New. Benign FNA. Hurthle cells?

Cls1
  • By Cls1 · September 19, 2011 at 4:30 pm · 19 replies
  • In Young adults and thyroid cancer
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Im not sure where to start.
I am 36 mother of 2 girls.
Last year my gyn found a lump in my neck. She tested my thyroid and everything looked fine except for my tgab was 1270 (<41). She sent me to an endo for an ultrasound that showed a single hypoechoic solid nodule 2cm. Biopsy was inconcusive. A year later follow up. Nodule is now 3.6cm ill defined solid hypoechoic heterogenus. New 2cm hypoechoic ill defined heterogenus nodule on other lobe. Fna report says benign on both nodules. here is what is said follicular cells, hurthle cells, coloid, lymphocytes, neutrophils, erythrocytes. My question is this...are hurthle cells normally seen on fna's? It says nothing about hashi's just benign. Very vague.

Any input would be helpful. What would you do? The dr. suggested coming back in six months and ultrasound again.

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19 replies   

susantexas

If I understand correctly, you have a nodule that grew from 2 CM to 3.6 CM in a year? I would want to have that removed, but that is just my opinion. Malignant thyroid tumors larger than 4 CM are usually classified as Stage III cancer, so I would be concerned about the tumor getting any bigger. Thyroid cancer is odd in that a tumor can be benign and not grow much for years, then suddenly it becomes malignant and starts growing faster; that is what happened with me. A lot of doctors will continue with the wait-and-see approach as long as the FNA results come back benign and the tumor is not causing discomfort or interfering with swallowing, speech, etc.

My FNA was inconclusive, but suggested one of my nodules could be precancerous. It also suggested the presence of Hurthle cells. My post-op biopsy found no evidence of Hurthle cells, just follicular cancer. My point is that I wouldn't freak out over the mention of Hurthle cells just yet.

Again, it's not appropriate for me or anyone here to tell you what to do, as far as treatment is concerned. But I would do some research, prepare a list of questions, and schedule a consultation with your doctor to discuss your questions and concerns.

susantexas

Also, I think it's wiser to have your thyroid monitored by an endocrinologist instead of an OB/GYN. Endocrinologists are specialists in thyroid disease.

Cls1

Thank you susantexas,

I do have an endo. But he does not seem alarmed. I should also mention that the endo didn't tell me of the hurthle cells. He just said it came back benign(i snagged a copy of the report). For the past week I can feel it when I swallow...great!

Thx for your opinion

RayeRaye

I would be inclined to want to remove it, but, then again, I have thyroid cancer and am a 36 year old mother of two. I might not be the most rational, but I would probably want any growth in my neck that large removed (I had a 2.7 cm cyst removed in my neck that turned out to be a cancerous lymph node). If you know you have a good endo, you can watch and wait. If you have good insurance and are in an area where you have a choice of endos, I would go for a second opinion, taking a copy of your FNA with you. You might check around here for opinions on good endos to see for a second opinion if you go that route.

StephSVA

I agree, get a second or third opinion and then have the surgery, if this was me.

I have had several FNA's and they all came back with no malignancy indicated. My right lobe was 100% replaced by foc/pap with Hurtle Cell cancer and my left lobe was full of Hashimoto's and some pap/fol. My first FNA said Hurtle Cells but no Hashimoto's. I had no diagnosed thyroid disease prior all this.

My thyroid levels (except my TgAb) were all within normal levels right before my diagnosis.

So FNA results are not always dependable. If your node has grown, nearly doubled in 1 year. Stay on top of the doctors. I would say the time for watch and wait is over.

Cls1

it has been tough finding a good endo. I am in phoenix, az (if anyone knows of a good endo). I do have good insurance.
What do you all feel about ENT doctors? I dont want to seem paranoid but this thing is getting bigger! Why wouldnt the dr. want to remove it? Thanks for the input. Im torn. My gp said to forget about it...cancer is so rare! I dont like that approach.

Thx again for weighing in.

Cls1

I guess I need to be more persistant and ask more questions. I agree, watch and wait time has run out. However, the idea of surgery to remove a gland that may be perfectly normal is scary too. But it would be really scary to not remove it and there be cancer.

Grrrrrr

DariaJ

My story started with an ill defined area on an ultrasound and multiple benign biopsies. The whole time it was cancer. I was diagnosed with a ruler - my trusted Endo put it on my neck and said "that's grown too much in a short period of time." The cancer had spread to my lymph nodes. I say "trusted" because I fired the first doctor who said "benign and stable" for three years with inconclusive ultrasounds and "clean" biopsies. He was an endo also. First visit with my trusted endo and she diagnoses me with a ruler! She did her own FNA and that found cancer cells. That was 15 years ago.
Get a second opinion!!
Be vigilant. Even a benign growth of that size may cause you issues with swallowing, etc.
Hang in there, we're here for you.
dj

DariaJ

http://www.endocrineweb.com/conditions/thyroid/fine-needle-biopsy-thyroid-n odules check this site too. Hurthle and Follicular are inconclusive with FNA - surgery is a likely next step...
dj

StephSVA

I am 34 and have 3 children.

I had a lump on my neck since 2005 when the doctor first felt it. I had no insurance then so I ignored the advise of the doctor for an ultrasound, it was too expensive and we had a sick child that we were dealing with. I was up to my eyeballs in medical problems and bills. My neck lump could wait. I always went to my annual exams and had the thyroid labs ran and they were always in normal range. Ignore the neck lump some more.

In 2008 the neck lump jumped in size! Still no insurance and my doctor had retired so I was going to the ambulatory clinic for exams, where the different doctor I saw every year did not care about my neck lump. I ignored it too. It caused no problems, I could swallow fine, talk fine, it did not hurt. Leave it alone. I figured it was a goiter and the thyroid was working so no problem.

Jump to 2010, I lost 86 pounds from March to December of that year. My neck was skinnier and now the lump was HUGE. Some of my neck fat had been hiding the largeness of the lump and since my neck was fat on the left you never noticed the lump on the right. Now I could not ignore the lump, other people were noticing it. It just stuck out of my neck. I still had no insurance until November 2010.

Found a new regular doctor and she noticed the lump as soon as she walked in the room. I agreed to have an ultrasound since I was insured, I had a goiter we were going to get some meds and everything was going to fine. I went in January 2011 and got all the tests. I never never never thought it could have been cancer. I mean who has cancer on their neck for at a minimum 6 years and probably longer since the lump was large enough to be felt in 2005.

Well sure as heck it was cancer. Not only was it cancer it had spread all the way down into my chest, behind my sternum. That made my thyroid case extra complicated and I had extensive spread. I really had no idea about the mediastinal spread it also never caused any problems, I could breath just fine.

The point of my long boring story is don't wait. In my case it was me saying "no big deal" "it is nothing" "leave the lump alone"; in your case the doctors are saying to just wait and watch. Go to new doctors, tell them you do not want to wait. Find an oncologist head and neck surgeon to be on your side.

If I would of had my lump checked out in 2005 I might not have had the chest spread and my cancer would not be as extensive. It might have been just as bad, we will never know. I would have been in medical debt and my poor husband would probably have gone insane to have to care for a child and wife cancer patients. So maybe it was for the best that I ignored the lump, who knows.

Do what you know is right. Go with your heart. Pray over it. I prayed over it throughout the years and felt like it was ok for me to ignore the lump. Turns out everything did fall into place for me. My child is in remission and I had insurance to cover all this thyca stuff for me. Since you are here and questioning the doctors your time to act might just be now.

Good luck and prayers for you!

Jennmarie1

I had 3.3 cm cold nodule on left lobe growing substernally. When it grew it would push on my trachea and cause shortness of breath and panic attacks. I had 2 inconclusive fna biopsies and one that contained cells with extra genetic material. They did six months scanning and other tests before I had surgery. I ended up having follicular thyroid cancer. Very tough to diagnose without surgery and full path report. Get a second opinion and stay on top of it. Good luck.

GratefulGal

I would get a second opinion. Here's yet another example of why you need a specialist to investigate further:
Since my mom had (and was successfully treated for) thyroid cancer several years ago, I've always made sure my primary care physician checked my thyroid at my annual exam. There's no genetic link for the papillary form, but I was paranoid nonetheless. Every year my doc would reassure me that my thyroid felt fine, and that since my thyroid panels were normal and I was healthy and slim that of course nothing was wrong...I naively believed him.
Last year I felt a swollen lymph node in my lower neck/shoulder and my doc said it was nothing to worry about (and technically he was right), but I insisted on an ultrasound. When he got the report, he said it confirmed everything was fine. What I didn't know, since I blindly trusted him and didn't obtain a copy of the report until recently, was that the ultrasound technician DID confirm that the tiny swollen lymph node was nothing to worry about, but that I had some nodules on my thyroid that should be checked out if "clinically warranted." I suppose my doc's interpretation was that since I didn't have any thyroid issues or symptoms, it didn't warrant any further steps.
I went to an ENT for a second opinion on the swollen node, and I didn't have the ultrasound report with me so the focus was the node and not thyroid, and the ENT confirmed the lymph node was nothing to worry about.
A few months ago, I felt another swollen lymph node in my lower neck/shoulder, but because I was in the midst of preparing for my wedding, didn't act on it right away. (I can relate to StephSVA because in retrospect I'm so glad I was living in ignorant bliss and enjoyed my amazing wedding without a care in the world!)
I got married in May (yay!!) and in June I went to my primary care physician for reassurance on that second tiny node. He felt it, said the node was harmless, and felt my thyroid and declared it "perfect."
I still had an uneasy feeling, so 3 days later I went back to that ENT, who agreed that the tiny nodes were/remain nothing to worry about, but he felt a bump on my thyroid. I got a same day biopsy -- it was papillary carcinoma. Talk about the honeymoon being over! : ) I had my cry and then got into go mode. : )
3 weeks later, in July, I had a total thyroidectomy -- I booked with an amazing doctor at a leading hospital -- I wasn't taking any chances! : )
So, as you can see, doctors, even with their good intentions, can make mistakes! My *former* doc is a good man but he clearly showed poor judgment and lack of experience with thyca, and it's just plain luck that it wasn't a mistake with more serious consequences.
My assumption is that the mass grew in size between my first consult with the ENT in December (when he didn't notice anything on my thyroid) and May (when he felt it). I didn't feel anything myself (nor did the former doc!) so perhaps the small size (1.2cm) made it hard to detect -- which perfectly illustrates the point that you need a second opinion from a thyca specialist. I had one doctor miss it entirely, and a second doc (the ENT) miss it the first time he felt it (it might not have been physically detectable yet, we'll give him the benefit of the doubt...).
At any rate, even though I was not diagnosed as early as I could have been, we still found it quite early -- 1.2cm is fairly small and I had no spread whatsoever, my surgery was very straightforward, and I didn't require RAI. So the sooner you get checked, the better -- it could make your treatment less complicated!
Are you sick of my rambling yet? I'll stop now...if you promise us you'll get a second opinion! : )

CherryW

Hello,

I'll offer some thoughts and information as a patient (treated successfully in 1999) and ThyCa volunteer, also since 1999.

This information is also on ThyCa's web site www.thyca.org, which receives review from numerous thyroid cancer experts.

First, my understanding is that an FNA can't determine for sure whether follicular or Hurthle is benign or malignant (whereas it can do so for papillary). Only the tissue analysis after surgery (versus the cell analysis in the FNA) can determine whether or not it's cancer.

Thus, when my FNA report said that my biggest nodule was "suspicious" for Hurthle cell carcinoma, or might be a benign adenoma instead of cancer, my endocrinologist recommended surgery. The final pathology after the surgery was benign for my big nodule, and papillary thyroid cancer in one of my smaller nodules.

Second, a Phoenix endocrinologist who is a thyroid cancer specialist will be speaking at the ThyCa Conference in Los Angeles, California, on October 14 - 16, 2011. His name is Daniel Duick, M.D. He also spoke at ThyCa's conference several years ago in Denver. Brief information about him is in the Speaker List in the Conference page of www.thyca.org.

Third, if you go through the staging information on www.thyca.org, in the Thyroid Cancer Basics booklet and in the Thyroid Cancer Types section, you'll find that people under age 45 are stage 1 or stage 2 if their cancer is papillary or follicular or one of their variants. That's because younger age is a very favorable prognostic factor.

I hope that this helps and that things will go well for you. You can write to ThyCa's e-mail team also, if you have further questions.

Best regards,
Cherry in Maryland
TT and RAI, 1999

katydogcrazy

The highish TgAb and Hurthle cells probably mean Hashimoto's (as you know) but as has been said the Hurthle cells can be part of either benign or malignant nodules. The cells look exactly the same in either case and the diagnosis can't be determined until the tissue is surgically removed.

I had abundant Hurthle cells throughout, the big nodules were benign adenomas, and the cancer was one of the smaller nodules. My Hurthle cells were Hashi's and the cancer was follicular variant papillary; no Hurthle cancer.

The problem with these small cancers like mine is that while the great majority of them will never amount to any real problem if left untreated, some sure as hell will (as you have heard from others, above). Between this factor and the fact that very few bumps on the thyroid will actually BE cancers tends to have some physicians a bit over-relaxed about the whole matter. So, the question is how to avoid either making light of a possible real problem or how to avoid scare mongering. The "watchful waiting" routine of following up with ultrasound every 6 months is the accepted course, and is just fine until you get the rapid growth and the uneasy patient. FNAs are useful when they are diagnostic for cancer but really don't tell you about the remaining untested tissue - every non-cancerous FNA suggests there may not be cancer present but cannot rule it out.

And you sure don't want to lose a functional thyroid gland unless you have to. At the moment it looks like you have Hashimoto's Disease which is not yet impairing your clinical course - you feel well and your thyroid hormone lab levels are within bounds. Your FNAs are not finding cancer. The Hurthle cells could indicate just Hashi's or a benign tumour, or a malignant tumour. You are beginning to feel really uneasy about it all.

I'm thinking that in order to get more specific opinions from the group it may be helpful for you to gather copies of all your ultrasound reports, plus the pathology reports from the FNAs, plus all the thyroid related labwork you have had done since this started. Of course you need to do that for yourself anyway to get a better feel of whether things are being followed well, and for if you want another medical opinion.

Having this uncertainty in your life is unsettling but it really is hard to GET certainty - if you have your whole thyroid removed and pathologist says "no cancer" you DO have certainty but then need to deal with the crap shoot of trying for the rest of your life to hit a good balance on replacement thyroid (although some people do very well on this). If you have the most suspicious 1/2 of the gland removed you are still left wondering what is going on in the other half.

I don't know what I would want to do in your shoes. Well, actually I would want another ultrasound in 3 months with very careful attention paid to the myriad lymph nodes in the neck as well as to the thyroid itself. And with ultrasound guided FNAs of as many nodules as can be accessed, not just the biggest ones. Then try to figure it out with that info. But that's just me - we have cancers in the family and this was my second cancer.

Much to think about,eh?

- Katy :-)

GSMontana

After several benign FNAs and years of Hashi's and goiter, I wanted to have my throid out. BEHIND the benign nodules was a cancerous one that didn't show on ultrasound.

How many times can you endure the stress of waiting for the path report on yet another FNA?

Cls1

I hear you. ALL of you. Thank you for sharing your amazing, sometimes painful stories and giving me your honest opinion. I have made an appointment for the end of October with Dr. Duick. I am going to make an appointment with one more Endo. Better to be safe than sorry is my new motto. I don't get a lot of support from family. They really believe I should let it be, but my gut just won't let me (and trust me, I would rather turn the other cheek).

A few year ago, I had chest pain, couldn't breathe, and the Doctors (even at the emergency room - several times) told me I had anxiety, and they gave me valium and vicodin. Turns out, I had pericardial effusion/pericaritis and was adventually admitted for emergency surgery where they gave me a pericardial window. No, I wasn't having panic attacks, I was having heart attacks. They never concluded why it happened, just a fluke. After that experience, I do have anxiety that something may be "overlooked" again.

There is a high probability that I am in the clear. I probably would have gone on my way and been okay with the benign diagnosis. But of course, now I keep copies of ALL my medical records, and so when I saw that the FNA report said Hurthle cells, my ears perked up. If my very little understanding is correct (I may be wrong here): There are both benign and not so benign Hurthle cells, but FNA cannot differentiate between the two. Is this correct? If this is correct, then how can the pathologist say benign instead of inconclusive? AND why wouldn't the Dr. tell me we need to watch for Hashi symptoms? So confusing.

Anyway, thank you for all of your help. I hope you are all feeling healthy and happy. I am so sorry for your diagnosis, and I hope you find peace with your bodies. Thank you so very much. Any additional information is very helpful.

Very appreciative,

Christina :)

Cls1

U

Cls1

Got my records:

Sept 2010 - One year ago
Blood work:
Microsomal TPO-Ab 122 H (<35 IU/ml)
Prolactin Diluted 3.6 (3.3 - 26.7 ng/ml)
T3 Free Non-Dialysis 3.3 (2.0 - 4.8 pg/ml)
T4 Free Non-Dialysis 1.3 (0.8 - 1.7 ng/dl)
Thyro globulin 5 (<56 ng/ml)
Thyroglobulin Antibodies 1266 H (<41 IU/ml)

AND my FNA report:
Non-diagnostic. Repeat FNA recommended
Cells Present:
follicular cells: rare
macrophages
lymphocytes

1.4cm firm nodule
Right lobe is heterogeneous. In the mid pole there is a 1.4 X 1.5 X 1.3 nodule that has a thin hypoechoic rim and is heterogeneous otherwise.
Right size... 4.3 X 2.0 X 2.1 cm
Left lobe is heterogeneous, but no descrete cysts or nodules are seen.
Left lobe .... 4.3 X 1.9 X 1.9 cm
Isthmus: 0.5 cm


October 2010 - 1 Year ago

TSH 0.35 (.45-4.50) Low
My Protein 8.2 (6.0-8.0) High
TPO-Ab 320 ( <35) Higher than last time
TgAb 1283 ( <41) A little higher than last time
T4 11.2 (4.5-12.5)
Not sure why my T3 wasn't done

Okay now for my RAIU & Scan.....
After 4hrs the uptake was 3%
After 24hrs the uptake was 6%
Nodule did not uptake
The ultrasound shows the nodule has grown from 1.4cm to 2.5cm

SEPTEMBER 2011 - This year!!

Right lobe: Heterogeneous in echotecture. Lobular. The previous nodule within the midpole is now surrounded with more heterogeneous echotexture and is not seen as a discrete lesion, however the overall size of this area measures 3.6cm X 1.7 X 2cm. There is no evidence of hyperemia.
Size of lobe 5.2 X 2 X 2.1

There is a cluster of nearly isoechoic solid nodules measuring 3.6 cm on right lobe.
Very heterogeneous.
There are more clusters on the left , nearly isoechoic solid measuring 2 cm.....
Heterogeneous as well.

FNA:
Ill defined 3.6cm nodule right. No calcifications
Ill defined 2.8cm nodule left. No calcifications

Follicular cells
Hurthle cells
Coloid
Neutrophils
Erythrocytes
Slides adequate for evaluation

Blood work (sept)
TSH 1.85 (.45-4.5)N
Free T3 2.8 (2.0-4.8)N
Free T4 1.0 (0.8-1.7)N
TPO AB 339 (<35)H
TGAB 276 (<41)H
Thyroglob 6 (<56)N


That is my list! lol

So as far as I can see from the ultrasounds A year ago the right nodule was 1.4cm, then it went to 2.5cm, now 3.6cm, and up pops a 2.8cm on the left?....am I reading this correctly???? Good news is the TGAB antibodies went down. That is good. The TPOab still high.

Any thought on all of this information. I don't know what most of this means.

Thanks

Cls1

Well I woke up this morn to an inflamed thyroid.
I changed my profile picture to my beautiful thyroid. The doctors say there's noting "wrong",
however, my nodules/goiter says different! I can feel the nodules on BOTH sides (ewww)

I am going in to see my doctor. This is just crazy! How do I treat this myself, until I see my Doctor (3 weeks from now)!!!!

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