# Preparing for second opinion visit



## alfabch (Mar 21, 2013)

Background Information: 65 year old female initially diagnosed with hypothyroidism 16 years ago in 1997. In October of 2012 found to have Hashimoto's and a thyroid nodule. Until 2009 when I suspect the Hashimotos began my daily does of Synthroid was 25 mg. I was on 100 mg of Synthroid at the time of diagnosis.

Thyroid ultrasound shows a gland that is diffusely heterogeneous and nodular. Right lobe is 4.1 cm in length and no discrete nodule found in this lobe. The left thyroid lobe is 4.3 cm in length with a 1.1 x 1.1 x 1.0 cm predominantly solid nodule noted at midpole. The isthmus is heterogeneous. No enlarged lymph nodes or parathyroid glands are seen in the visualized neck.

FNA on 11/12/12 came back with the following results. "Consistent with a mixed micro- and macrofollicular lesion. Aspirate consists of follicular cells in small follicles, microfollicles and small sheets displaying extensive Hurthle cell changes. Rare colloid present. Most probably benign.

I was told the nodule was begin by the Endo that I had been seeing. After January 2013 blood work Synthroid dose reduced to 75 mg. Already suffering from frontal fibrosing Alopecia, I suddenly developed Alopecia Areata.

At a visit in April with the Endo I told her I was having some strange symptoms. Suddenly I was almost always hot, sometimes I had a rapid pulse and other times a low one. Always feel like I have a hair ball in my throat. My blood work came back with a TSH of 0.06 and normal Total T3 and T4 levels. 
Endo says reduce Synthroid to 50 mg seven days a week rather than 75 mg six days a week.

Started doing a little research and decided I was going to bite the bullet and go down to Brigham and Women's Endo Center to get a second opinion on this-went to get my records and when I read the report of the FNA biopsy I was stunned. I have an unknown family history, my age is not in my favor, a basically useless thyroid gland and a questionable biopsy report. By the way, she didn't want to see me again after the change in my Synthroid dose, till November.

So I'd like folks who have some experience in this area to weigh in with their thoughts. My own feeling is, based on the FNA report, unknown family history and Hashimotos and the fact I've been dealing with a daily does of Synthroid for the last 16 years it might be time to get rid of a body part that isn't doing me any good. Do you think it would be reasonable to point this out to the Endo I'm seeing Wednesday?


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## Andros (Aug 26, 2009)

alfabch said:


> Background Information: 65 year old female initially diagnosed with hypothyroidism 16 years ago in 1997. In October of 2012 found to have Hashimoto's and a thyroid nodule. Until 2009 when I suspect the Hashimotos began my daily does of Synthroid was 25 mg. I was on 100 mg of Synthroid at the time of diagnosis.
> 
> Thyroid ultrasound shows a gland that is diffusely heterogeneous and nodular. Right lobe is 4.1 cm in length and no discrete nodule found in this lobe. The left thyroid lobe is 4.3 cm in length with a 1.1 x 1.1 x 1.0 cm predominantly solid nodule noted at midpole. The isthmus is heterogeneous. No enlarged lymph nodes or parathyroid glands are seen in the visualized neck.
> 
> ...




I'll tell you, when I saw the word "solid", my mind was pretty much made up. Combine that with an indeterminate biopsy and I do believe that bad girl has to come out. They will send the whole gland to pathology. Then you will know.

And the thing about Hurthle cells and it worries me that they did not say; "There are Hurthle Cells indigenous to cancer and Hurthle Cells indigenous to Hashimoto's." It is of a great concern that the report did not definitively state which ones they were.

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis

Cancer Hurthle Cells
http://www.thyroidmanager.org/Chapter21/ch01s12.htmlI su

http://www.mayoclinic.com/health/hurthle-cell-cancer/DS00660

Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2

http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/

It probably would not be a good idea to wait until November and it may be an excellent idea for you to see an ENT about all of this.


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## alfabch (Mar 21, 2013)

Thanks, there were a number of things that bothered me about the report one of them being the word "probably."


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## alfabch (Mar 21, 2013)

Endo I saw yesterday shares my concerns over the pathology report from the FNA that was done in November. He did an US of the nodule and found it had grown from 1.0 cm to 1.5 cm in six months. FNA slides are being sent to the pathology department for their review. If a definitive diagnosis can't be made after that review, he wants to do a RAIU test.

So hopefully in two weeks I will have a better idea of what is going on with the nodule.

He thinks my 0.06 TSH with normal T4 and T3 values on my most recent blood work is due to the nodule producing thyroid hormone while my thyroid gland isn't. Thyroid antibody tests positive for Hashimotos.


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## joplin1975 (Jul 21, 2011)

alfabch said:


> He thinks my 0.06 TSH with normal T4 and T3 values on my most recent blood work is due to the nodule producing thyroid hormone while my thyroid gland isn't. Thyroid antibody tests positive for Hashimotos.


There are also other antibodies (beyond TPO associated with Hashi's) that skew results and can make you feel nutty. Especially if you have any TSI in your system.


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## Andros (Aug 26, 2009)

alfabch said:


> Endo I saw yesterday shares my concerns over the pathology report from the FNA that was done in November. He did an US of the nodule and found it had grown from 1.0 cm to 1.5 cm in six months. FNA slides are being sent to the pathology department for their review. If a definitive diagnosis can't be made after that review, he wants to do a RAIU test.
> 
> So hopefully in two weeks I will have a better idea of what is going on with the nodule.
> 
> He thinks my 0.06 TSH with normal T4 and T3 values on my most recent blood work is due to the nodule producing thyroid hormone while my thyroid gland isn't. Thyroid antibody tests positive for Hashimotos.


I am so very glad you are following through on this and you must keep us in the loop!


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