A patient of mine with euthyroid Hashimoto’s thyroiditis was noted to have a single nodule on sonogram; FNAB showed follicular cells with Hurthle cell change and colloid, consistent with Hurthle cell metaplasia within a nodular goiter. As a pediatric endocrinologist, I am not particularly experienced with analyzing these results. Is this just Hashimoto’s or something else that I should be concerned about?
Ian Marshall, MD
I hesitate to be too specific, since I am not a pathologist, and have not seen the slides. But— nodular areas with Hurthle cells, normal follicular cells, colloid and lymphocytes are common in Hashimoto’s thyroiditis, and may present as nodules on exam and by US. I believe an FNA with only Hurthle cells from a lesion that is a very distinct single nodule on US, would be suggestive of a growth. But one with all of the other components, including lymphocytes, especially if there are other slightly nodular areas in the gland, would be typical of Hashimoto’s, and not alarming.
Leslie J De Groot, MD