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Suggest Treatment For Follicular Adenoma After Left Thyroid Removal
Posted on
Mon, 29 Sep 2014
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Mon, 29 Sep 2014
Answered on
Wed, 22 Oct 2014
Last reviewed on
Question : I had my left thyroid removed due to a nodule. They opted not to do an FNA prior stating frozen section pathology after removal would be better. The report, or rather how it was shared with me, seemed vague. They said follicular adenoma and no further radiation or such was necessary. In my own research, I've read frozen section analysis isn't a good determination for follicular variant. My concern now is how accurate the pathology report may actually be and what I can or should do about it now. Surgery was in March of this year. Since then I've bounced back and forth from hypo to hyper and diagnosed with Hashimoto's. Thank you for any advice, direction you can give. Danni
Brief Answer:
Post operative biospy gives better picture
Detailed Answer:
Good day,
Noted your concern. You had left subtotal thyroidectomy . I realize that you were told that the nodule was a follicular adenoma. If that is the case, it is a benign lesion and doesnt need any radiotherapy. But as you correctly pointed, it is extremely difficult to differentite between follicular variant of papillary carcinoma from a folicular adenoma in a small volume sample.
However, after the surgery, the pathologist would have got the specimen ( thyroid along with nodule) in total and that would have given a better and musch clearer picture. You must approach your surgeon to know what the post operative biospy result was. If in doubt, you may ask for the cell blocks and slides and may approach another pathologist to have a re look at the slides.
Even though the surgery was 6 months ago, they keep the slides for much longer time.
After the surgery, you are just left with a single side gland and it may not be enough to supply hormone in adequate quantity. You may require some levothyroxine supply to keep TSH in normal range. How much leothyroxine are you on now?
Regards
Binu
Post operative biospy gives better picture
Detailed Answer:
Good day,
Noted your concern. You had left subtotal thyroidectomy . I realize that you were told that the nodule was a follicular adenoma. If that is the case, it is a benign lesion and doesnt need any radiotherapy. But as you correctly pointed, it is extremely difficult to differentite between follicular variant of papillary carcinoma from a folicular adenoma in a small volume sample.
However, after the surgery, the pathologist would have got the specimen ( thyroid along with nodule) in total and that would have given a better and musch clearer picture. You must approach your surgeon to know what the post operative biospy result was. If in doubt, you may ask for the cell blocks and slides and may approach another pathologist to have a re look at the slides.
Even though the surgery was 6 months ago, they keep the slides for much longer time.
After the surgery, you are just left with a single side gland and it may not be enough to supply hormone in adequate quantity. You may require some levothyroxine supply to keep TSH in normal range. How much leothyroxine are you on now?
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I'm currently on Armour, 120mgs.
How do I go about finding out who the pathologist was and requesting the report and slides?
My concern also stems from the fact that my aunt has papillary thyroid cancer, diagnosed 2 years ago.
My general MD ran a lot of blood tests recently to try and determine why I'm still having so much fatigue, lack of motivation, hair loss, stomach issues and brain fog. some of them were hard to understand and differentiate the auto immune issues with other possible issues.
How do I go about finding out who the pathologist was and requesting the report and slides?
My concern also stems from the fact that my aunt has papillary thyroid cancer, diagnosed 2 years ago.
My general MD ran a lot of blood tests recently to try and determine why I'm still having so much fatigue, lack of motivation, hair loss, stomach issues and brain fog. some of them were hard to understand and differentiate the auto immune issues with other possible issues.
Brief Answer:
Could you attach the reports please
Detailed Answer:
Thank you for the reply. You need to discuss with your surgeon about getting the slides and you must discuss about the post operative biopsy report. Otherwise you may discuss this issue with your General practioner who ca discuss with the surgeon and then the pathologist. You have every right to do so.
Armour thyroid is not preferred by many endocrinologists incliding myself. Most endocrinologists prefer Synthroid over Armour thyroid. Your fatigue may be due to under replacement of hormone, or due to the anxiety associated with the dignosis/reports etc. Do you have a copy of the bood works? If so, could you attach them ?
Could you attach the reports please
Detailed Answer:
Thank you for the reply. You need to discuss with your surgeon about getting the slides and you must discuss about the post operative biopsy report. Otherwise you may discuss this issue with your General practioner who ca discuss with the surgeon and then the pathologist. You have every right to do so.
Armour thyroid is not preferred by many endocrinologists incliding myself. Most endocrinologists prefer Synthroid over Armour thyroid. Your fatigue may be due to under replacement of hormone, or due to the anxiety associated with the dignosis/reports etc. Do you have a copy of the bood works? If so, could you attach them ?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes I'll figure out how to attach. I was on Levo from April to August. My T3 was low which is why we switched me to Armour. My symptoms have improved slightly in the last month I've been on Armour. Why are most Endos, including yourself opposed to it? Most patient blogs, sites, groups etc prefer Armour to synthetic... curious why the disconnect between the two.
Brief Answer:
Animal product
Detailed Answer:
Armour thyroid is a porcine ( animal) product and in this modern era, we are switching from crude animal products to more bioengineered human medicines. There is always a fear of antigenicity while on animal products. Besides, it is difficult to totrate. It is true that Armour contains both T3 and T4 and if you have a T4 to T3 conversion problem in body, then i Armour may work better. Most apex endocrine organizations stress uponn the use of T4 alone ( levothyroxine) and discourage the use of T3 ( except i special situations) and animal preperations.
The ""Natural"" label or tag of armour makes it more preferable to many people.
Animal product
Detailed Answer:
Armour thyroid is a porcine ( animal) product and in this modern era, we are switching from crude animal products to more bioengineered human medicines. There is always a fear of antigenicity while on animal products. Besides, it is difficult to totrate. It is true that Armour contains both T3 and T4 and if you have a T4 to T3 conversion problem in body, then i Armour may work better. Most apex endocrine organizations stress uponn the use of T4 alone ( levothyroxine) and discourage the use of T3 ( except i special situations) and animal preperations.
The ""Natural"" label or tag of armour makes it more preferable to many people.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had to take pictures of test results. hope that works. The nurse said the biggest concerns were the ones she circled; high c-reactive protein, high glucose, low AST (SGOT), low ALT (SGPT), low alkaline phos, high A/G RATIO, folate and reverse T3 ... not sure what each of those mean individually or as a combined group?
Brief Answer:
Reports
Detailed Answer:
Hi,
Got the reports. I guess you had ? joint pains or stiffness. Hence they have done arthritis/connective tissue disease panel. The CRP ould be due to an inflammation anywhere.
Blood glucose is slightly on the higher side ( if it is fasting). I am not particularly concerened about the low lier enzymes.
Reverse T3 is bit on the higher side hence probably explains why your T3 was low. In a sick situation, T4 gets reduced to reverse T3 instead of T3. However i can not see a TSH and Free T4 report
Reports
Detailed Answer:
Hi,
Got the reports. I guess you had ? joint pains or stiffness. Hence they have done arthritis/connective tissue disease panel. The CRP ould be due to an inflammation anywhere.
Blood glucose is slightly on the higher side ( if it is fasting). I am not particularly concerened about the low lier enzymes.
Reverse T3 is bit on the higher side hence probably explains why your T3 was low. In a sick situation, T4 gets reduced to reverse T3 instead of T3. However i can not see a TSH and Free T4 report
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
so with Hashimoto's how.does one tell if there's another issue or if the CRP is due to that? Is it true that there isn't any remedy for Hashi?
My left knee aches with sharp pain if I sit too long, stand too long or walk to much. My hands, fingers mostly ache.
what is the AG Ratio test check and what is a high result an indication of?
My general Dr ran these he didnt do the full thyroid panel for some reason?
My left knee aches with sharp pain if I sit too long, stand too long or walk to much. My hands, fingers mostly ache.
what is the AG Ratio test check and what is a high result an indication of?
My general Dr ran these he didnt do the full thyroid panel for some reason?
Brief Answer:
A/G Ratio
Detailed Answer:
Hashimotos disease is an autoimmune hypothyroidism. The treatment is thyroid hormone replacment only. In active phase of hashimoto's thyroiditis, CRP can be elevated.
A/G ratio alters when either albumin goes down or when globulin goes high which is typically seen in liver cirrhosis. But it is not specefic to that. Please get a full Liver function panel test and if it shows the same result, you may need an ulrasoud scan of liver.
A/G Ratio
Detailed Answer:
Hashimotos disease is an autoimmune hypothyroidism. The treatment is thyroid hormone replacment only. In active phase of hashimoto's thyroiditis, CRP can be elevated.
A/G ratio alters when either albumin goes down or when globulin goes high which is typically seen in liver cirrhosis. But it is not specefic to that. Please get a full Liver function panel test and if it shows the same result, you may need an ulrasoud scan of liver.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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