A Two-Fer Sale
A Two-Fer Sale
CASE OF THE MONTH
PRESENTED BY
THE THYROID SURGERY CENTER OF TEXAS, P.A.
1927 Lohmans Crossing Road, Suite 201, Austin, TX 78734
www.thyroidcancer.com
512-608-9595; Fax-512-608-9833
A TWO-FER SALE
Patient #1 is a 51 year-old lady who was referred to the Thyroid Surgery Center by her cardiologist in the Texas Medical Center in Houston. She was found to have a 1.8cm nodule in the right lobe of the thyroid gland. Thyroid function test were within the normal range. An ultrasound and a thyroid scan confirmed the physical findings. A fine needle biopsy was performed, but the patient passed out from the pain of that test, and the diagnosis was incorrect, being not “hyperplastic nodule” as described in the FNA diagnosis, but a Hurthle cell adenoma as seen on the final pathology report after thyroidectomy. Interestingly, after her surgery the specimen had to be sent out to the University of Pennsylvania for additional consultation, because the FNA had made it very difficult to interpret the pathology. Ultimately, the Hurthle cells trapped in the capsule were determined to have been there as a result of the needle biopsy, and not as a result of capsular invasion of the tumor, an event which would then have changed the diagnosis to cancer.
In the course of evaluating Patient #1, she mentioned that her daughter also had a thyroid mass that was being “watched” for several years by her Houston physicians. Thyroid function studies were normal. This mass was now 10cm in diameter and hanging down off the front of her neck. It was a terrible cosmetic problem for this 20-year-old college student, and the mass itself was causing considerable compression symptoms on the trachea and esophagus. Clearly, this was a surgical problem and we did no further testing. No FNA was performed. The final diagnosis was nodular hyperplasia, colloid cyst, and cystic degeneration.
Both patients underwent outpatient thyroidectomy one week apart. Mom, of course, went first to test the waters. She had a sub-total thyroidectomy as the opposite lobe was found to be normal. Her daughter, Patient #2, had a complete thyroidectomy to remove this rather large mass. No complications occurred. Both ladies are on a maintenance dose of Synthroid and doing quite nicely.
This experience underscores the fact that thyroid difficulties do sometimes run in families, although the pathology is not necessarily identical. Some forms of medullary thyroid cancer and the MEN syndromes are definitely passed on genetically.
We had one family, years ago, where the father, mother, and daughter all had thyroidectomies for different thyroid diseases. One had cancer, another had Hashimoto’s thyroiditis, and the third had multiple benign tumors. I also recall seeing a 50ish year old lady back in 1995, or so. She had a 1cm in diameter hard cancer in the lower aspect of the left thyroid lobe. She said my partner had operated on her mother in 1956 and removed a thyroid cancer. We have kept all thyroid records dating back to 1949 and, sure enough, her mother had an identical cancer in exactly the same spot. Thyroid disease is one area where family history can sometimes be significant and helpful.
“…Thyroid surgery…it’s all we do…”