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I Had A FNA Biopsy Done On Both Sides Of
Question: I had a FNA biopsy done on both sides of my thyroid after a decade of observing nodules. My left side is benign consistent with goiter nodules. My right side has features that favor a follicular neoplasm. I haven’t been with my endo long (maybe 6 months) and he wants to go straight to removing the right thyroid. I have read that the only way to find out if it’s thyroid cancer is to send it to pathology to determine if it’s follicular adenoma and follicular carcinoma. But isn’t just the fact it’s follicular cells confirmation it’s cancer? Should I be worried I have cancer? Or is this not a big deal? This is pretty much all the info I was given from my Endocrinologist.
Brief Answer:
Presence of follicular cells is not a confirmation of cancer
Detailed Answer:
Hello and welcome to " Ask a Doctor " service,
I carefully read your query and also checked the uploaded report and understand your concern.
There is a presence of excessive folicular cells in FNA of the right thyroid nodule and this means there is a neoplasm (new growth) but does not always mean it is cancer. There are other conditions with similar findings that are benign (not cancer).
The only way to tell for sure if a thyroid mass is benign or malignant (cancer or not) is by biopsy (FNA suggests but can not for sure tell this difference), thus the next step to follow such a FNA result is to remove the lump and biopsy it. To do so a lobectomy is generally done (removal of the side of the thyroid that has the lump) and biopsy is performed. Biopsy shows if the folicular cells have invaded the capsule and the blood vessels of the lump, which makes the clear difference between adenoma (benign) and carcinoma (cancer).
To conclude:
- presence of folicular neoplasm does not always mean it is cancer, there are several benign conditions with similar findings in FNA
- biopsy is the only way to tell for sure if cancer is present or not
- removal of the lump by removing the lobe of the thyroid where the lump is, is the recommended next step
- it seems the doctor is recommending proper steps to diagnose your condition and I would say you need to follow his advice.
I hope this answers your query and is helpful to you. I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj, General and Family Physician
Presence of follicular cells is not a confirmation of cancer
Detailed Answer:
Hello and welcome to " Ask a Doctor " service,
I carefully read your query and also checked the uploaded report and understand your concern.
There is a presence of excessive folicular cells in FNA of the right thyroid nodule and this means there is a neoplasm (new growth) but does not always mean it is cancer. There are other conditions with similar findings that are benign (not cancer).
The only way to tell for sure if a thyroid mass is benign or malignant (cancer or not) is by biopsy (FNA suggests but can not for sure tell this difference), thus the next step to follow such a FNA result is to remove the lump and biopsy it. To do so a lobectomy is generally done (removal of the side of the thyroid that has the lump) and biopsy is performed. Biopsy shows if the folicular cells have invaded the capsule and the blood vessels of the lump, which makes the clear difference between adenoma (benign) and carcinoma (cancer).
To conclude:
- presence of folicular neoplasm does not always mean it is cancer, there are several benign conditions with similar findings in FNA
- biopsy is the only way to tell for sure if cancer is present or not
- removal of the lump by removing the lobe of the thyroid where the lump is, is the recommended next step
- it seems the doctor is recommending proper steps to diagnose your condition and I would say you need to follow his advice.
I hope this answers your query and is helpful to you. I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj, General and Family Physician
Above answer was peer-reviewed by :
Dr. Nagamani Ng
I was wondering, is there any ways to find out if it is malignant without having it removed? I saw a statistic that said something like 60%-70% of patients who have their thyroid removed end up finding out its not cancer. Of course, when I read that I can't help but think that I might be fine if I don't have the surgery.
On a side note, more information because I don't know what's relevant or not. I have large red dry patches on my face, where the skin feels like low grit sandpaper (the other cheek is smooth as normal), I can't seem to exfoliate enough. I have red bumps on the back of my arms that never seem to go away, I have PCOS, I lose clumps of hair during my showers and when I brush my hair or run my fingers through it. Lastly, it has been maybe a month or so that I noticed that when I take my nighttime meds (some with large pills like metformin or 400mg magnesium malate pills) I have that feeling like there is something stuck in my throat. I couldn't tell you how long it has been going on but for at least the past few weeks. I thought it was my GERD acting up, but I have been religious in taking my Prilosec and I still get that "lump" feeling. (I actually have it right now as I type this.)
Again, I don't know what is relevant or not, but I mostly want to try to see if there is another course of action while giving you any random things I have noticed.
Thank you for your time and guidance on this.
On a side note, more information because I don't know what's relevant or not. I have large red dry patches on my face, where the skin feels like low grit sandpaper (the other cheek is smooth as normal), I can't seem to exfoliate enough. I have red bumps on the back of my arms that never seem to go away, I have PCOS, I lose clumps of hair during my showers and when I brush my hair or run my fingers through it. Lastly, it has been maybe a month or so that I noticed that when I take my nighttime meds (some with large pills like metformin or 400mg magnesium malate pills) I have that feeling like there is something stuck in my throat. I couldn't tell you how long it has been going on but for at least the past few weeks. I thought it was my GERD acting up, but I have been religious in taking my Prilosec and I still get that "lump" feeling. (I actually have it right now as I type this.)
Again, I don't know what is relevant or not, but I mostly want to try to see if there is another course of action while giving you any random things I have noticed.
Thank you for your time and guidance on this.
Brief Answer:
Detailed answer below
Detailed Answer:
Hello and welcome back,
I read your reply carefully and understand your concern related to surgery and the desire to find alternative ways. Unfortunately, there is no other way to tell for sure the difference between a benign and malignant lump of the thyroid other than with surgery followed by a biopsy.
Lobectomy is a possible surgery, which means removing only the side where the lump is and not all the thyroid.
On the other hand, even though 60-70% of patients that do biopsy may find it is not cancer, it is 30-40% that may have cancer, which is not a small percentage, being more than one in three. So it is worthy to have the surgery and be reassured than to have cancer and not have it diagnosed and treated promptly.
As for the hair fall, there are many possible causes for this as well but PCOS is a possible one in your case. The thyroid lump does not seem to be related to it if your TSH is normal.
As for GERD symptoms, Prilosec is not enough, diet precautions and some other measures such as raising the bed head, eating frequent small amounts of food, avoiding caffeine, smoking (even passive smoking) and alcohol (if at all consume), avoiding spicy food and dried or junk food are important. If no improvement with the above measures an upper endoscopy of the GI tract may be indicated.
I hope this answers your query and is helpful to you.
I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj,
General and Family Physician
Detailed answer below
Detailed Answer:
Hello and welcome back,
I read your reply carefully and understand your concern related to surgery and the desire to find alternative ways. Unfortunately, there is no other way to tell for sure the difference between a benign and malignant lump of the thyroid other than with surgery followed by a biopsy.
Lobectomy is a possible surgery, which means removing only the side where the lump is and not all the thyroid.
On the other hand, even though 60-70% of patients that do biopsy may find it is not cancer, it is 30-40% that may have cancer, which is not a small percentage, being more than one in three. So it is worthy to have the surgery and be reassured than to have cancer and not have it diagnosed and treated promptly.
As for the hair fall, there are many possible causes for this as well but PCOS is a possible one in your case. The thyroid lump does not seem to be related to it if your TSH is normal.
As for GERD symptoms, Prilosec is not enough, diet precautions and some other measures such as raising the bed head, eating frequent small amounts of food, avoiding caffeine, smoking (even passive smoking) and alcohol (if at all consume), avoiding spicy food and dried or junk food are important. If no improvement with the above measures an upper endoscopy of the GI tract may be indicated.
I hope this answers your query and is helpful to you.
I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj,
General and Family Physician
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Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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