# Results are in... Atypical (Follicular) cells



## ives6797 (Apr 23, 2013)

I'm in the "gray area". They can't say it's fine and they can't say it's not.

Atypical cells of undetermined significance, follicular epithelial cells with mild cytologic and architectural atypia.

Specimen tissue: FNA- 30 ML tan, clear, right thyroid FNA. (they biopsied 2 nodules, both were about 1cm)

TSH: 2.43 (ref 0.27-4.2)
Thyroxine (T4) 8.28 (ref 5.1.-14.1)

Recommendation: Repeat u/s in 3 months to see if they are growing. Also gave me a number for specialist at Yale if I want to check with them and get their opinion.
*
Kat92*, this was the same result as yours, wasn't it?? Was telling my hubby this is freaky, we have been following each other, had FNA a couple days apart, same size nodules, same result? I was joking with hubby that you probably live in my town too! You don't live in New England, do you? lol

EDITING TO ADD... *ADDING U/S RESULTS* that they failed to give me this morning. I had to go back to sign a records release since they failed to tell me that when I was there this morning so while I was there I asked for u/s report.

"The right lobe is heterogeneous and measures 4.9 x 1.1 x 1.3cm. The upper pole there is a hypoechoic nodule measuring 6x4mm. In the midpole there is a solid isoechoic nodule measuring 1.0x0.6x 0.5cm. In the lower pole there is a hypoechoic nodule with a calcification (*umm is that bad???*) measuring 6x6x5mm.

The left lobe is heterogeneous and measures 4.9x1.4x1.3cm. There is a complex nodule in the lower pole measuring 5x4x4mm. The isthmus measured 1mm. 
Impression: Heterogeneous gland. Three nodules on the right and one on the left as described above."

What does complex, isoechoic and hypoechoic mean?? And calcification, that one I am thinking might be bad?? OH and the dr said he biopsied 2 on the right because they were both the same size, 1cm. Yet the u/s report from a couple weeks prior (results that are above) doesn't list 2 on the right that are the same size, does it?? I am confused. I wouldn't think one would grown that much in only a couple weeks (from half cm to 1 cm)


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## kat92 (Apr 22, 2013)

ives6797 said:


> I'm in the "gray area". They can't say it's fine and they can't say it's not.
> 
> Atypical cells of undetermined significance, follicular epithelial cells with mild cytologic and architectural atypia.
> 
> ...


yea!! Wonder if this whole "we don't know" is a common occurance in terms of biopsies?? It's irritating. That's all I've figured out. I go for my second opinion on the 22nd. hoping he just wants to yank it out. I'm tired of worrying. The not knowing is going to make me stroke out pretty soon. So I've gotta do something!!

Hopefully someone here can interpret your biopsy results better than I can. I see "atypia"....but sometimes that means nothing. Cytologic?..not sure what that means? But On a good note, in the words of my dr..."we did not find the most common cancer and the other possible cancers are way down on the list, so that right there is reassuring"...

Im picking up a copy of my biopsy report today. I wanna know EXACTLY what it says. Doctors loose interpretation is almost more misleading than the biopsy result itself. 

** and nope...not in New England. Wish i was ...we could really commiserate together then hugs2


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## Octavia (Aug 1, 2011)

I, too, was in the gray area with follicular cells. Doc said there was only a small chance that it was cancer, and I was having surgery anyway because my nodule was pretty large and it was causing discomfort, slight difficulty swallowing, and my voice was hurting (which made no sense to me at the time, until I noticed the nodule popping out of my neck one day).

Anyway, surgeon and I decided the best approach was a partial thyroidectomy. Wrong decision this time. Had to go back for the total a few weeks later, unfortunately.

But despite what I've just shared, odds are still with both of you. It's impossible to know for sure what to do.


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## kat92 (Apr 22, 2013)

Octavia said:


> I, too, was in the gray area with follicular cells. Doc said there was only a small chance that it was cancer, and I was having surgery anyway because my nodule was pretty large and it was causing discomfort, slight difficulty swallowing, and my voice was hurting (which made no sense to me at the time, until I noticed the nodule popping out of my neck one day).
> 
> Anyway, surgeon and I decided the best approach was a partial thyroidectomy. Wrong decision this time. Had to go back for the total a few weeks later, unfortunately.
> 
> But despite what I've just shared, odds are still with both of you. It's impossible to know for sure what to do.


This is what I don't understand. You read about how minimal the chances are....even when it comes back suspicious. Yet, almost everyone's I've read, when it's all said and done, they say oh, yep...it was cancer. If it was so rare, and only a "20% chance" or whatever they say, why do so many people have this!?!? Someone needs to re-do their statistics I think!!! World of medicine needs to catch up!! :aim33:


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## joplin1975 (Jul 21, 2011)

Yes, but remember...as we always say, when you hang out on line on thyroid boards, you are most likely dealing with the exceptions while the people who fall into the vast majority of the population aren't worrying about their thyroids any longer.


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## kat92 (Apr 22, 2013)

joplin1975 said:


> Yes, but remember...as we always say, when you hang out on line on thyroid boards, you are most likely dealing with the exceptions while the people who fall into the vast majority of the population aren't worrying about their thyroids any longer.


Excellent point.


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## Andros (Aug 26, 2009)

ives6797 said:


> I'm in the "gray area". They can't say it's fine and they can't say it's not.
> 
> Atypical cells of undetermined significance, follicular epithelial cells with mild cytologic and architectural atypia.
> 
> ...


Did anybody do Thyroglobulin and Thyroglobulin Ab labs? Might be a good idea to consider having thyroid ablation.

What do you think?


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## ives6797 (Apr 23, 2013)

I only had those blood tests listed, I know it was not enough yet the ENT says they are normal an no further blood testing is needed. She said that if I had Hashi's, it would've shown in those #s. I think he is wrong. She also said a couple other things that I know are incorrect today so I can't put a whole lot of faith into what she says at this point! I am trying to get a second opinion. I am working on transferring records and getting an appt on the books.

ADDING U/S RESULTS that they failed to give me this morning. I had to go back to sign a records release since they failed to tell me that when I was there this morning so while I was there I asked for u/s report.

"The right lobe is heterogeneous and measures 4.9 x 1.1 x 1.3cm. The upper pole there is a hypoechoic nodule measuring 6x4mm. In the midpole there is a solid isoechoic nodule measuring 1.0x0.6x 0.5cm. In the lower pole there is a hypoechoic nodule with a calcification (*umm is that bad???*) measuring 6x6x5mm.

The left lobe is heterogeneous and measures 4.9x1.4x1.3cm. There is a complex nodule in the lower pole measuring 5x4x4mm. The isthmus measured 1mm. 
Impression: Heterogeneous gland. Three nodules on the right and one on the left as described above."

What does complex, isoechoic and hypoechoic mean?? And calcification, that one I am thinking might be bad??

ADDING: OH and the dr said he biopsied 2 on the right because they were both the same size, 1cm. Yet the u/s report from a couple weeks prior (results that are above) doesn't list 2 on the right that are the same size, does it?? I am confused. I wouldn't think one would grown that much in only a couple weeks (from half cm to 1 cm)


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## joplin1975 (Jul 21, 2011)

ives6797 said:


> What does complex, isoechoic and hypoechoic mean?? And calcification, that one I am thinking might be bad??


Complex means its part solid and part cystic.

Hypoechoic means that when the u/s waves reflect off that nodule, they are not returning at the same pace as the waves that bounce off the surrounding tissue. It is generally indicative of some kind of disease process.

Isoechoic, as I understand it, means that the sound waves are bouncing off that nodule at the same rate of the surrounding tissue.

So, hypoechoic, califications, solid (to a lesser extent, complex) and vascular are those classic red flags.


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## ives6797 (Apr 23, 2013)

Thank you for the info, joplin... not great news, but it as what I thought.


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## ives6797 (Apr 23, 2013)

ENT says 90% sure all is fine. Is it really that high though? I'm sorta afraid it's not.


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## Andros (Aug 26, 2009)

ives6797 said:


> I only had those blood tests listed, I know it was not enough yet the ENT says they are normal an no further blood testing is needed. She said that if I had Hashi's, it would've shown in those #s. I think he is wrong. She also said a couple other things that I know are incorrect today so I can't put a whole lot of faith into what she says at this point! I am trying to get a second opinion. I am working on transferring records and getting an appt on the books.
> 
> ADDING U/S RESULTS that they failed to give me this morning. I had to go back to sign a records release since they failed to tell me that when I was there this morning so while I was there I asked for u/s report.
> 
> ...


Solid, complex and calcification are not good words. Fast growing is not good.

I would like to encourage you to seek another opinion as I believe this doctor does not know what she/he is talking about.

Hashi's does not show in numbers. Numbers may "suggest" Hashi's but FNA has to be done to confirm.

Please read........

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis

Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2

http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/

Thyroid cancer diagnosis..........
http://www.cancer.org/Cancer/ThyroidCancer/DetailedGuide/thyroid-cancer-diagnosis


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## ives6797 (Apr 23, 2013)

The FNA results are in the original post. Hashi's can't be told from that though, can it? I am confused.


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## joplin1975 (Jul 21, 2011)

Yes, a definitive dx of Hashi's should be made via FNA.


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## ives6797 (Apr 23, 2013)

What would the FNA result say if it were positive of Hashis? I thought they were only looking for cancer.


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## joplin1975 (Jul 21, 2011)

I believe mine said something to the effect of "presence of hurthle cells consistent with chronic thyroiditis." Or something like that.

Remember they (the pathologists) aren't really looking for anything -- they are just reporting on what kinds of cells they find and what they look like.


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## kat92 (Apr 22, 2013)

ives6797 said:


> ENT says 90% sure all is fine. Is it really that high though? I'm sorta afraid it's not.


That sounds exactly like my ENT. "90% sure". How can they be!?!? Statistics are only good for so much....

Definitely get a second opinion!


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## ives6797 (Apr 23, 2013)

I have to think that the red flag words in my results would bring that number down. I want it out. Trying to get an appt with the endocrine surgeon she gave me the # for. I did everything on my end to get them the records etc, now I wait for a call back with the appt date. I hope that he will take it out. It wouldn't be overly convenient because this dr is at a major hospital (Yale New Haven) and with the traffic that is pretty much always in that area, I don't think I could get there in less than 2 hours. However, the drs are likely outstanding, and by the time I get there, I will likely beg the janitor to take it out, so it may not matter....


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## kat92 (Apr 22, 2013)

"Beg the janitor to take it out"... That literally made me laugh outloud.  I'm the same way anymore. Just take it!... I don't want it anymore!!

My dr/surgery will also be about 2 hrs from home. I worry about the inconvenience, but more so about the drive back home after the surgery!!! I don't wanna be in excruciating pain for two hours and on the road. I'll jump out of the da*n car!!! Haha!!


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## ives6797 (Apr 23, 2013)

I booked an appt with an endocrine surgeon at Yale's Smilow Cancer Center for next Thursday. I am so anxious to hear what she says!!


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## abymom99 (Apr 15, 2013)

ives6797 said:


> I booked an appt with an endocrine surgeon at Yale's Smilow Cancer Center for next Thursday. I am so anxious to hear what she says!!


That's great! Were you able to just call and schedule or did they need a referral?

At least you have something to move forward with, even though it's still vague right now. I'm still waiting for ANY answer. My biopsy report was supposed to be to my endo by last Thursday afternoon. I called on Friday afternoon and the nurse said she didn't have it and would have to call over for it. I'm pretty sure she just misplaced it like she did the initial MRI report I sent her letting them know my other doc had found a nodule. Normally I would think "no news is good news", but with this nurse I can't even count on that! 

Please keep us posted after your appointment next week!


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## ives6797 (Apr 23, 2013)

abymom, I had to wait for my results too! The hosp told me 48 hours for my ENT to get the results. My FNA was on a Monday morning, so hey should've gotten them on Wed. I even waited until Thurs to be sure (which was hard for me to do! lol) and they told me they had them but dr ned to look at them and then she ended up leaving early for the day, said they would call me Fri morning. I waited, no call. Called them back and finally found out Fri afternoon that they never even received them. They finally got them Mon afternoon, a full week after my FNA. And to top it off, I still don't know what's going on because my result came back as atypical/suspicious. Frustrating. ENT said she is 90% sure it's fine, though personally I don't think she even knows what she is talking about. Thankfully though, she also gave me the number to the endocrine surgeon if I wanted to see what they thought (and YES I do!) So I called the number she gave me and they said I needed to have the ENT fax over all my paperwork/results (which, btw,took them 2 days to do). I've been working on getting an appt with them since Wed and finally got it today.


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## Andros (Aug 26, 2009)

ives6797 said:


> What would the FNA result say if it were positive of Hashis? I thought they were only looking for cancer.


You have some really good links which explains all this stuff. There are Hurthle Cells indigenous to Thyroid Cancer and Hurthle Cells indigenous to Hashimoto's.


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## ives6797 (Apr 23, 2013)

I didn't originally realize that Hashi's was dx via FNA. Apparently, that has been crossed off the list then because my results had no mention of that type of cell, only atypical follicular epithelial cells with focal mild cytologic and architectural atypia, whatever that means!


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## Andros (Aug 26, 2009)

ives6797 said:


> I didn't originally realize that Hashi's was dx via FNA. Apparently, that has been crossed off the list then because my results had no mention of that type of cell, only atypical follicular epithelial cells with focal mild cytologic and architectural atypia, whatever that means!


Absolutely; the lab report would have pointed out the Hashimoto's Hurthle Cells as per the pathologist. You could always call and double check though; do you think?

It would not hurt just to put your mind at ease.


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## abymom99 (Apr 15, 2013)

ives6797 said:


> abymom, I had to wait for my results too! The hosp told me 48 hours for my ENT to get the results. My FNA was on a Monday morning, so hey should've gotten them on Wed. I even waited until Thurs to be sure (which was hard for me to do! lol) and they told me they had them but dr ned to look at them and then she ended up leaving early for the day, said they would call me Fri morning. I waited, no call. Called them back and finally found out Fri afternoon that they never even received them. They finally got them Mon afternoon, a full week after my FNA. And to top it off, I still don't know what's going on because my result came back as atypical/suspicious. Frustrating. ENT said she is 90% sure it's fine, though personally I don't think she even knows what she is talking about. Thankfully though, she also gave me the number to the endocrine surgeon if I wanted to see what they thought (and YES I do!) So I called the number she gave me and they said I needed to have the ENT fax over all my paperwork/results (which, btw,took them 2 days to do). I've been working on getting an appt with them since Wed and finally got it today.


Are we seeing the same endo? LOL. I just called again and this time the nurse told me that she just faxed the hospital about 5 minutes before I called because the hospital sent over the wrong information. Apparently, they sent her the procedural info only, not the pathology report. UGH! So hopefully she'll get the path report this afternoon AND have the doc review it so that she can call me back today with the results. I told her I also want her to fax the report to me, but only after she calls me back since my fax is in a shared office and I want to know right when she's sending it so I can wait for it. I'll be posting as soon as I get my results. Fingers crossed!

So glad you got in, even though it sounds like you've had to work as hard as I have been just to get anything done!


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## ives6797 (Apr 23, 2013)

Yeah no kidding! When I went to see ENT for followup, she gave me the # for endo surgeon, so I go home and call them... they asked me if I had signed a records release from for them to be able to fax my info. Ugh, would've been nice if they had told me that while I was there!! So I had to drive back down the 35min each way to sign it, right after I had already been there. Also, I ad asked for copies of ALL my results and they did not give me EITHER u/s report even though I had 2 done. So I had to ask for that when I went back, then they only gave me one, I gave up at that point. It's been a disaster there, not sure will go back there once this ordeal is over. I do probably still need an ENT though because I have vocal polyps that I'd like taken are of. They've been there since 2009 (yes that long) and ENT says she doesnt like to do surgery and says she can refer me to speech therapy instead. Hmmm. I don't know about that.


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## abymom99 (Apr 15, 2013)

Ugh, that's awful! How annoying. Well, my other master plan was to go up to the hospital and get the path report from them directly, but I looked up their medical records department on their website and it turns out they charge $50 for the first 10 pages of patient records. Ridiculous!!! I decided I could wait a few more days. LOL.


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