# Newbie with FNA diagnosis of suspicious for malignancy



## my3gr8girls (Mar 18, 2016)

Hi,

My name is Liz. I'm 51 years old. I live in Virginia and work at the University of Virginia Medical Center. I was recently diagnosed with a thyroid nodule that is suspicious for malignancy for which they want to do a lobectomy or TT depending on final diagnosis.

I've been scouring these boards for information to alleviate my panic and fear because I'm terrified that my quality of life is going to take a nosedive. I currently have no physical or mental health issues. I have not reached menopause but expect to any day... I just can't imagine dealing with menopause and thyroid issues all at once. I'm not sure of the size of the nodule but I think it's over 3 cm. It's kind of aggravating because neither of the ultrasound reports I'm reading mentions the size. The differential is papillary CA vs. Hurthle cell lesion. I have never had thyroid problems before so the thought of creating them by removing my thyroid is scary. My ENT head & neck surgeon wants to do a lobectomy and and then a biopsy in the OR. If it's cancer, they will remove the rest. I was terrified of that but after reading these boards now I wonder if I really want them to leave half of it. I really wish I could have a more definitive diagnosis BEFORE they remove any of it at all.

I have not seen an Endocrinologist yet. I'm trying to get in to talk to my daughter's Endocrinologist before I see the surgeon so I can learn more about my options. The ultrasound also showed one possibly abnormal lymph node so I had a CT with contrast of my neck. I don't have the results of that yet. I'm supposed to see the ENT surgeon on Tuesday (3/22) for the results and to schedule surgery.

Would it be weird to ask for a second FNA biopsy before they actually do a lobectomy? Below is the note from the FNA:

DIAGNOSIS:

THYROID, LEFT NODULE, US-GUIDED FNA:
SUSPICIOUS FOR MALIGNANCY. (See note.)

Note: The smears are paucicellular, but show small clusters of atypical cells
with significant increase in nuclear size, overlapping, and nuclear grooves.
The differential diagnosis includes a papillary thyroid carcinoma as well as a
Hürthle cell lesion.

Any advice and/or insight is appreciated. Thank you,

Liz


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## Octavia (Aug 1, 2011)

Hi Liz, and welcome!

Not long ago, I was in your shoes, but 10 years younger. No health issues. Indeterminate FNA, but a large nodule.

I opted for a partial thyroidectomy, and that turned out to be a mistake in my case. Pathology came back positive for Papillary cancer, so I had to turn around two weeks later and have a second surgery. In hindsight, I should have insisted on a second FNA biopsy because if the cancer would have been known in advance, my surgeons and I would have known to remove my entire gland in one surgery. (Yes, my surgeon did the mid-surgery "frozen section" quick pathology, but that was negative in that moment; it's notorious for being inaccurate.)

Can you request a second FNA?

My quality of life has not suffered one bit. Other than taking a couple of pills each morning and getting occasional labwork done, the entire experience was a hiccup in my life. A major inconvenience, but not much more than that. Often, people are concerned about gaining weight after a thyroidectomy. I weigh less now than I did before surgery. As long as you have a competent doctor to help you manage your meds, you should not suffer any quality of life issues. By competent doctor, I mean one who will listen to you and will test and dose based not only on TSH, but also Free T3 and Free T4 (as well as any symptoms).


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## joplin1975 (Jul 21, 2011)

Well, first and foremost, I want to say that I, for one, love life without a thyroid. I came on these boards a number of years ago and would swear up and down that I most certainly did not have a thyroid problem, had no symptoms, and was doing just fine. Turns out, I was pretty sick and was so unaware of all the things a punky thyroid could impact that I never realized how ill I was. Were there days after the surgery when it was tough? Was the adjustment process a bit long? Yes and yes. But long term, I'd argue 'till I'm blue in the face that the thyroid-less life is the way to go.

Back to you...

Did they ever run any thyroid antibodies tests? Have they mentioned the possibility of doing Afrima testing on the samples for a better diagnosis? Did you have any regular thyroid labs run?

Honestly? I think the vast majority of the time, if its suspicious for malignancy, it's probably cancer. When you get a diagnosis of indeterminate, THEN it's more of a toss up....but suspicious more often than not = cancer. And, since you are over 40, I think a total thyroidectomy would be your best bet (thyroid cancer tends to be a bit more aggressive in people over 40).


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## my3gr8girls (Mar 18, 2016)

Thank you for your replies! My doctor did do a TSH but that's it, and it was normal. I don't recall the exact value. I don't believe they have done any antibody testing. What exactly does that show? Also I have not heard about Afrima.

I'm currently working full time and in college taking 2 classes. I wonder if I'll be able to manage the schoolwork if I have the surgery in the middle of the semester. Is there a lot of brain fog? I feel like I have brain fog right now due to the stress and fear I'm dealing with right now.

I just keep praying (I'm a Christian) that God will take it all away. Supernatural healing and all that. I know that in life these things can happen, but I just finished raising two very difficult (off-the-charts difficult) teenagers who actually turned out great finally, and my youngest daughter who has struggled with migraines is doing better too. And now this! It's testing my faith and I just feel depressed. I don't want to be depressed.

Do people without thyroids tend to have to be treated for other things too like depression usually? What other meds/supplements do you have to take?

Liz


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## Mike1973 (Feb 25, 2016)

I was in your shoes about 8 weeks ago. Had a biopsy that was sent for an Afirma test and came back suspicious. Endo sent me to a surgeon, he said take the whole thing since there were nodules on the other side too.

Surgery was a breeze, recovery not bad and I feel better now than I did with the thyroid intact. I'm only 2 months out and still tweaking meds a bit but I don't regret it at all! Remember that there are probably at least hundreds of these done per day in the U.S. and a majority of them go without issue, the ones you read about online are the few that have problems. Make sure your surgeon does a lot of these (mine does over 100/year) and you'll be through it before you know it.

Let me know if you have any questions!


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