Please Help Me - is this Cancer?

[Pinot]

Finally got my biopsy results today and I am trembling as I type.
My GP has no clue about any of this and is going to refer me to an ENT for surgery.

Some of the phrases in this lab report are huge red flags to me,
but I truly don't know what it all means exactly, other than it's bad, possibly very bad, news.

MICROSCOPIC DIAGNOSIS:
Atypical, Hashimoto's thyroiditis, favored, or Hurthle cell neoplasm.
See comment.

COMMENT: There are numerous follicular epithelial cells, the majority of which show oncocytic metaplasia (Hurthle cells). There are abundant lymphocytes, few neutrophils and an occasional plasmacytoid lymphocyte in a background of scant colloid-like material and fibrinoid debris. Features favor a Hashimoto's thyroiditis. Hurthle cell neoplasm cannot be excluded. Excisional biopsy is recommended if clinically indicated.

I would deeply appreciate any insight, whether it's posititve or negative, because right now I am a nervous wreck!

[CarolynF]

Medscape: Medscape Access

Read this and maybe it helps you. I don't know what this means, but my daughter had
1/2 her thyroid out because her FNA was inconclusive and she didn't have cancer.

If you do have cancer, thyroid cancer is very easy to treat..But, praying that you don't.
Keep us posted.

[Leo41]

Pinot-

I've never heard of Hurthle cell neoplasm, but when I Googled it, I learned that it's possible to be carcinoma (cancer) and also possible not to be malignant. However, it's difficult to tell even with a biopsy, so I wouldn't be surprised if the doctors recommended removing your thyroid (or a portion of it).

I've heard that when a biopsy is rated 'inconclusive,' doctors always recommend surgery because it's wise to be safe.

Those of use with thyroid problems are on meds for life, so if I had to have my thyroid removed, it wouldn't bother me much--all it would involve would be replacing my thyroid hormones, which I'm already doing.

If it turns out to be cancer, you should know that thyroid cancer is one of the LEAST difficult cancers to cure. Try to stay calm and get all the necessary information from your doctors. In your situation, it's always wise to take someone with you when you see a doctor to insure that there's someone with more objectivity to 'hear' what the doctor tells you.

[clarke]

I am sorry you dont have a more definite diagnosis. I dont understand or have enough knowledge to decipher your report. I can tell you that i had thyroid cancer 3 years ago and although scary, it was more of a nuisance with treatment than anything else. Treatment is generally much easier than other cancers. The success rate is also extremely high. I dont want to minimize your worry, yes i was scared too. Just want you to know that all things consudered, it is manageable.

I am out of town this week with limited internet, but should you get a cancer diagnosis and want someone to talk to, i am available. Take care and try not to worry too much Hugs

[cocoanut]

Originally Posted by Pinot

Finally got my biopsy results today and I am trembling as I type.
My GP has no clue about any of this and is going to refer me to an ENT for surgery.

Some of the phrases in this lab report are huge red flags to me,
but I truly don't know what it all means exactly, other than it's bad, possibly very bad, news.

MICROSCOPIC DIAGNOSIS:
Atypical, Hashimoto's thyroiditis, favored, or Hurthle cell neoplasm.
See comment.

COMMENT: There are numerous follicular epithelial cells, the majority of which show oncocytic metaplasia (Hurthle cells). There are abundant lymphocytes, few neutrophils and an occasional plasmacytoid lymphocyte in a background of scant colloid-like material and fibrinoid debris. Features favor a Hashimoto's thyroiditis. Hurthle cell neoplasm cannot be excluded. Excisional biopsy is recommended if clinically indicated.

I would deeply appreciate any insight, whether it's posititve or negative, because right now I am a nervous wreck!

Follicullar epithelial cells - the main cells of the thyroid that produce hormones.
Oncocytic Metaplasia - a swollen follicular cell
Lymphocytes - makers of thyroid antibodies - part of any normal immune system
Neutrophils - also part of the immune system, they find and surround foreign matter (think white head or a zit)
plasmacytoid lymphocyte - another type of lymphocyte
scant colloid-like material and fibrinoid debris - within the follicular cells, colloid is a reserve for the thyroid pro-hormone thyroglobulin as well as the hormones T4, T3, etc.


From the texture, it looks like Hashimoto's Thyroiditis, the most common type of thyroid disease. Also pointing toward Hashi's are the lymphocytes and neutrophils. Hashi's, or any autoimmune disease, is when (for some reason) your body thinks an organ is a foreign material.)
However, because of the follicular & hurthle cells, a positive diagnosis is impossible.
With follicular involvement, a larger specimen of thyroid tissue is needed (excisional biopsy). The sample is frozen, thawed, then examined. This process takes several days. Most doctors prefer to be safe and remove the thyroid, or the part of the thyroid that is effected.

[Pinot]

Carolyn, Leo and clarke - thank you so much for prayers and good thoughts.
I can't even express how they have comforted me.

And cocoanut - Thank you! thank you! for the definitions and interpretation. That helps immensely!
I've been googling phrases all evening and couldn't make sense of it all.
After reading that, I might even be able to get some sleep tonight.

I was thinking the "excisional biopsy" was surgery to remove the thyroid,
I didn't realize it's what I've heard called an "open biopsy".
But I wonder if it's worth doing the open biopsy at all?
Maybe I should just have this half of my thyroid removed to begin with?
(Have to admit, I'm also considering the costs of what would amount to two surgeries.)
Those Hurthle cells are what scare me.
All my googling kept leading me back to Hurthle cell cancer, which is supposedly very rare.
Normal thyroids or even *normal* hypo thyroids don't usually contain Hurthle cells, do they?

Thank again ... I hope you ladies realize what a blessing you have been!

[CarolynF]

The large biopsy wasn't an option for my dd, as they just removed half of it..She is now on meds, of course. She was in the hospital 2 days, I believe, went home, I was with her and it took about a week for her to feel normal.

Pinot: Anything like that is scary, but the surgeon will know what to do. Keep us posted.

Glad you can sleep...

[Beezer Louisiana]

I'm so sorry about the scary results. I wish your dr. could have explained them better at your appt.

When is your ENT appt?

(I go to the endo on Friday. I expect him to want to biopsy my nodule. I will be following your experience closely.)

[Leo41]

Pinot-
When I had a biopsy, they diagnosed Hashi's (my regular blood tests didn't show enough antibodies for a definite diagnosis), but there were no Hurthle cells. However, all of us with nodules may develop cancer at any time--although most don't. My endo does an annual ultrasound because any growth in the nodules would indicate the need for another biopsy.

I suspect the reason they want to do the 'open biopsy' is that surgeons have to adhere to standards--i.e., they cannot perform more radical surgery unless they have exhausted preliminary tests or have a definite diagnosis.

One of the worst things about situations like yours is the issue of costs--medical care is horrendously expensive. But at age 70, I consider my health one of my most valuable assets and worth those costs.

[betty301]

Hope you got some sleep

It's crazy how you keep getting sent home with these results without anyone to explain it to you!!

[inatic]

Afirma Thyroid Analysis May Help Patients Avoid Unnecessary Thyroid Surgery

[poe2you]

thank goodness for the ladies around her.. they are very helpful
your in my thoughts
Sharon

[Star73]

Stay positive. I know it's hard, I really do. I went through a scare in my early 20s with multiple lymph nodes being swollen and had a biopsy. Your report says it favors Hashi's and the other cannot be ruled out. This tells me that more than likely it is Hashi's, but they need more tissue to be sure. Take a deep breath and try not to worry until you know for sure what you are dealing with (easier said than done I know)

[cocoanut]

Originally Posted by Pinot

Carolyn, Leo and clarke - thank you so much for prayers and good thoughts.
I can't even express how they have comforted me.

And cocoanut - Thank you! thank you! for the definitions and interpretation. That helps immensely!
I've been googling phrases all evening and couldn't make sense of it all.
After reading that, I might even be able to get some sleep tonight.

I was thinking the "excisional biopsy" was surgery to remove the thyroid,
I didn't realize it's what I've heard called an "open biopsy".
But I wonder if it's worth doing the open biopsy at all?
Maybe I should just have this half of my thyroid removed to begin with?
(Have to admit, I'm also considering the costs of what would amount to two surgeries.)
Those Hurthle cells are what scare me.
All my googling kept leading me back to Hurthle cell cancer, which is supposedly very rare.
Normal thyroids or even *normal* hypo thyroids don't usually contain Hurthle cells, do they?

Thank again ... I hope you ladies realize what a blessing you have been!

A small excerpt from Thyroidmanager org :

FNA typically reveals lymphocytes, macrophages, scant colloid, and a few epithelial cells which may show Hurthle cell change. In this context Hurthle cells do not represent a discrete adenoma. However if only abundant Hurthle cells dominate the specimen, and there are few or no lymphocytes or macrophages, the biopsy must be interpreted as a possible Hurthle cell tumor.


According to the path report, you have "abundant Lymphocytes" .

Few doctors recommend an open biopsy. If results are positive, that would mean a 2nd surgery within a few days. If results are negative, you may still want to have the portion of the thyroid removed as a preventative measure as hurthle cells can become cancerous.

Please, do not accept my word as any type of diagnosis. I am not a medical professional, only a thyroid cancer patient who has been Googling for 11+ years. Talk to the doctor. Get a 2nd, 3rd, or even 4th opinion if you'd like.

[Emmaline]

Keeping you in thought Pinot...

[Pinot]

Thank you so much everyone for all the positive thoughts and info.
I'm basically only a lurker here at LCF so this support just overwhelms me.

I have an appointment with a highly recommended ENT in Pinehurst, NC
on Monday, December 19.
I've already faxed over my ultrasound and biopsy results to his office.

At least something positive has come from this so far.
For years now, I've been so lax when it comes to what I eat.
But since I got this news on Tuesday,
I haven't had a bite of sugar, very few carbs and no gluten.
Also finally started using my rebounder again. And walking.
In just two days, I already feel SO much better emotionally.

I'm trying to stay busy.
It's those quiet, still times when the fear overtakes me again
and I start imagining the worst.
And I'm actually trying *not* to read stuff about thyroid cancer.
As of right now, I have NOT been diagnosed with thyroid cancer.
Reading about it now just brings on all the negative what-ifs
and I just cannot allow that in my mind right now.
I work in a church office and our sweet old janitor told me,
"Don't you claim that cancer! Don't you claim it!"

I'll have an appointment on Monday, that's all I'm going to concentrate on now.
A dear friend, old enough to be my mother, is going with me.
She had her own thyroid scare years ago,
plus she's one year post-op from a successful double-lung transplant,
so she knows her way around a doctor's office!

Thank you again for all your kind words and support.
My thoughts and prayers go out to EVERYONE here
who is fighting this thyroid battle in their own life.

[Skinnurse]

I have read pathology daily for 14 years. I would say currently not to worry about that it MAY be a malignancy however with the Hurtle Cells and the Metaplasia, I would say that it is evolving. Meaning that there are changes slowly going on that are leaning towards early stages of cancer in the near future if left untreated now.

I would definately have the partial removal for the biospy to get a definitive diagnosis. IF they say there is any Dysplasia (meaning a pre-cancerous cells aka evolving into like I suggest it currently is) I would definately just go for the Thyroid removal. You are young and healthy and it will be a breeze to recover from. IF it is a cancer, Thyroid cancer has the highest cure rate of ALL internal cancers. So the prognosis is fantastic as long as you keep up with your follow up exams. Either way, it sounds like you are being extremely proactive and that is amazing because most people are not. You obviously have caught whatever is going on early enough to treat it and be done.

[Psmileyf]

I hope the appointment went well today!

[clarke]

Checking in to see how things went

[Pinot]

Sorry for not checking in after my appointment.
Feeling a little down prior to the holidays
and it took all I had to make it through
and put on a happy face for daughter and son-in-law.
Plus, to make matters worse, our sweet kitty, Gyp
died today - on Christmas Day! - of liver disease.

Well, the appointment with the ENT surgeon went well.
Only real question now is, do I have a total thyroidectomy (TT) or a partial?
At first, I was all gung-ho on taking the whole cursed thing out,
but after reading so many horror stories online about TT and its aftermath,
I am not sure anymore.

There are so many women post-surgery who are only given T4.
Who feel worse than they did before,
who go months or even years without being properly medicated.
I guess I do have an advantage over a lot of people in this situation
because from reading here, STTM and Mary Shomon's site,
I know how crucial the right medication is.

And please, can you please say a prayer or send me some positive vibes
because I *think* I may have found an NP in Lexington, SC (90 miles away)
who is very much in favor of natural thyroid and prescribes Naturethroid.
Her office was closed last week, but I plan to call again
(and again and again) until I can get an appointment.
I'll cry over the phone if I have to ... ha ha.
In fact, when I called the pharmacy in Columbia,
asking about doctors who prescribe natural,
I burst into tears of gratitude
when the sweet little pharmacy tech, Stacy, told me about this doctor.
She probably thought I was nuts!

Half or no thyroid, I don't want to be one of the horror stories.
I want to reclaim my life and LIVE again.
Feel like myself again.
The thought of feeling worse than I do now just terrifies me.


The right lobe is bad, gotta go.
3 cm nodule. Hurthle cell neoplasm cannot be ruled out.
Of course, if it is cancer, there's no question, it all has to come out.

But do I take the chance on a partial?
The left lobe has a 7 mm nodule that may very well contain
the same Hurtle cells found in the 3 cm nodule on the right lobe.
But what if it doesn't?
Do I sacrifice a relatively good left lobe on the chance that it might be cancer?

But if I do a partial and it's cancer,
then I'll have to have surgery again to get the left lobe.
At this point, I can barely afford one surgery, much less two.

My blood work showed an elevated TSH,
but despite my many hypo symptoms,
my free T3 and free T4 were both in normal ranges.
Doesn't that mean that my thyroid is at least working to some extent?
In fact, just taking a mere 25 mcg of Synthroid since Thanksgiving Day,
I do feel a whole lot better than I did before.
I'm eating better and trying to exercise some every day.

Sorry that I'm just rambling and probably not making much sense,
but I am just so torn.
Plus just the thought of surgery of any kind scares me so.
I've gained so much weight over the last six years,
I worry that I'm too much of a risk for surgery.
I'm 5'3" and at least 100 pounds overweight.

The doctor's office should call sometime after the 27th
to let me know my surgery date.
I hope God will give me clarity and peace of mind about it before then,
because right now, I really don't know what to do!

[cocoanut]

I'm so sorry about your dear kitty, Gyp. I know how difficult it is to loose a beloved 4 legged family member.

You already know the pros and cons of having a TT vs PT. I won't try to persuade you either way.

I will keep you in my thoughts and send the best of vibes for you and your doctor.

[Star73]

to you. I hope you get the answers you need. I'm sorry that I don't know what to suggest to you, but you are in my thoughts and you are smart by doing your research. Keep your chin up

[clarke]

I had one half taken out in July? and the other half taken out in September - 2 months apart. My doc didn't check for cancer while I was still under and when I went back for my 1 week checkup, he informed me of the cancer. I then had to decide if I wanted the other side out too. I was given options, take it out, leave it and wait and see. I had a second opinion which mirrored the first. I decided just to go ahead and get it over with and go for the RAI. I figured I had good insurance now, so......

Anyway, the surgery itself wasn't too bad, so it wasn't too upsetting going back again. However, finding a good doc after to treat you properly is an issue. Tough choice for you to make. Good luck with your decision. Which ever you decide, it will be the right one for you. There is no wrong one.

PS. sorry to hear about your kitty...

[lisabinil]

I had a total thyroidectomy in 2009-best decision I ever made. I am on the Synthroid/Cytomel protocol with optimized meds and feel good. Don't discount the Synthroid/Cytomel synthetics-everyone is different as to what they tolerate. Good luck to you!

[Pinot]

Thanks clarke and lisabinil for your input!
My surgery is scheduled for February 7,
so I've still got some time to get some things sorted out.
I go in for my pre-op blood work and an EKG tomorrow.

Amazingly, since I last posted in this thread,
I have found a wonderful doctor (an ob-gyn)
who really seems to know about thyroid.
I met with her last Thursday and she really put my mind at ease about the whole thing (nodules, surgery, treatment, etc).
She took a lot of blood and is testing everything for me.
Should know the results (and have a new prescription for compounded Armour) tomorrow.

Now that I know I have someone who will work with me post-surgery,
I feel so much more confident and peaceful about the surgery itself.
She promised me she won't let me be one of the "horror stories" I've read about online.

lisabinil - that's so encouraging to hear how successful your TT was.
This new doctor will start me out on compounded Armour
(I'm on a small 25 mcg dose of Synthroid now)
but she admits that not everyone does best on the natural
and she's willing to try whatever works for me.
I truly believe finding her (by calling a compounding pharmacy)
was a real answer to prayer!

[clarke]

Sounds like you are in good spirits!! Going in with a positive attitude will help plenty!

Take care. The surgery and recovery itself generally isn't too bad. Think positive!!