# Had biopsy this afternoon and US results



## abymom99 (Apr 15, 2013)

Well, the biopsy all went pretty well. I really liked the radiologist and he said he feels he got a really good sample of my nodule. He said the results should be sent over to my endo by Thursday afternoon and to call them on Friday if I haven't heard anything. It's been about 3 hours since the biopsy and I'm a bit sore with some bruising at the injection site, but otherwise it seems to have gone smoothly. I put an ice pack on it when I got home just to help any swelling/bruising.

The not so good part is that I got my ultrasound report while I was there, and although I already knew about the nodule, apparently my lymph nodes on that side are also very enlarged. :confused0003: The radiologist was actually planning to biopsy the largest one, but for some reason had a hard time locating it. So he went back and re-reviewed the ultrasound that was done last Monday and said that all of the ones he could get to are all pretty thin from a biopsy standpoint, so he likely wouldn't be able to get a good sample from them, at least not easily. The other that he did find himself was actually behind my thyroid, so he couldn't get to it. So we talked about it and decided to put the lymph node biopsy on hold at this point.

Here are all of the findings from the ultrasound report:

Complex, predominantly solid nodule in the left pole of the left lobe measuring 1.9 cm x 1.6 cm x 1.3 cm. Doppler blood flow is present within the nodule.

Coarse heterogenous echotexture of the thyroid bilaterally consistent with history of Hashimoto's thyroiditis.

Prominent lymph nodes are seen in the anterolateral left neck, measuring up to 19 mm in length. (Four lymph nodes seen in total measuring 16x11x3mm, 13x9x10mm (I think this is the one behind the thyroid), 19x6x3mm and 9x6x5mm)

Measurements of the thyroid:

Right lobe measures 5.2 x 1.7 x 1.1 cm
Left lobe meausres 5.1 x 2.2 x 1.3 cm
Isthmus measures 3mm​
I guess the one good thing is that I didn't have microcalcifications like the tech thought. But otherwise it's still a bit scary. The radiologist kept assuring me that it was highly unlikely I had thyroid cancer, but it still isn't looking very good on paper!

Any thoughts? Thanks!!!


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## joplin1975 (Jul 21, 2011)

I'm glad you survived with minimal issues. 

Enlarged nodes are a concern, but at this point? You just have to wait and see. Hang tight, Friday will be here soon!


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## abymom99 (Apr 15, 2013)

joplin1975 said:


> I'm glad you survived with minimal issues.
> 
> Enlarged nodes are a concern, but at this point? You just have to wait and see. Hang tight, Friday will be here soon!


Thanks joplin1975! hugs1 Fortunately, I have a few things to keep me busy between now and then, which should hopefully help some. Mostly work-related, but distraction is distraction!


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## webster2 (May 19, 2011)

Hang in there! Friday's not too far away.


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## abymom99 (Apr 15, 2013)

Just a quick update. I STILL don't have a path report yet, but I'm not surprised since the office staff seem completely incompetent, or are perhaps just taking in more patients than they can truly handle. I called the hospital this morning to get access to my online chart to see if I could pull it up that way, but fortunately found out that they would give me a copy of the path report at no charge if I wanted to come pick it up. Their website says they charge $45 for the first 1-10 pages, so I made sure to take note of the lady's name I spoke with in case they try to charge me. No way I want to pay that, although at this point it might be worth it for peace of mind!

Anyways, I'll report back on a new thread with my results. Fingers crossed!


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## joplin1975 (Jul 21, 2011)

Good luck!

(But one minor thing...if you can, keep your posts in one thread. It helps everyone follow along and you'll get more responses!  )


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## abymom99 (Apr 15, 2013)

joplin1975 said:


> Good luck!
> 
> (But one minor thing...if you can, keep your posts in one thread. It helps everyone follow along and you'll get more responses!  )


Will do! I just saw everyone else starting new ones and figured that was what I was supposed to do.


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## abymom99 (Apr 15, 2013)

Benign! hugs4 Other than that, I don't understand any of the report, so please provide any input you might have. Here is the complete report:

Final Diagnosis: Benign follicular nodule

Microscopic Description: The Diff-Quik stained smears demonstrate prominent areas with colloid and cracking artifact. There are also areas with thick colloid. An adequate number of thyroid follicular cell groups is identified. The cells in some areas have a honeycomb arrangement and there is pale nuclear chromatin without inclusions or nuclear grooves. No significant number of micro-follicules is appreciated. No cytoarchitectural features of papillary carcinoma are identified.​
So anyone know what any of this means and can give me a breakdown of terms? Thanks!!!


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## I DClaire (Jul 31, 2011)

I wish I knew enough to share some words of encouragement right now but I have a mental block when it comes to the terminology of thyroid disease. "Benign" is good - I do know that word! hugs3

I hope you'll get more good words soon. I had no earthly idea I had a tiny papillary cancer until I woke up from surgery but, considering what a worry wart I am, that was probably for the best!! My little cancer was the size of the tiniest bead you can imagine but my biopsy report was something like five pages long, single spaced, margin to margin...and the only thing I remember was the word "encapsulated"!


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## joplin1975 (Jul 21, 2011)

I can't help with the specifics, but yay!! Congrats on the benign result.


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## abymom99 (Apr 15, 2013)

Thanks to you both! I was surprised by some of the wording myself as I thought I knew most of the terms after all of my research! I did a bit more and basically discovered that I have either a "colloid" nodule or "hyperplastic" nodule. Here is a great pathology article I found that talks about a lot of various pathology terms, in case it's useful to anyone else:

http://rcpa.tv/parts/educational/anatomical/Dr_Alpha_Tsui/Thyroid_cytology.pdf

The part I'm now confused about is that there is no mention of any Hurthle cells, despite my "diagnosis" of Hashimoto's. But perhaps there are none simple because this was a nodule biopsy, and not specifically a biopsy of the regular thyroid tissue? I'm just wondering if this somehow rules out Hashimoto's, despite my very high TPO antibodies and ultrasound noting that the appearance of my thyroid is "consistent with Hashimoto's.

By the way, I STILL have not heard from my doctor's office about these results, what they mean or what my endo wants to do next, if anything. I went to the hospital where the biopsy was done and just picked them up. I'm hoping I'll get more insight from my endo's office...one of these days.


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## abymom99 (Apr 15, 2013)

I DClaire - I forgot to mention that my aunt had thyroid cancer back in 1990 and although she doesn't remember now what type it was, she said it was so tiny (size of the tip of a pencil) and the only spot in her nodule that she just had the nodule removed with no further treatment required. It sounded very similar to yours so I wanted to share. 

By the way, this is my only worry, that somewhere within my nodule there is still cancer lurking since the FNA can't test it all, but I guess it will now just be a watch and wait thing.


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## abymom99 (Apr 15, 2013)

Oh, and one more thing. I'm still worried about my "prominent" lymph nodes that were found on the ultrasound. They were supposed to biopsy one of those but couldn't get to one.  I'll have to ask my doc about that as well because I know enlarged lymph nodes can't be good!


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## abymom99 (Apr 15, 2013)

So after faxing them my path report Wednesday afternoon, I finally heard back from my endo's nurse this morning. She asked if I had sent the report and told her yes, because I hadn't heard anything from them. For Pete's sake they're only a full week late in getting me the results! 

Anyways, she went on to say that since my results were benign, he wanted to keep my f/u appt in 4 months and will get another ultrasound in 1 year. As she started to say goodbye I told her to wait because I had questions. :confused0003: I told her I wanted to know what he had to say about the prominent lymph nodes on my ultrasound report since they weren't able to biopsy one. She said she would have to talk to the doctor and call me back.

Much to my surprise, she actually did call me back just a little while ago. She said that my doc had forgotten about the lymph nodes (since he was just reviewing the path report I guess? ) and that he's going to want to do another ultrasound in 6 months, instead of a year, and if there is any growth he's going to refer me to an ENT specialist for surgery.

What I didn't tell his nurse was that I've already made myself an appointment to see a ENT and that will take place on 5/30. I went ahead and made an appointment with one not only to get a second opinion, but also because my allergist had recommended I see one anyways to check out my dizziness/vertigo problems. The ENT's office was wonderful and they're also setting me up for a hearing test 30 minutes before I see the doc (since they said dizziness could be related to this and want to rule it out) and have already asked me to bring in my actual ultrasound, not just the report, and all other labs and medical records. They said they could try to work me in sooner if I wanted, but honestly I could use a little break from appointments and I don't want them overbooking me anyways. I want her to spend her time with me and from what I've heard about her, she will. She's been highly recommended and is actually the Chief of ENT at one of our major medical centers. Needless to say, I'm very much looking forward to that appointment!

Anyways, I just wanted to let you all know what my endocrinologist finally had to say.


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## Andros (Aug 26, 2009)

abymom99 said:


> So after faxing them my path report Wednesday afternoon, I finally heard back from my endo's nurse this morning. She asked if I had sent the report and told her yes, because I hadn't heard anything from them. For Pete's sake they're only a full week late in getting me the results!
> 
> Anyways, she went on to say that since my results were benign, he wanted to keep my f/u appt in 4 months and will get another ultrasound in 1 year. As she started to say goodbye I told her to wait because I had questions. :confused0003: I told her I wanted to know what he had to say about the prominent lymph nodes on my ultrasound report since they weren't able to biopsy one. She said she would have to talk to the doctor and call me back.
> 
> ...


You got it going on now!!! Good for you!! We are all thrilled at this news! It's just a few weeks away; you actually got in fast as well.

How are you feeling these days?


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## abymom99 (Apr 15, 2013)

Thanks Andros! Yes, I feel much better about the plans going forward at this point. 

As to how I'm feeling, maybe a little better, but I think my main concerns at this point are possibly not related to my thyroid. I'm still having a lot of nystagmus, fluctuating and progressive blurred vision, dizziness, nausea, rapid heart rate (especially after eating and when laying down) and terrible reflux causing chest and throat pains (in the area of my nodule). My neurologist wants me to see an ophthalmologist so I'm actually going to one tomorrow. Then I go back for a follow-up to my GI on Tuesday and will see what he wants to do next. He had mentioned a HIDA scan as a possible next step.

The only thing that's been pointed out to me that could be my thyroid causing all of this is Hashimoto's encephalopathy. My neurologist said that very well could be causing my neurological symptoms, but that my endo would need to handle that.  So at this point I really have no one identifiable cause and that is the frustrating part.

My cardiologist had put me on a beta-blocker (bystolic) and although I didn't think it was helping with anything, I noticed my heart rate go back up after I got off of it. I think my nystagmus might have been minimized while on it as well. The problem is, I'm in the process of getting establishing on allergy shots (highly allergic to grass) and my allergist won't give them to me if I'm on it, in case of a reaction. Once I get to monthly doses, he said I could take it and just go off it a night or so before my shot, but with weekly shots at this point it's too risky. I may get back on it and then skip a week of shots to make a better determination at this point and if it is helping me, will have to weigh out pros/cons as to which I want to do at this point.

Why can't anything be simple? LOL.


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## Andros (Aug 26, 2009)

abymom99 said:


> Thanks Andros! Yes, I feel much better about the plans going forward at this point.
> 
> As to how I'm feeling, maybe a little better, but I think my main concerns at this point are possibly not related to my thyroid. I'm still having a lot of nystagmus, fluctuating and progressive blurred vision, dizziness, nausea, rapid heart rate (especially after eating and when laying down) and terrible reflux causing chest and throat pains (in the area of my nodule). My neurologist wants me to see an ophthalmologist so I'm actually going to one tomorrow. Then I go back for a follow-up to my GI on Tuesday and will see what he wants to do next. He had mentioned a HIDA scan as a possible next step.
> 
> ...


All the causes on the list below have been ruled out re the nystagmus?

Acquired nystagmus can be caused by a disease (multiple sclerosis, brain tumor, diabetic neuropathy), an accident (head injury), or a neurological problem (side effect of a medication). Hyperventilation, a flashing light in front of one eye, nicotine and even vibrations have been known to cause nystagmus in rare cases. Some acquired nystagmuses can be treated with medications or surgeries.

This is a horrible situation for you and I would like to think that the fix lies w/the thyroid. However, all avenues must be explored and it seems like you are doing that.


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## abymom99 (Apr 15, 2013)

Yep, I've been through the ringer the last two months. Brain/c-spine MRI (how we found the nodule), EEG followed by 72-hour video EEG (first had non-specific findings), nerve conductivity study and electromyogram plus lots and lots of blood work. Basically my neuro said he ruled out all of the big stuff (brain tumor, MS, etc.) and that all of my neuropathy problems were secondary to something else. This is why he said it could very well be Hashitmoto's encephalopathy. He still wants me to be checked out by the ophthalmologist and started me on B12, even though my levels were normal/low. I don't think the ophthalmologist is going to find anything, but maybe he'll be able to provide better direction.

I forgot to mention that I also have a lot of anxiety and feel tired almost all of the time, but can't sleep at night without ambien. I do sleep okay with the ambien, but all day I just feel like I want to go back to sleep, even though I can't if I try to lay down (heart gets racey). I think I might have something called dysautonomia, but I that's one of those things docs don't always believe in. I just always feel like my "fight or flight" response is active and always for no apparent reason. I had mentioned this to that I thought my autonomic nervous system seemed to have a mind of its own, but he never did mention anything about it specifically, just wanted to rule out what he could with all of his tests. 

I thought I was just swinging into hyper, but my thyroid levels checked out okay, so I'm starting to feel maybe it is related more to a neurological issue that my neuro just didn't get to the root of (or even digestive related?). I don't know, it's just all very frustrating, most especially the dizziness, nausea and exhaustion. It's starting to affect my personal life as well, which is the scariest part about all of this. I used to be so outgoing and active, and now I just want to stay home and lay around all the time.


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## CindiG (May 9, 2013)

abymom99 said:


> Thanks to you both! I was surprised by some of the wording myself as I thought I knew most of the terms after all of my research! I did a bit more and basically discovered that I have either a "colloid" nodule or "hyperplastic" nodule. Here is a great pathology article I found that talks about a lot of various pathology terms, in case it's useful to anyone else:
> 
> http://rcpa.tv/parts/educational/anatomical/Dr_Alpha_Tsui/Thyroid_cytology.pdf
> 
> ...


Actually people with Hashimotos have a somewhat more higher % of benign nodules(as opposed to cancerous ones) than people without Hashimotos or other thyroid conditions.One of my 3 thyroid nodules,the one on my isthmus that grew 50% in 3 years,has a majority of Hurthle cells and I *don't* have Hashimotos. Now,I have found more than a few people on thyroid and other health boards who had the same thing as me and their nodule(s) were benign when removed.

Also, I don't mean to scare you but the flip side is that research studies I read some years ago,I think it was on About Thyroid.com,showed that papillary thyroid cancer is even more common and more of a risk for people with Hashimotos.


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## abymom99 (Apr 15, 2013)

Thanks CindiG. And no, you didn't scare me as I was already aware of the statistics. I did a LOT of research in between my ultrasound and biopsy results. 

My nodule was also a bit higher risk for cancer because of the following:

-History of thyroid cancer in my family
-Solitary nodule
-Nodule is >1cm in diameter
-Nodulce is highly vascular
-Nodule is predominantly solid and very hard​
Plus my lymph nodes in the area are all "prominent", but I'll be getting a second opinion from a ENT soon so we'll see what comes out of that visit. I'm really more worried about the lymph nodes at this point, more than the possibility of thyroid cancer anyways. Hopefully I just have large nodes.


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## abymom99 (Apr 15, 2013)

I had my first visit with an ENT yesterday and, unfortunately, she wasn't as thyroid savvy as I was hoping she was going to be.  I did like her and got the sense that she is highly intelligent and caring, but still left with a little of that "she thinks I'm crazy" feeling. I know I have an enormous history and probably sound like a crazy person, but I just want them to have the entire picture because I can't help but feel everything is related somehow.

She asked what I wanted her to focus on first, because it was so much, so I told her my primary concern at this point is the pain I've been having in my neck (both deep pain and swelling/strangling pain) and that I'm still concerned about the enlarged lymph nodes. She said she didn't consider them to be all that large, nor was my thyroid, at least not to where I should be having symptoms, but that she would go ahead and order a CT of the neck to be sure. This way we can see if the lymph nodes are the same size or larger and if so, go ahead and try to get a biopsy now instead of waiting 6 months. If they are smaller, she said it was likely that I may have just had a small infection going on at the time, even though I wasn't symptomatic for any infection. I have the CT scheduled for next Wednesday afternoon (6/5) and will go back to see her the next morning.

The part that was frustrating was when we really started talking about my thyroid and I mentioned the labs. She definitely wanted to run my thryoid levels again, but I had to convince her to just to run the TPO antibodies again, since that was last run in 2009 and I'm concerned I'm developing Hashimoto's encephalopathy (I have a LOT of the primary symptoms). She agreed to run it, but was convinced my symptoms are all related to Hashi only (and my confirmed GERD), and didn't want to run anything else at this point (i.e. TSI, TrAb, etc.). I kept asking why everyone looks at those intial TPOab's and immediately assumes Hashi instead of Graves, since I'm becoming more hyper than hypo, but she just kept saying Hashi can cause severe hyper swings also. Didn't exactly answer my question.  My ultrasound did say the appearance was "consistent with Hashimoto's", so I think she also focused on that and didn't consider other options, at least for now.

She basically said she wants to start small and go from there and she again emphasized that she thought I was just in a really hyper Hashi swing right now. So in total, she is running four labs: TPOab, TSH, Free T3 and Free T4. I haven't had Free T3 run since 2009, so I was glad to see I was at least getting that instead of total T3 this time. I had my lab draw yesterday so I'm guessing I'll just get those numbers when I see her next Thursday. My TPO antibodies were around 330 (range <35) in 2009, so I can't wait to see what they are at now. I swear the two times I've mentioned Hashimoto's encephalopathy, the docs look at me like I just told them I was a unicorn. HE is a life-threatening condition so I don't know why anyone wouldn't take it seriously. I guess they're all just so uneducated about it since it's so rare. I wouldn't have even known about it if my neuroradiologist friend hadn't brought it up as a possibility, since it coveres all of my symptoms.

Before I left, I let her know that I am frustrated because my thyroid numbers always show to be normal, but I clearly am having major thyroid symptoms. I guess we'll just have to wait and see what the new labs and CT show us, if anything. :sad0049:


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