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Fna “Positive” Contralateral Node Following Hemithyroidectomy

Last Updated: · Doctors
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Question

I have a 21 year old who presented with a 3.6 cm Left thyroid mass, TFT’s were normal, TG and TPO antibodies were negative. The right lobe did not show any nodules but she had a calcified LN measuring 1.8 cm with no fatty hilum. She underwent left hemithyroidectomy and final pathology was reviewed at Mayo clinic by Dr.Gary Keeney and signed out as as benign follicular adenoma with background of Hashimoto’s thyroiditis. The right LN was biopsied after the surgery ( I ordered a repeat US post hemithyroidectomy 6 months later to evaluate the contralateral lobe and the right LN with calcification was seen and radiology suggested FNA) and the FNA result now showed follicular cells with minimal nuclear pleomorphism, and cells with abundant cytoplasm consistent with Hurthle cell differentiation. Is it possible to have thyroid tissue in a LN in the absence of malignancy? I’m thinking of sending her for excision of the LN but what about the right lobe? Recent US now showed a 8 mm nodule on the right. Should I send her for completion thyroidectomy “just in case” this developes into malignancy being that she is only 21 years old. There is no family history of thyroid cancer and no exposure to childhood head and neck irradiation. Please advise. Her mother has been calling us everyday and I honestly am not sure how to proceed from here.

Marie Mercado, MD
Overland Park, KS

Response

Thyroid tissue in a lateral node is usually considered a met, but I wouldhesitate tosay that it can never be benign. Since she has a probable met on the R side, and a (?) new nodule by US, and had a good sized (3.6cm) follicular lesion, R lobectomy and local node dissection might be the best approach, followed by RAI, depending upon the pathology.

L De Groot, MD.