3 FNA's two Inconclusive one a 3a - what to do?

[wysewoman]

Hello,

So my saga began 8 months ago when I noticed a small lump in my thyroid. I was referred to an Endo. My bloods were all within normal range apart from my TSH which was very low and below range. My Endo doesn't seem that concerned about that though. I have also had antibodies tested and they came back as 40 (ie withitn accepted range)

An intiial ultrasound revealed that I have two smaller nodules on the other side too and a small goiter.

Anyway, so far i have had three Fine Needle Aspirations in my largest nodule (around 2cm in size). The first FNA result was a 1, the second was a 3a (some atypical cells but still low chance of malignancy.) My Thy3a was based on some atypical follicular cells with irregular nuclei. My last FNA was 1c - which seems to mean inconclusive but cystic components present.

My Endo, who is also a surgeon, seems to be of the opinion that I should have a hemithyroidectomy as it's the only way to know for sure. Even though about 80% of people in my situation with a 3a result will still have a benign nodule and thus have unnecessary surgery.

I have been looking at the Veracyte Afirma test which is for people in my situation (with indeterminate FNA 3 results) but unless I find thousands of pounds, this test is not currently available in the NHS or, as far as I am aware, Europe.

I just can't believe that 2/3 of my FNA have been '1's - has anyone else had similar test results? If so what happened and what did you decide?

On my ultrasounds, two different radiologists said that they couldn't see anything that gave them cause for concern. No micro-calcifications (fairly strong indications for malignancy) were seen by them (although that just because they aren't there, doesn't mean that there may not be cancer present).

I'm in such a quandry as my Endo said that assuming my nodule does prove to be benign after a proper biopsy following a hemithyroidectomy, only 10% of people would need to have long term medication and there is about a 3% chance of damage to my vocal chords.

Weighing up all these stats is driving me insane!

My lump seems to me, to be about the same size as it was 6 month ago.

Would love to hear others thoughts...

Thanks,

Melissa

[Clutter]

If you can bear the anxiety you could ask to wait and watch, retesting in 3-6months. Or you could get a 2nd opinion.

My FNA and core biopsy were inconclusive but hemi had to be done to relieve compression on my windpipe. |Histology was positive for Stage II Hurthle cell carcinoma.

I have read that papillary cancer is very slow growing and surgery isn't a foregone necessity for patients under 40 when the tumour is less than 2cm. My problem with this is that if FNA can't even be conclusive that tumours are cancerous, how can they determine whether the cancer is slow growing papillary (80%) or more aggressive follicular (15%).

I'm really sorry for your predicament. You might find the following link useful thyroid.about.com/od/cancer...

[wysewoman]

Hi Clutter,

Thanks for the reply.

I'm 40 years old. It was some atypical follicular cells that were listed as the reason for the 3a result. I assume that there weren't enough? or perhaps didn't display enough of the characteristics required for a Thy3f result?

Typically would one expect to see a rapid growth in nodule size if it was a follicular or papillary Cancer? I'm not sure how these things progress.

I'm also peeved that the decision for a hemithyroidectomy is based on this nebulous 3a result! It just feels like my endo isn't taking account things like my age, its size, lack of any sonographic features. I have read that all these things affect the chances of malignancy.

Melissa

[Clutter]

I really wouldn't fault the endo on this. The FNA isn't a precision tool and it's almost as much luck as judgement if it grabs cells from suspect areas.

I had a camera down my throat so that the surgeon could avoid damaging the vocal chords.

I don't know if my timeline helps but lump appeared overnight 10/6/11, saw GP 13/6/2011 TFTs, ECGs, Ultrasounds June/July, referred to surgeon 28/7/2011 more bloods, FNA, core biopsy, decision to operate made same day and surgery 7/12/11. Nodule had grown but not much in almost 5 months and it hadn't invaded any surrounding lymph nodes, tissue or organs. Hurthle is an aggressive follicular variant.

Ask your endo whether inconclusive results are referred to a multi-disciplinary team for consideration and whether you can hold off making decision until the MDT have deliberated.

This site is devoted to ThyCa inspire.com/groups/thyca-th... You have to register to access it.

[wysewoman]

Thanks for the info Clutter.

The Endo did say that she had discussed it with her peers and will discuss it again next week. She also said she would make some enquiries about the Afirma test and whether anything similar is offered in the UK. She thought that there may be one place but that it would be in London and would be a private clinic.

[Clutter in reply to wysewoman]

I'd like to know how you get on. Please contact me if there's anything you want to discuss.

Very best wishes x

[CARO100 in reply to wysewoman]

Did you ever find out whether the Afirma test is available in the UK?

[gcarrie in reply to wysewoman]

Hello

I am in the same situation with a FNA test result of 3a. There is a 1cm lump on the left thyroid gland and two smaller lumps on the anterior right gland.

The ENT doctor has suggested a repeat FNA cytology in a few weeks. Is the Afirma test available in the UK?

I have a nunber of symptoms such as a swollen tongue, difficulty swallowing and pain along my right jaw and sometimes the right inner ear. The radiologist said he thought the lump was too small to be causing my symptoms. I am a little worried as i have also recently been diagnoaed as having an off the charts level of intraepithileal lymphocytes in my small intestine but the cause for this has not been found despite many tests. The current diagnosis from my gastroenterologist is that i am a resistant celiac and the high the very high IELs means that it could turn into an agressive lymphoma of the small intestine. Although i was never diagnosed with cleiqc disease i stopped eating any gluten or dairy almost four years ago in an effort to improve my longstanding gastrointestinal issues. Any thoughts or advice would be much appreciated?