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Enlarged THYROID GLAND with NORMAL FUNCTION. FNAC,CT.

Resolved Question:

Hi,
My mother of age 64 is having enlarged thyroid gland with normal functioning thyroid.
She has undergone FNAC and CT Scan twice in a span of a year. The reason for again undergoing for test was continuous growth of size of swelling on neck even after taking proper homeopathic medicines. However as I see following results are varying.
Apart from all this the only health issue she has is that she is diabetic and usually have high sugar.
Request you to advice for the same and diagnose what is the actual issue here and let me know if it is benign or malignant. And why the reports are varying.
Thanks a lot for your help.

FNAC 1 on 7 Sept 2013
Smears show thyroid follicular cells arranged in microfollicles with colloid and tridimensional aggregates. Background shows blood.
Diagnosis: Nodular Goitre

FNAC 2 on 5 Nov 2014
Smears are cellular and consist of cells arranged in monolayered sheets, groups and few three dimensional groups. These cells have mildly enlarged nuclei, focal nuclear crowding, scant to moderate amount of finely vacuolated cytoplasm. Focal binucleate and occasional multinucleate forms are seen.Background is haemorrhagic and devoid of colloid.
Diagnosis: Atypical Cytology, cannot exclude a neoplastic process. Advice for histopathological examination

CT Scan on 7 Nov 2013
Computed tomography of neck was performed without the benefit of intravenous contrast.
5 mm thin serial section were obtained from the level of skull base upto the root of neck.
Findings:
Axial sections through the nasopharynx reveal normal patent airway with symmetrical pharyngeal walls and clear para-pharyngeal fat palnes.

The oropharyngeal airway is clear with unremarkable tonsiliar fossae.

The epiglottis is midline with clear pyriform sinuses.

Section through the larynx reveal normal and symmetrical vocal cords with intact cartilages and bones.

Multiple bilateral subcentimeter deep cervical lymph nodes are present.

The right lobe of throid is markedly enlarged exhibiting homogenous appearance of parencyhma and punctate foci of calcification within. Mild tracheal compression and deviation is noted.

Early spondylotic changes are present in cervial spine.

Impression:
Thromegaly, as described above. Suggested further evaluation.


CT Scan on 5 Nov 2014
CT Neck with Contrast
3 mm thin sections were taken for the neck with administration of intravenous contrast.

Findings:
A heterogeneously enhancing nodular lesion measuring 86*76 mm is noted arising from right lobe of thyroid causing its enlargement. The lesion is extending beyond the midline. It is pushing rest of the right lobe and isthmus to the opposite side. It is causing tracheal deviation to opposite side. However, no luminal compression is seen. It is pushing the throid, cricoarytenoid cartilages to the opposite side, right submandibular gland anteriorly and right sternocledomastoid anterolaterally. It is also causing splaying and deviation of the neck vessels. However, no luminal compromise is seen.Eccentric nodular calcification seen within the lesion.

Bilateral level I, II, III, V lymph nodes seen(largest measuring 17*11 mm in size).
Right paratracheal, pretracheal and precarinal lymph nodes are seen(measuring upto 1 cm).
Focal hypodensity is alos seen in upper part of the left lobe of thyroid.

The naso, oro and hypopharynx appears normal.
Left parotid and submandibular glands are normal.
The IVC and jugulars are normal on wither side.
The tongus colli on either side are normal.

Impression:
Hetrogenous enhancing nodular lesion arising and enlarging the right lobe of thyroid with mass effect and bilateral cervical and mediastinal lymph nodes as described above.
Advice for histopathological correlation.

 


Category: Endocrinologist

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Category: Diabetologist
Dr. J Muthukrishnan is online now

Expert:  Dr. J Muthukrishnan replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
From the reports, it is evident that the nodule in the thyroid right lobe is enlarging over a year and present size is almost 8 cm. The FNAC shows an atypical cytology in the latest report. In this setting, in a 64yrs lady, it is best to under surgery to remove the right lobe and do a histopathology to get the proper diagnosis. it may be benign, but to rule out malignant nodule completely, FNAC is not enough and it is important to remove the lobe completely. It is advisable to undergo this procedure as soon as possible.
Hope this was helpful,
Regards.


Patient replied :

Hello Doctor,
Thanks a lot for replying.

  • I have one concern here, howcome the FNAC at first place confirms that it is just nodular goitre. However, the second FNAC says atypical cytology. Why is the diffference in report?
  • Also, my mother is diabetic patient with usually high level of sugar, so is it good to undergo surgery at this age alongwith diabetes?
  • I was trying if the goitre could be cured with ayurvedic or homeopathic medicine thus avoiding surgery. Is it possible?
  • Are there any risk for throid surgery? As it is situated at very close proximity to larynx, trachea etc and probably is a sensitive area.
  • What is the after surgery recovery time and when can the patient get back to daily routine?

Thanks in advance for replying
Best Reagrds


Expert:  Dr. J Muthukrishnan replied 3 Days.

Hello,
1. FNAC done in a gap of a year can show different results as the nodule has enlarged and nature of cells in it might have changed. Also, FNAC takes a sample from a small area of the nodule. Another FNAC taken from another area may give different picture. The point is that nodule has increased in size beyond 5-6cm, and cells are atypical, which needs confirmation by a Biopsy which needs surgery (Removal of Right half of thyroid.
2.Diabetes can be controlled with Insulin prior to surgery and one need not worry about surgery once diabetes is controlled.
3. I am not aware of any Homeopathic or Ayurvedic cure for such a noodule. It will only waste precious time.
4. There is a small risk involved but in the present day, in experienced hands, its a very minor risk and is worth taking for the benefit.
5. Usually, within 3-4 days, she will be fine, and scar takes a few weeks to heal. Daily routine is hardly affected beyond a week.
Regards.


Dr. J Muthukrishnan
Category: Diabetologist
Experience: 
Fellowships/Training: 
1. 10th Asia-Pacific Pediatric Endocrine Society  Fellows meeting, Seoul, Korea, Oct 2008
2. Eighth ICMR Course on Genetics and Genetic Counseling – Jul 2008 – SGPGI, Lucknow
3. Annual Certificate Course on Endocrinological Laboratory Techniques at National Institute of Nutrition (ICMR) Hyderabad,India, ( Aug-Sep 2006) 
Fellowship: Endocrinology, Diplomate of National Board, National Academy of Medical Sciences, New Delhi, 2008, Medwin Hospital, Hyderabad
Senior Residency: Diplomate of National Board (General Medicine), National Academy of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, 1997-2000, Armed Forces Medical College, 2nd position in University
Medical School: MBBS, Armed Forces Medical College, 1992
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