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Biopsy of thyroid showed atypia of undertimined signifiance. Suggested surgery. How serious?

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I had n fna biopsy of my thyroid. Cytology report came back atypia of undertimined signifiance. 13x8x10 mm solid, hypoechoic, right lower pole thyroid nodule with increased vascularity. Considering follicular neoplasm vs adenomatoid nodule. The endocronogolist said I should remove entire thyroid. I am worried this may be a rush judgement for surgery. How serious is this and should it be watched or is it reason to do total thyroidectomy.
Posted Sat, 20 Jul 2013 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 1 hour later
This is a tricky area for endocrinologists worldwide for this given situation. The vast majority of thyroid nodules are benign ie 95% or so. When FNA is done and the report comes back like this, a significantly high percentage of endocrinologists will advise the same as what your doctor guided you towards.
It is a reasonable medical decision in view of the cytology.

Although a good number of thyroids that are removed surgically in such circumstances turn out to have no cancer (when the entire thyroid specimen is examined after surgical removal). This is precisely the problem which the endocrine-pathology-genetics specialty is trying to solve. So genetic markers have been devised to obtain predictors of cancer. However, these tests have limitations too.

The other fundamental way to asses the risk of cancer in thyroid nodules is to go by history and physical examination. Past history of radiation to the neck or family history of thyroid cancer are examples, as is the finding of a large solid nodule that appears immobile with enlarged lymph nodes on examination. Ultrasound characteristics reveal suspicious features and are helpful in evaluating cancer risk.

Some individuals chose to monitor this with ultrasound over time, others repeat FNA 3 months later or so, and finally some people prefer to have surgery.

For more information you may wish to peruse this weblink:
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Follow-up: Biopsy of thyroid showed atypia of undertimined signifiance. Suggested surgery. How serious? 9 hours later
I have heard through colleagues that there is another test that can be done which is called Affirma Thyroid Analysis by Veracyte in California. There are only a handful of doctors that do this biopsy test and the specimens are sent to the lab in CA for cytopathology and what they say is called a Gene Classifier. The company states that they can then classify the nodule as benign or suspicious. The test is mainly for people who have had a prior result of undetermined significance as I do. Have you heard of this new test and do would you suggest this is an a step that should be taken before I decide on surgery? Also since the nodule is only in the right lobe if surgery is the next step would it be advisable to demo e just the right lobe or a total thyroidectomy.
Answered by Dr. Shehzad Topiwala 8 hours later
Yes I am aware of Afirma and Veracyte, and the gene classifier work they perform. It is being increasingly used by endocrinologists. I use their service in my practice too. It is a reasonable option. The genetic marker testing I was alluding to in my first response above is in reference to this type of analysis which is now being offered by other companies too.

In addition, your endocrinologist may wish to consider doing an XXXXXXX 123 uptake and scan test to see if the nodule is a cold one.This decision is best left at the discretion of the treating endocrinologist.

Regarding removal of nodule versus lobe versus entire thyroid, typically the surgeon makes the call. Surgeons often like to do a 'frozen section' in the operating room to get a preliminary idea if the nodule is cancerous or not. If it is, then typically the entire thyroid is removed. If not, then a 'nodulectomy' (removal of nodule only) or hemi-thyroidectomy' (removal of half the thyroid gland) may be performed. This is a general idea I am giving you. Often the surgeons make this decision on table., but you can definitely engage the surgeon in a discussion on this prior to going in for surgery
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