# Thyroid lobectomy pathology results



## sarahgb93 (Mar 21, 2018)

Hi everyone, I'm about 2 weeks post-op from having a thyroid lobectomy on my left side. I just received my pathology results and wanted a little more help understanding. I do have an appointment next week with my doctor to discuss them but just wanted to get a little more info beforehand. Originally I was told I'm at a 75-85% chance for it being cancerous due to a gene mutation they found with the FNA biopsy. It's looking like the final results did come back as cancer, but I wasn't too sure how to interpret if it had spread or not, which is what he was looking for to see if I need a total thyroidectomy. Any help would be appreciated

FINAL DIAGNOSIS:
THYROID, LEFT LOBE AND ISTHMUS, LOBECTOMY AND ISTHMUSECTOMY (8 GRAMS):
A. PAPILLARY THYROID MICROCARCINOMA (0.2 CM).
B. TUMOR IS CONFINED TO THE THYROID AND RESECTION MARGINS ARE FREE OF
TUMOR.
C. NO ANGIOLYMPHATIC OR PERINEURAL INVASION SEEN.
D. PATHOLOGIC STAGE: pT1a NX; STAGE GROUP 1.
E. ONCOCYTIC ADENOMA (1.4 CM).
F. ONE NORMOCELLULAR PARATHYROID.
RP/acs

SPECIMEN TYPE: Left thyroid lobectomy with isthmusectomy
SPECIMEN INTEGRITY: Intact
WEIGHT: 8 grams
OVERALL DIMENSIONS: 3.0 x 2.5 x 2.0 cm
left lobe: 3.0 x 2.0 x 2.0 cm
isthmus: 2.5 x 0.5 x 0.5 cm
other(specify): Adherent left inferior potential parathyroid/lymph node 1.0 x
0.6 x 0.4 cm and weighing 15.8 g.

NUMBER OF DISCRETE LESIONS: 1
LESION #1:
Location: Left, lower Size: 1.4 x 1.0 x 0.8 cm
Border: Well-demarcated
Characteristics: Tan-yellow, circumscribed, glistening and thinly encapsulated
Distance to inked isthmus margin: 0.4 cm
Distance to inked thyroid capsule: 0.2 cm
Grossly suspicious for extrathyroidal extension: None

SURROUNDING UNINVOLVED PARENCHYMA: Tan-pink, soft, homogeneously nodular

CASE SYNOPSIS:
SYNOPTIC DATA - PRIMARY THYROID TUMORS
PROCEDURE: Lobectomy with isthmusectomy, Left
TUMOR FOCALITY: Unifocal
TUMOR SITE: Left Lobe
TUMOR SIZE (largest or most significant nodule):
Greatest Dimension: 0.2 cm
HISTOLOGIC TYPE: Papillary carcinoma
MARGINS: Margins uninvolved by carcinoma
ANGIOINVASION: Not identified
LYMPHATIC INVASION: Not identified
EXTRATHYROIDAL EXTENSION: Not identified
Number of regional lymph nodes examined: 0
PRIMARY TUMOR (pT): pT1a
REGIONAL LYMPH NODES (pN): pNX
DISTANT METASTASIS (pM): Not applicable
ADDITIONAL PATHOLOGIC FINDINGS: Adenoma
Parathyroid gland(s)
Present (number and location): One
Within normal limits


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## joplin1975 (Jul 21, 2011)

So the short version is that you had s very small cancerous nodule that did not extend beyond the thyroid capsule, had clear (ie, cancer free) margins, and did not impact you lymph nodes.

If you had antibodies, you may want to consider a total, but it's not necessary for the cancer. You should be sure to get annual ultrasounds and to keep your TSH supressed.


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## susan68 (Feb 3, 2018)

So, I had a partial about 7 weeks ago. Had a large cancer 3.7cm found in pathology report but FNA was negative before the surgery. I saw my endocrine dr. last week and he said although my tsh was normal 3.16 (Range .45 -4.5) he recommended putting me on levothyroxine to raise my tsh to the upper end of the range to help me fend off cancer in the other side. He recommended 50 mcg and retest in 8 weeks.

Two questions: 1) Is this the same as suppressing tsh, as mentioned below? 2) could this make me hypo?

My tests have always been normal. I am waiting on the T3 & T4 results from my surgeon as my dr does not think it is necessary.

Thank you.



joplin1975 said:


> So the short version is that you had s very small cancerous nodule that did not extend beyond the thyroid capsule, had clear (ie, cancer free) margins, and did not impact you lymph nodes.
> 
> If you had antibodies, you may want to consider a total, but it's not necessary for the cancer. *You should be sure to get annual ultrasounds and to keep your TSH supressed.*


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## joplin1975 (Jul 21, 2011)

Yes, this is TSH suppression. Your TSH should be ~1.0 or lower.

This will not make you HYPO, but there is a chance it could make you hyper (to much thyroid hormone). But, 50mcg is a pretty low dose.

Free t4 and t3 tests will be really, really helpful.

Have they discussed removing the other half of your thyroid?


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## susan68 (Feb 3, 2018)

Thank you, Joplin.

I have recently had 2 ultrasounds on the other side and there is nothing appearing that seems to draw major concerns. At this point I will just watch it and follow up with an ultrasounds.

I should get my T3 and T4 results in the next day or so. I am anxious to see those.

I am a little confused about the TSH suppression. As I understood the information from my dr. the goal was to get the TSH up towards about 4.5 not 1.0 or less. I am not clear how raising it to 4.5 would help. Perhaps I misunderstood.


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## joplin1975 (Jul 21, 2011)

Noooooooooooooooooooooo, do not RAISE your TSH. Suppression means keeping it as low as possible.

TSH is a stimulating hormone. The more stimulated your thyroid, the more likely you are to have a cancer recurrence.

Here's some additional information: http://thyca.org/pap-fol/more/tsh-suppression/


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## susan68 (Feb 3, 2018)

Thats what I thought...suppression means lower. Like I said before, maybe I misunderstood my dr.

Thank you for the article. That helps a lot. It seems as though I am on the right course to suppression by being prescribed the levothyroxine.

Im still trying to learn so much. This board is great for that!


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