In April 2011 my husband came home from nursing school telling me that he didn't think I had PCOS but that he thought I had Cyclical Cushings Syndrome. After researching it and finally making an appointment to see the doctor, they tested my thyroid levels. That showed I was Hypo. They referred me to an Endocryinologist but also ordered an ultrasound of my thyroid.
Here's the pathology report for the ultrasound.
Examination: -ou Thyroid or Neck May 3, 2011
History: Elevated TSH.
The right lobe of the thyroid gland measures 4.0 x 1.9 cm. It is diffusely hetergeneous and I suspect it contains multiple coalescing nodules that cannot be clearly seperated from one another.
The left lobe of the thyroid glad measures 4.5 x 2.0 cm. The left lobe is also heterogeneous but not to the degree the right is. There are multiple nodules seen in the left lobe largest one measuring a centimeter. The isthmus measures 3mm.
Impression:
1. Multiple subcentimeter thyroid nodules seen in the left lobe.
2. The right lobe is diffusely hetergeneous and I believe consistent of multiple coalescing thyroid nodules which almost entirely replaces the thyroid gland. Most lekely a multinodular goiter but I would recommend correlation with a nuclear medicine thyroid scan to evaluate for potential cold thyroid nodules.
So then of course, a nuclear uptake scan was ordered. Here's the pathology from the uptake scan.
Examination: Thyroid Scintigraphy
History: Abnormal thyroid function tests. Hypothyroidism.
Tehnique: The patient was administered 571 uCi of I-123 orally and returned for 24-hour uptake measure. Scintigraphic images were also obtained.
Findings: The 24-hour uptake is 35.5%. The expected normal range is between 10% and 30%. They thyroid gland is normal in size. There is a homogeneous distribution of activity without photopenic or hyperfunctioning nodules. An extended field-of-view images was sent which shows activity in the left upper quadrant. This is likely physiologic activity in the stomach.
Impression:
1. Elevated radioiodine uptake at 35.5%. This is consistent with Graves' disease, but can also be seen in the setting of decreased dietary iodine uptake or early Hashimoto's thyroiditis. Correlate for hypothyroidism versus hyperthyroidism.
2. No hyperfunctioning or clear photopenic nodules.
I was informed that this report was good and it showed nothing concerning with the nodules. It did show that I was Hyper (Graves Disease) and not Hypo (Hashimoto's) though. So then my doctor ordered a blood test to test my T4, TSH and Antibodies to solidify the diagnosis.
Lab Results
Free T4- (normal range 0.70-1.60 nd/dL) 1.18
TSH- (normal range 0.35-5.50 M Int Units.mL) 4.86
Anti-TPO Antibodies
Result 353 H
Reference <35 IU/mL
So according to those results, I am neither Hypo or Hyper. So back at square one as to why my thyroid is not functioning correctly. But the Synthoid I was put on is helping and I have noticed a difference. After seeing these results, my Endo steps in and orders a biopsy for the nodule on the right side of my thyroid. I had the biopsy done and waited all of two days (Saturday and Sunday) to hear back with those results.
Endo's response: The results came back suspicious. You need to have the right side of your thyroid removed but I would prefer the entire thyroid just to be cautious. Don't be scared. What surgeon do you prefer and lets get you an appointment set up to see him.
Not very informative and I was not about ready to make a decision with so little information. I had an appointment scheduled the next day anyway with my family doctor who has been the primary doctor in all of this.
Family Doc's response: I am in complete agreement with the Endo. He read the pathology report and said that he was going to call the ENT's office and schedule an appointment.
A little more information but I have known this doctor for 7 years and he's a good doctor. I trust his judgement. Besides, how can you argue with two different doctors with the same opinion. The appointment for the ENT was made for that same afternoon. But before I get to that appointment, here is the pathology report from the biopsy that we got from the Family Doctor's office. (yes, we get the records for our persnal use. It's a good habit to get into when dealing with serious health issues. This way if you ever need a second or third opinion, you already have the information with you).
Final Diagnosis
Fine needle aspiration, right thyroid, smears (8) and cyto spin preparations (2):
A. Atypical cells present, often with spindled morphology, strongly suspicious for neoplasia.
B. Many small lymphocytes
C. Scattered groups of cytologically benign follicular epithelial cells.
D. A large amount of blood.
Comment: Favored in the differential diagnosis although not cytologically conclusive for this diagnosis, is medullary carcinoma. Although felt to be less likely, a lymphoma cannot be entirely excluded. Excision of the nodule is recommended for definitive diagnosis.
Gross Description
The specimen is labeled "FNA right thyroid" and consists of 30cc of Saccomanno fixative with needle washings. Eight smears and to Cyto spin preparations are made.
Microscopic Description
Smears from the fine needle aspirations of the right lobe of the thyroid gland reveal background blood. In a couple of the smears, large sheets of cells are seen within a pale blue matrix. These cells demonstrate little to no cytoplasm but exhibit large, pleomorphic nuclei with irregular chromatin features. Occasional grooves are seen and lymphocytes are seen within the background. Elsewhere in the smears, atypical cells are seen with a spindled morphology. Again, lymphocytes are seen in the bacground. Scattered throughout the smears are groups of cytologically benign follicular epithelial cells demonstrating small uniform nuclei and small amounts of delicate pale blue cytoplasm. The cyto spin preparations reveal numerous small lymphocytes. The overall cytologic features are strongly suspicious for neoplasia.
So according to the ENT, neoplasia is a rare form of thyroid cancer and it is aggressive. Since they can not be sure that this is what I have, they have to remove my thyroid. Anytime anyone puts "Cancer" + "Rare" + "Aggressive" in a sentence, it's not good. My head is spinning and of course I went through a period of shock, I'm still in shock but I'm also depressed and extremely angry. The ENT also informed me that the pathologist was talking with him about it before I was even referred but no personal info was released, just information about my case.
The surgery has been scheduled and I am freaking out. I was told that while they have my neck open, they have to look at surrounding glands/lymph nodes and my vocal nerves to make sure these cells have not spread. If the cells have spread, those areas will also be removed.
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