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Asked by dacton (Female; 28; Just found out within the year I was hyperthyroid.; Relevant drugs:0.125mg of Synthroid ) on Tue 30, Mar 2010 04:56pm :
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I recently found out that I'm hypothyroid and my Endocrinologist told me I
likely had Hashimoto's Thyroiditis. After reviewing my second ultrasound, she
sent me for a fine needle bioposy because I had a nodule on my thryoid that was
1.3cm. My results came back as abnormal, but didn't look like normal thryoid
cancer. She then send me to a head and neck surgeon. He told me the results came
back as Hodgkins Lymphoma, and that he didn't really believe it because this was
so rare. He send the results to a Pathologist who specializes in Lymphoma and
the report came back inconclusive, but that there was a possibility that it
could be Lymphoma. My first instinct is to get my thryoid gland removed if there
is a possibility it could be lymphoma, but I am only 28, and have not had
children yet. I'm not sure what my next steps should be. I'm wondering if there
are any other tests that could be done before I jump into removing the gland?
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Answer by Dr.Kokil Mathur (doctor) on Tue 30, Mar 2010 07:08pm:
Hi! Thanks for the question on the forum. Thyroid nodules are both benign (90%) and cancerous. I can
understand your dilemma as the fine needle biopsy is inconclusive. Usually biopsies are more conclusive than
imaging techniques. However in your case maybe a CT scan or a MRI should be done to know what the nodule is.
Before a surgery is contemplated it is important to know the level of thyroglobulin in the blood. This protein
is formed by the thyroid gland and usually its level falls after surgery. However if the level rises,
possibility of cancer will have to be looked into. Radioactive iodine studies should also be done. If the
nodule is cancerous, it will appear as a ‘cold spot’ on imaging as abnormal cells will not take up iodine to
make thyroid hormone. If there is too much iodine uptake by a portion, ‘hot spot’, then it could be due to an
overactive thyroid gland. Also FNAC can be repeated if it was inconclusive as in about 50% cases a repeat FNAC
results in conclusive report. It is difficult to comment beyond this at this stage. Do consult your doctor
regarding these tests. Hope this helps. Please let me know if there is any thing else and do keep me posted.
Take care!
Please rate my answer (select the stars below, no need to log in.)
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This questions is open for comments. Please share your opinion.
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Follow up:
Request for Clarification by Dr. Srivastava on Thu 01, Apr 2010 03:43am:
Hello madam, I completely agree with Dr KOkil. Also, I feel sorry to hear your dilemma of possible
Hodgkin's lymphoma at such young age. I would like to inform you few things upon both thyroid goitre and
Hodgkin's lymphoma. A young female who presents with a swelling near the thyroid gland(centre or near to
midline of neck) have 95% chances of thyroid related issues and hodgkin’s lymphoma is considered a rare
possibility. This nodule can be a single nodule(solitary nodular goitre) or part of multinodular goitre. You
had thyroid issues since past which also points towards possibility of thyroid issue. This you can confirm by
your present or recent thyroid blood tests(TSH, T3 and T4). You should first go for a radioactive iodine
thyroid scan which can help discriminate between hyperthyroidism, thyroid cancer or any other growth. This
being non-invasive technique could be more convenient to you. If the results favor thyroid cancer then you can
opt for partial or total thyroidectomy which can be then sampled in pathology lab to verify any possibility of
other type of cancer like Hodgkin. Though, many individuals may have small masses (nodules) in the neck and
majority of them are thyroid nodules which are benign (non cancerous). Most thyroid nodules do not cause any
symptoms and are found in incidental exam. Doctors usually perform a needle aspiration biopsy or radioactive
iodine scan of the thyroid to determine the status of the nodules. If the nodule is found to be non-cancerous,
no other treatment is required and they remain asymptomatic for years. If the nodule is suspicious, then
surgery is recommended. I would also share some information upon Hodgkin's lyphoma. Although, it is
usually asymptomatic but following symptoms could be seen in 1/3rd of cases. The symptoms are night sweats,
fever, unexplained weightloss, eosinophilia( increased number of eosinophils in the blood count seen.
Therefore it is best to consult your endocrinologist again and consider the possibility of Iodine scan to
reach to any conclusion before making a final decision of surgery. Hope this helps.
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Comments:
Comment by Unregistered on Wed 31, Mar 2010 03:11pm:
Hi,
It is very difficult to give a diagnosis of lymphoma (Hodgkins versus non-Hodgkins) based simply on a sample
obtained by fine needle sampling. One of the key features used by pathologists in diagnosing lymphoma is loss
of architecture, which is not obvious on the scanty material obtained by fine needle sampling. Thus a biopsy
is necessary. Additional tests like immunohistochemistry (IHC) are usually needed before a firm diagnosis is
made. Lymphoma of the thyroid gland is unusual, but not unknown. There is effective treatment available for
lymphoma.
In your case, please seek the opinion of a good oncologist, who may arrange for additional imaging or biopsy.
All the best, and God Bless.
Dr Bobby S, MD. Thank you for your comments. I found your suggestions useful in discussing my options with my
Endocrinologist. I have been getting regular thyroid blood tests done, and my thyroid levels seem to be
adjusted. I don't seem to have any symptoms that would indicate I had Lymphoma. A second Pathologist,
who specializes in Lymphoma, reviewed my bioposy and the results were inconclusive and suggested further tests
should be done as there was still a possibility that it could be Lymphoma. The DNA tests came back negative,
however I was told that there were some rare types that this might be the case. My surgeon is in disbelief,
but cannot ignore the results. My endocrinologist told me that an idodine scan would not be an option for me,
due to me being Hypothryoid and that thryoid cancer was ruled out.
The endocrinologist recommended a hemothryoidectimy (sp?), as I want to have children soon, and this will
tackle the problem head on, and once the nodule is removed tests can be done, and I will know for sure if it
is Lymphoma.
Thank you again! |
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