# Need help deciding on options



## gwlaw99 (Jul 29, 2013)

My wife has a 1.1 centimeter nodule that came back indeterminate. Afirma molecular testing said that there was a 40% chance that it was cancerous. Her options are

1. Wait 6 months to see if it grows.
2. Remove one lobe to check for cancer and if it is cancerous remove the entire Thyroid
3. Remove the entire Thyroid.

Here are the results of the biopsy that found it indeterminate.
THYROID, LEFT, ULTRASOUND GUIDED FINE NEEDLE ASPIRATIONS:
- Follicular lesion of undetermined significance (see note)

Note: The differential diagnosis includes cellular adenomatoid nodule (favored), follicular neoplasm, and follicular variant of papillary carcinoma. Tissue will be sent out for Afirma molecular testing.

MICROSCOPIC DESCRIPTION: Smears contain small amount of colloid, hemosiderin-laden macrophages, and follicular epithelial cells arranged in clusters and sheets. Some follicular cells who nuclear enlargement and hyperchromasia. However, there are no microfollicles or nuclear pseudoinclusions.

Any opinions based on your experience? I am leaning on waiting to see what happens. I am in the US so surgery can be scheduled quickly without much waiting time if that matters. Thanks!


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## joplin1975 (Jul 21, 2011)

I would either take option #1 or #3. If she decides to wait, I would ask for another FNA at six months.

What are her feelings on the matter?


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## gwlaw99 (Jul 29, 2013)

Thanks very much for your response. What is your reasoning for excluding a partial?

She doesn't want the whole thing hanging over her head so her emotional reaction was to have it all removed, but her head says to wait. Two other wrinkles are that she is an actress and is afraid to have her vocal cord damaged. She also has been diagnosed as bipolar 2 (mild bipolar). It is controlled with medication, but we are concerned that taking out her thyroid and using synthetic hormone could have serious effects on her mental state. Also, they found two very small nodules on her other lobe that were too small to biopsy.

I was also under the understanding that they could take out part of the thyroid and test it for cancer while you are still under anesthesia and if it is cancerous, then take out the entire thyroid.


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## joplin1975 (Jul 21, 2011)

Gotcha.

I didn't have a second surgery -- I only had one...there are others on this board who have had two surgeries and I think the consensus is that it's not awful, but not ideal. I mean...who wants to have two surgeries that close together? If it happens, it's manageable, but if I were going in for surgery, I'd want the whole thing gone.

The other reason is...has she had her antibodies tested? If she does have antibodies and opts for a partial, regulating medication post-op can be tricky because there's part of the thyroid left. Meaning the antibodies have a target...meaning that there is often significant waxing and waning of the antibodies and you have to deal with constant adjustments of medication. Add that on to the issues she's already dealing with and it just sounds less than ideal to me.

The frozen section test they use during surgery is notoriously flawed. I would hesitate to rely on that.

The vast majority of people 1) come out of surgery just fine and 2) do well on replacement hormone medication. I would be drilling the surgeon about how many PTs or TTs s/he does a week. I think they should be doing minimally six or so a week. I was the fourth of the day for my surgeon.

Related, there is a connection between mental illness and thyroid dysfunction. I'll try to find some links for you, but other members have them as well, so hopefully they will be along shortly. Often, the mental illness becomes more manageable after ablation of the thyroid.


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## gwlaw99 (Jul 29, 2013)

Thanks for the insight. Very very helpful. I am not worried about the surgeon. A friend of the family is the head of one of the largest hospitals in our city. He also happens to be a world renowned endocrinologist. So he will find us the best surgeon he can. I will ask him all this, but we just found out yesterday and he is still going over the results. I just want some practical feedback from people who went through this and you have been very helpful. Thanks again.


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## joplin1975 (Jul 21, 2011)

Also, here you go: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144691/


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## gwlaw99 (Jul 29, 2013)

joplin1975 said:


> Also, here you go: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144691/


wow. thanks!


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## Eliza79 (Jul 23, 2013)

I had a similar biopsy result and am having a partial thyroidectomy later this week.

However, your wife's nodule is really small and the report notes a FLUS (follicular lesion of undetermined significance) which is usually associated with only a 15% chance of malignancy. The Affirma test is notorious for saying a nodule has a 40% chance of cancer. I wouldn'tbput too much faith in it.

My biopsy results were more definite for a follicular neoplasm and a 20-33% of malignancy. I'm going through with the surgery but am still wondering if I made the right call. It's tough!

If I were in her shoes, I'd probably wait no more than 6 months and then check again. Good luck!


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## Velcro (Jul 26, 2013)

I am going through the same thing right now, which pretty much the same FNA results as your wife. I did choose to wait 4 months and repeat the FNA instead of straight to surgery. I think everyone has to decide for themselves, but I will tell you why I decided to wait. 1) My nodule is extremely small that they biopsied. I have 3, but the biggest is only 7mm. 2) I have other autoimmune diseases and I never have a normal test result. 3) After researching, knowing that if it turns out to be cancerous, it is such a slow-growing cancer and very treatable.

That was my reasons and I am also a very conservative approach person. I have learned to be patient because of my other autoimmunes and I don't stress about waiting.

As far as the checking for cancer in the operating room, they do but it seems to have a high percentage for showing ok initially, but yet when they are able to do a thorough pathology on it in the next days, ends up a pretty high percentage of cancer. That's why most say go ahead with the TT.


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## Andros (Aug 26, 2009)

gwlaw99 said:


> Thanks very much for your response. What is your reasoning for excluding a partial?
> 
> She doesn't want the whole thing hanging over her head so her emotional reaction was to have it all removed, but her head says to wait. Two other wrinkles are that she is an actress and is afraid to have her vocal cord damaged. She also has been diagnosed as bipolar 2 (mild bipolar). It is controlled with medication, but we are concerned that taking out her thyroid and using synthetic hormone could have serious effects on her mental state. Also, they found two very small nodules on her other lobe that were too small to biopsy.
> 
> I was also under the understanding that they could take out part of the thyroid and test it for cancer while you are still under anesthesia and if it is cancerous, then take out the entire thyroid.


Interesting in that many diagnosed w/bipolar perhaps are misdiagnosed and it is the thyroid instead.

You may enjoy reading this.

bipolar/thyroid disease
http://www.psycheducation.org/thyroid/introduction.htm

It does appear that your wife's thyroid is not a healthy one and it is my humble opinion that she could better get on w/her life if she had the whole gland removed.


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