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Thursday, April 17, 2014
Thyroid Testing Results
Thyroid gland ultrasound result:
- Enlarged right lobe of thyroid gland with heterogeneous echotexture.
- Several hypoechoic nodules of variable sizes and with cystic degeneratyion within noted in the right lobo of thyroid gland. Largest of them measured 3.1x3.03cm and 1.94x1.13cm.No evident calcifications.
- Normal left lobe and isthmus with no focal lesion. Right lobo measures approximately 4.4x2.8x3.7cm Left lobo 3.3x1.4x1.4cm. Isthmus measures 3.1cm
- Remarks: Multinudular goitre involving the right lobo with areas of cystic degeneration within.
- Report of Exfoliative Cytology: FNA smears reveal a thick colloid background. Cellularity is high. Follicular cells small and large monolayered sheets are seen. Cluster, microfollicular structures and discrete ductal cells are present. Scattered foam cells are present. There are no nuclear grooves or inclusions. Free T4 1.02 T.S.H 1.36 E.S.R. 22 HGB 122 RBC 3.86 WBC 6.06, 38 year old female.
My question: First, do I have to remove the right side all or the part which is large only. Second, since everything is okay and I don`t feel any kind of problem, do I have to do the surgery? Third, if I don`t have to do the surgery, is it okay for the longer term, i.e. nothing will happen in the future?
This pathology report is purely descriptive. I would have your doctor call the pathologist and get a commitment as to whether this specimen is most consistent with a colloid nodule (enlarged thyroid) or if there is concern that this could be a follicular neoplasm (possible thyroid cancer). The thick colloid is reassuring, but the high cellularity could be seen in a thyroid cancer.
I'm not sure what "Cluster, microfollicular structures and discrete ductal cells" means. If the pathologist is comfortable that this is most consistent with an enlarged thryoid then I think it would be OK for your doctor to just follow you - perhaps with a series of ultrasounds at regular intervals. If there is suspicion for a possible thyroid cancer, then surgery is in order.
Your doctor should discuss with you the risks and benefits of lobectomy (partial thyroid removal) versus total thyroidectomy. You can and should help make this decision. Lobectomy has fewer complications, but if the pathology from the lobectomy turns out to be thyroid cancer then you would need to go back to surgery again for a complete thyroidectomy. My bias is that this kind of surgery should only be done by a surgeon who does thyroid surgery on a regular basis.
Thomas A Murphy, MD, FACP, FACE
Associate Professor of Medicine
School of Medicine
Case Western Reserve University