrn said:


> I have the report right here. These are the boxes listed: tests ordered, diagnosis, clinical provided history, clinician provided cytology information, and gross description. Unfortunately, I don't see a recommendation. It makes me feel SO much better to have just one person understand where I'm coming from. I've felt for a while that "something" was off, but my labs were always fine, so basically I was told it was all in my head. Even my internist dismissed me. I'm still trying to get that second opinion. My internist thinks that even an ENT wouldn't take out my thyroid at this point. Of course, I'm not necessarily wanting it out, just something. I don't know. I'll let you know if I get another appointment.


Wonder if you can call the pathology department? It is unusual that there is no recommendation.

Doctors are very good at dismissing. Very good. It is a scary world out there. We should not have to pay them for dismissing us. They need to make some better laws. Either you get the patient well or you don't get paid. Dang!!!

Take all your stuff w/you including the pathology report. There has to be someone somewhere who is willing to help you and get to the bottom of this.

We here on this board will support you best we can. It's a sin that a patient is sick and has to work so hard to advocate for themselves but that "is" the way it is now a days.


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## hillaryedrn (Dec 14, 2009)

The pathology report is from a lab company that most MD's around here use. I can try calling them and see. The second opinion (Yay! I have an appointment for mid-February) asked me to get my current Endo to fax all my records to them. We'll see what comes of it.


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## Andros (Aug 26, 2009)

hillaryedrn said:


> The pathology report is from a lab company that most MD's around here use. I can try calling them and see. The second opinion (Yay! I have an appointment for mid-February) asked me to get my current Endo to fax all my records to them. We'll see what comes of it.


Well, that appt. can't come too fast to suit me!! I will be anxious to learn all about that visit and in the meantime, you have nothing to lose by calling the lab about your pathology report. Absolutely nothing; so please do give that a try!


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## hillaryedrn (Dec 14, 2009)

I will! Thanks again for all your support!!


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## Andros (Aug 26, 2009)

hillaryedrn said:


> I will! Thanks again for all your support!!


Thank you for your thanks. That is what I am here for! It is a pleasure to help if I can.


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## hillaryedrn (Dec 14, 2009)

Ok, so I went ahead and kept a follow-up appointment that I had made with my original Endo. He brought up my path report so we would have everything. He said that considering my history, questionable Hurthle cells on path report, and me voicing my concerns, he's setting me up with a surgeon for a lobectomy! He doesn't recommend a tt, but they will remove the left lobe (one with the largest nodule) and go from there. Thanks again!!


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## Andros (Aug 26, 2009)

hillaryedrn said:


> Ok, so I went ahead and kept a follow-up appointment that I had made with my original Endo. He brought up my path report so we would have everything. He said that considering my history, questionable Hurthle cells on path report, and me voicing my concerns, he's setting me up with a surgeon for a lobectomy! He doesn't recommend a tt, but they will remove the left lobe (one with the largest nodule) and go from there. Thanks again!!


Cool and I am impressed with your self-advocacy. This is one of many things I am interested in helping the posters acquire skills in. Your voice must be heard.

Oh, do let us know when everything is set up. You "know" I am very interested and I care a lot about what is going on w/ you.

Well, I am happy. This is a good thing!

See? "Questionable!" Hah!!!!


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## hillaryedrn (Dec 14, 2009)

Thanks, Andros! I feel much better now. He still didn't say much about the Hurthle cells, but we'll know more now, won't we! Of course, now I have surgery to think about, but I'm much more comfortably with that than waiting for it to get huge or something!


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## Andros (Aug 26, 2009)

hillaryedrn said:


> Thanks, Andros! I feel much better now. He still didn't say much about the Hurthle cells, but we'll know more now, won't we! Of course, now I have surgery to think about, but I'm much more comfortably with that than waiting for it to get huge or something!


While it is not me who is going to have the surgery, I am relieved. I truly think this is a very smart move given your family history and your own current medical presentation.

I would like to think that a life has been saved. We will know soon enough.


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## hillaryedrn (Dec 14, 2009)

I am relieved as well. My parents are much relieved also! My father, especially, since he went through this before. I'm not sure about my husband. I think he might be pretty nervous about it, but he's kinda reluctant to talk about it. I'll try talking with him tonight because I don't want him worrying like crazy over this. Andros, you really don't know how much your support has meant to me. I thank you so very much!


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## Andros (Aug 26, 2009)

hillaryedrn said:


> I am relieved as well. My parents are much relieved also! My father, especially, since he went through this before. I'm not sure about my husband. I think he might be pretty nervous about it, but he's kinda reluctant to talk about it. I'll try talking with him tonight because I don't want him worrying like crazy over this. Andros, you really don't know how much your support has meant to me. I thank you so very much!


When husband's can't "fix" it, they get upset. Most men like to fix things and are quite good at it. When they can't fix the wife or the children, they do have a tendency to withdraw. Bear in mind, this is a "general" statement.

Ever read the book, "Women Are From Venus, Men Are From Mars?" Gives great insight into this very thing.

And..............you are most welcome. That is why I am here.


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## hillaryedrn (Dec 14, 2009)

I'm sure you are absolutely right about that!!

I just got off the phone with the surgeon's office. I have an appointment with him on Jan 29th. I guess I'll find out more then. Any advice as to what I might expect at that appointment?


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## Andros (Aug 26, 2009)

hillaryedrn said:


> I'm sure you are absolutely right about that!!
> 
> I just got off the phone with the surgeon's office. I have an appointment with him on Jan 29th. I guess I'll find out more then. Any advice as to what I might expect at that appointment?


Glad the appt. is set up. I have no expertise in the field of what the surgeon should say or not say. You do have to feel comfortable w/ him though. I would say that would be a top notch priority.

It would also help if he is good looking.:anim_63:


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## hillaryedrn (Dec 14, 2009)

ROFL! Unfortunately he isn't all that good looking! He's kinda old!


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## Andros (Aug 26, 2009)

hillaryedrn said:


> ROFL! Unfortunately he isn't all that good looking! He's kinda old!


Aw pooey! But, I'll bet he is skilled at his surgery. The older the more experience and so on. That right there is a good sign all kidding aside, of course.


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## hillaryedrn (Dec 14, 2009)

I'm sure you're right there!! Maybe the anesthesiologist will be easy on the eyes! :anim_63:


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## Andros (Aug 26, 2009)

hillaryedrn said:


> I'm sure you're right there!! Maybe the anesthesiologist will be easy on the eyes! :anim_63:


Now that would be a bright spot to the surgery day!!!arty0006: You won't be awake much though. I wonder if you will have to have a drain in. That might be one question. I also wonder if when he gets in there and looks at the other side what he will find? That might be another question.


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## hillaryedrn (Dec 14, 2009)

Those are both definitely on my list of questions!


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## Andros (Aug 26, 2009)

hillaryedrn said:


> Those are both definitely on my list of questions!


And your list?? Maybe others might benefit from seeing it???


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## hillaryedrn (Dec 14, 2009)

Sounds like a good idea! I also wonder where I can read about other's experiences. I mean, I know what the surgery is and what it entails, but I'm wondering about how it was dealt with before and after.

Ok, so here's my list so far, and I realize that the answer to some of these might change once he gets in there and takes a peek :

1. How big do you expect my incision to be?

2. Will you be able to tell by just looking or will we need to wait for frozen section to decide on the other lobe?

3. How long should I plan on being in the hospital?

4. Will I have a drain? For how long?

5. When can I go back to work? (ER nurse!)

6. How long will it take to get the frozen section back?

7. How will the incision be closed? (stitches, staples, glue, etc.)

I'm sure I'll think of more before my appointment!! :anim_63:


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## Andros (Aug 26, 2009)

hillaryedrn said:


> Sounds like a good idea! I also wonder where I can read about other's experiences. I mean, I know what the surgery is and what it entails, but I'm wondering about how it was dealt with before and after.
> 
> Ok, so here's my list so far, and I realize that the answer to some of these might change once he gets in there and takes a peek :
> 
> ...


Thank you so much for sharing your list. I have one!! How about when will I be started on thyroxine replacement?


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## hillaryedrn (Dec 14, 2009)

That's one I should probably add. It's possible I won't need to, if they only do a lobectomy.

8. Will I need to be on thyroid replacement therapy? When will it start?


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## Andros (Aug 26, 2009)

hillaryedrn said:


> That's one I should probably add. It's possible I won't need to, if they only do a lobectomy.
> 
> 8. Will I need to be on thyroid replacement therapy? When will it start?


That's good. And also correct; you may not need thyroxine replacement.


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## hillaryedrn (Dec 14, 2009)

Update - I went back to my Endo today for an ultrasound of my little friends. The largest one (the one they biopsied) was 1.2 cm in October is now 1.8cm, the other one on that side was 0.4cm is now 1.0 cm. Interesting. . .


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## Andros (Aug 26, 2009)

hillaryedrn said:


> Update - I went back to my Endo today for an ultrasound of my little friends. The largest one (the one they biopsied) was 1.2 cm in October is now 1.8cm, the other one on that side was 0.4cm is now 1.0 cm. Interesting. . .


While not the expert here, that does seem like a rapid growth rate. I pretty much think that that confirms the surgery question, don't you?


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## hillaryedrn (Dec 14, 2009)

I agree! Just wonder what my Endo will say. Is Monday too early to call and ask him?


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## Andros (Aug 26, 2009)

hillaryedrn said:


> I agree! Just wonder what my Endo will say. Is Monday too early to call and ask him?


Well; the holidays are over so maybe folks are back in sync and things are moving along smoothly. It sure would not hurt to call, that is for sure.

I would; I like my voice to be heard so I don't get lost in the shuffle and it is indeed a shuffle.


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## hillaryedrn (Dec 14, 2009)

I will, then I'll let you know what he says!


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## Andros (Aug 26, 2009)

hillaryedrn said:


> I will, then I'll let you know what he says!


I hate weekends. LOL!! Waiting, waiting.:anim_03:


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## hillaryedrn (Dec 14, 2009)

Amen!! :anim_63:


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