Thyroid needle biopsy with indeterminate result

[Mionaonthehill]

My dentist referred me for scan because she said I had a lump in my neck. I went for scan and GP called and said I had a large nodule 3cm and I need a needle biopsy. Had biopsy on Monday and was told I had an indeterminate result. Dr did say I could watch it but recommended to have that half of my thyroid removed. Have others just watched it or is surgery the only option? Dr told me chance of cancer was something like 25%. I am new to this country and haven’t actually met my GP. He’s called me up but never actually asked about my medical history etc. I haven’t felt sick with this lump but I do have a history of autoimmune disease. I don’t feel I have all the information and have been thinking of paying to go private to get a second opinion. Appreciate any feedback with thanks.

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I had two FNA before I had my thyroid removed these were both inconclusive. Six months later when they removed my thyroid the 4 cm lump was one fifth cancerous. It's a difficult decision to make.

[Greekchick]

Dear Mionaonthehill,

Thyroid biopsies are sometimes inconclusive. Do you have Graves? If yes, then your chances do increase for cancer, but not by the amount your doctor is telling you - he has overstated the incidence. The majority (98%) of thyroid nodules are benign.

I would absolutely get a second opinion before I allowed anyone to remove any part of my thyroid. What were your blood results? Did he give you a reason for why it should be removed? Have you been offered drug therapy first?

I just had a TT 5 weeks ago for a toxic multinodular goiter with Graves. I had that goiter for 25 years and was asymptomatic with normal blood work and normal biopsies until 2 years ago when I was finally diagnosed with Graves. I was stable on Tapazole for 2 years until my goiter doubled in size over a 2 month period, and then it had to come out. My presurgery biopsy was normal and this was confirmed with the surgical frozen section and post surgery pathology.

You need answers before proceeding with any treatment. I don’t believe you have enough information to make a decision on whether or not to have surgery. With the limited information you have and inconclusive biopsy results, at minimum the biopsy should be repeated (hopefully it was done with ultrasound) and with a different doctor. The skill of the physician also plays some role in the accuracy of the biopsy.

I hope this is helpful and I wish you all the best. Sending you positive thoughts today. Bunnyjean is right- these are tough decisions to make. Please post again with update if you decide to seek another opinion from an endo.

[Mionaonthehill in reply to Greekchick]

Thank you for the replies. It has made me feel I am not alone. I don’t have Graves. The GP said my blood test showed normal Thyroid function and after I had my ultrasound, I saw on my patient access online they had diagnosed it as Nontoxic multinodular goitre. As I said the GP has not seen me or talked about it to me at all. He has just referred me to the hospital for the FNB.

[vocalEK]

If you have Hashimoto's Thyroiditis (HT), chances are that having part or all of your thyroid removed is not the best treatment.

"Hashimoto's thyroiditis, which is the most common cause of hypothyroidism (see Hypothyroidism brochure), is associated with an increased risk of thyroid nodules."

thyroid.org/thyroid-nodules/

"Patients with HT were significantly younger and more likely to be female. There was no significant difference between the two groups in the rate of malignancy. However, patients undergoing thyroidectomy with HT had a significantly higher postoperative complication rate. Specifically, the rates of overall complications, transient complications, and permanent complications were all increased in HT patients." ncbi.nlm.nih.gov/pmc/articl...

As for the cancer question, I found that, according to one study, a nodule larger than 2 cm carries a cancer risk of 15%. Another study found a risk of 16.3% in those with nodules of 3.0 to 3.9 cm. thyroid.org/professionals/a...

So the risk appears to be much smaller than the doctor told you. If it were me, I would do some other exploration before embarking on an irreversable (surgery) course.

Ask for a complete thyroid panel to include TSH, Free T4, and Free T4, as well as antibodies that will indicate whether you have HT or Graves Disease. If you have HT, there are protocols you can follow to reduce the antibodies that are attacking your thyroid.

[Keenbean]

Hi Mionaonthehill,

My daughter had hashimotos and had a nodule. After an inconclusive biopsy we were given a choice to either wait and watch or go for surgery. We opted for surgery and it was cancer. But in her case her antibodies were high and she has been on thyroxine for over a year. As mentioned by other get more blood tests done and wait. But be proactive and be on top of it.

Regards