# Biopsy?



## thumper54 (Sep 2, 2013)

I would like to know if a thyroid lobe can be biopsied or does it have to be a nodule? My endo says I have thyroiditis of one lobe only and he will not do antibody tests or a FNA. The first time he said viral thyroiditis and now he says maybe Hashimoto's. Isn't it important to know? If the FNA isn't possible how is Hashimoto's diagnosed? Thanks for your help.


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## joplin1975 (Jul 21, 2011)

The only definitive way to know if you have Hashimoto's is by a biopsy. That said, many people are diagnosed by the presence of antibodies. Minimally, I would want TPO and TSI run because, yes, I think it is important to know.


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## Andros (Aug 26, 2009)

thumper54 said:


> I would like to know if a thyroid lobe can be biopsied or does it have to be a nodule? My endo says I have thyroiditis of one lobe only and he will not do antibody tests or a FNA. The first time he said viral thyroiditis and now he says maybe Hashimoto's. Isn't it important to know? If the FNA isn't possible how is Hashimoto's diagnosed? Thanks for your help.


For one, you may wish to consider a better doctor. And secondly, Thyroiditis and Hashimoto's are one and the same. Just 2 different words for the same condition.

Here is some info.

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/


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## thumper54 (Sep 2, 2013)

Thanks for responding Joplin and Andros. I may be dense, so please bear with me.... Can the lobe itself be biopsied with a needle even if there is no nodule?

Andros, I thought there were several types of thyroiditis, such as silent, subacute, postpartum, acute, Riedel's. Obviously this is not postpartum.... but are the rest the same as hashi's? I appreciate how you always give references. I will do that when I learn how.


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## thumper54 (Sep 2, 2013)

Had a FNA Friday and hope to have results this Wed. They didn't get enough cells at first so had to have a couple extra pokes. It really wasn't as bad as I'd read about. No need to even ice things down. But I was so wobbly afterwards that I had to wait about 15 minutes before I could walk. And since the FNA, I have had to pee about 3 times more than usual, even thru the night. I feel like the biopsy really stirred things up. Has anyone else experienced this?


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## thumper54 (Sep 2, 2013)

The FNA came back inconclusive saying "crumbly blood with scant colloid and with small groups of follicular cells". So I get to do it again. What are the chances of the next FNA being inconclusive too?


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## Andros (Aug 26, 2009)

thumper54 said:


> The FNA came back inconclusive saying "crumbly blood with scant colloid and with small groups of follicular cells". So I get to do it again. What are the chances of the next FNA being inconclusive too?


It could remain inconclusive and when that happens, it usually is recommended to have the thyroid removed. Just depends but that is usually the protocol.


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## Andros (Aug 26, 2009)

thumper54 said:


> Thanks for responding Joplin and Andros. I may be dense, so please bear with me.... Can the lobe itself be biopsied with a needle even if there is no nodule?
> 
> Andros, I thought there were several types of thyroiditis, such as silent, subacute, postpartum, acute, Riedel's. Obviously this is not postpartum.... but are the rest the same as hashi's? I appreciate how you always give references. I will do that when I learn how.


So, 101 on thyroiditis............................

Course of the Disease (Table 8-1)

Hashimoto's thyroiditis begins as a gradual enlargement of the thyroid gland and gradual development of hypothyroidism. It is often discovered by the patient, who finds a fullness of the neck or a new lump while self-examining because of a vague discomfort in the neck. Perhaps most often, it is found by the physician during the course of an examination for some other complaint.

Table 1. Presentations of Hashimoto's Thyroiditis

1.Euthyroidism and goiter
2.Subclinical hypothyroidism and goiter
3.Primary thyroid failure
4.Hypothyroidism
5.Adolescent goiter
6.Painless thyroiditis or silent thyroiditis
7.Postpartum painless thyrotoxicosis
8.Alternating hypo- and hyperthyroidism

finish article here...............
http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/

All of the above are thyroiditis. That would be any inflammation of the gland.

thy·roid·itis
noun \ˌthī-ˌrȯid-ˈīt-əs, -rəd-\ (Medical Dictionary)

Medical Definition of THYROIDITIS

: inflammation of the thyroid gland 
http://www.merriam-webster.com/dictionary/thyroiditis

I do take issue w/acronyms and incorrect usage of medical terminology..............; or any terminology for that matter. So, I am always looking "things" up. ROLF!!! OCD; that's me!!


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## thumper54 (Sep 2, 2013)

Thank you Andros. I just got called to say they are scheduling the repeat FNA for Wed. I was surprised it was so soon, but do want a definitive answer to what is happening. I am so weak; it feels like I have 50 lb weights on each arm and leg. Just standing up is a chore. I don't know if it's from the thyroid or if more is going on. My left kidney area keeps hurting too. Yesterday the endo said he still thinks I have thyroiditis, but because I am not responding like a textbook case, he wants to get to the bottom of this too. Having only one side involved and being hyper with an entire cold lobe is more rare than both sided. And he expected I would be over this by now. He said that he thinks my ultrasound looks like hashis, but the painful and rapid onset are more consistent with viral (but I was never sick). And they are giving me anti thyroid meds which from what I've read is not the usual procedure for thyroiditis. It's been three long months of hyper so far and the labs have worsened instead of getting better, but the pain is now gone (at least while I'm taking the PTU) and I'm left with the difficulty swallowing over that lump and the throbbing fullness/pressure in the neck. He said he doesn't think its Graves. But isn't Graves basically the same as Hashis only with hyper labs? The biggest problem is still that there is differing opinions of whether I have a 3.4cm nodule or if its just the entire right lobe thyroiditis. I was really hoping to have found that out with the FNA. And that reminds me about the "crumbly blood" they found. What would cause that? I couldn't find anyone else with that in their report...


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## Andros (Aug 26, 2009)

thumper54 said:


> Thank you Andros. I just got called to say they are scheduling the repeat FNA for Wed. I was surprised it was so soon, but do want a definitive answer to what is happening. I am so weak; it feels like I have 50 lb weights on each arm and leg. Just standing up is a chore. I don't know if it's from the thyroid or if more is going on. My left kidney area keeps hurting too. Yesterday the endo said he still thinks I have thyroiditis, but because I am not responding like a textbook case, he wants to get to the bottom of this too. Having only one side involved and being hyper with an entire cold lobe is more rare than both sided. And he expected I would be over this by now. He said that he thinks my ultrasound looks like hashis, but the painful and rapid onset are more consistent with viral (but I was never sick). And they are giving me anti thyroid meds which from what I've read is not the usual procedure for thyroiditis. It's been three long months of hyper so far and the labs have worsened instead of getting better, but the pain is now gone (at least while I'm taking the PTU) and I'm left with the difficulty swallowing over that lump and the throbbing fullness/pressure in the neck. He said he doesn't think its Graves. But isn't Graves basically the same as Hashis only with hyper labs? The biggest problem is still that there is differing opinions of whether I have a 3.4cm nodule or if its just the entire right lobe thyroiditis. I was really hoping to have found that out with the FNA. And that reminds me about the "crumbly blood" they found. What would cause that? I couldn't find anyone else with that in their report...


If you don't mind my saying so, you just need to have that very very unwell thyroid gland out.

I feel sorry for you; I know you are very sick and to keep you in this condition is unconscionable.


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## SuzieSocialWorker (Jul 9, 2013)

Is crumbly blood a medical term? I would ask for a second opinion, and go to an ENT. My ENT was by far more knowledgeable about the thyroid than the many Endo's I've been to. This does not sound cut-and-dry, and an ENT will look at it from another angle. I agree with Andros, and whether it's Grave's or Hashi's, the lump/neck/nodule issues are more pressing (literally)!


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## jenny v (May 6, 2012)

I'm with Andros, I would push to just get it removed. It's not working, you're in pain, you can't really function well physically anymore, and who knows if it's going to get better or not. Surgery is not fun, but at least you're removing the source of your issues and hopefully getting your body to calm down so the medicine can actually work.


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## thumper54 (Sep 2, 2013)

Thank you all for your responses and concern. I agree with you. My husband and I would like it out, but we only have the VA for insurance until Jan. I've seen two ENTs and an endo there and they are the ones that keep saying its nothing. But an outside hospital in an emergency setting twice said otherwise. I have the scans from both places and I've got a call in to another endo center to see if they want me in two weeks or if they think I can wait until Jan. Maybe they can look at the scans and labs and give their opinion. Also the two small nodules on the left side have grown 2mm in 2 months. Isn't that a little fast? To me this means even more reason to do a total TT!


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## Octavia (Aug 1, 2011)

thumper54 said:


> Also the two small nodules on the left side have grown 2mm in 2 months. Isn't that a little fast? To me this means even more reason to do a total TT!


If these were ultrasound measurements, I wouldn't be too concerned about a change like that. Ultrasounds are pretty limited in their accuracy related to measurements. For example, my ultrasound said my nodule was 2.5 centimeters. But when it was removed a month or so later, it was actually 3.2 centimeters. I know it didn't grow that much in that short a time, if it actually grew at all.


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## thumper54 (Sep 2, 2013)

Thanks Octavia. Because of the rapid growth of the 3.4 cm nodule and the fact that this whole issue has been so non-textbook, I'm probably over worried that the other side wants in on the fun.


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