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Radiation and Possible Thyroid Malignancy

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Question

I am 51 years old male with some previous radiation exposure from Chernobyl disaster (I live in Kiev, until 1990, about 100 km from Chernobyl) but until recently my health worries were limited to dental

fillings and a slightly elevated blood pressure. About two years ago, after annual check up and blood tests, my physician prescribed me Pravachol for high cholesterol. After last year tests, he added

levotyroxine as a second pill I have to take regularly. I did not feel any symptoms before I started taking these medications and did not notice anything new after. Doctor also suggested thyroid sonogram (US) that I made in June 2006. I have been diagnosed to have thyroid nodule and than have biopsy that did not provide clear results about the nature of this nodule (FNA, right lobe, mid. Portion. Dx. Atypical: Cellular follicular leason, adenomatoid nodule vs follicular neoplasm.

Comment: The smears contain scattered clusters of follicular cells and scant colloid. Many of the clusters show crush artifact. The differential is between a cellular adenomatoid nodule and a follicular neoplasm. Suggest follow up as clinically warranted.) In December 2006, I have another US on a high-resolution machine and here are fragments of the endocrinologist emails:

“Your ultrasound of the thyroid was read as no nodules. i want to review with the radiologist so could you please bring your old films.” then: “..reviewed your most recent Ultrasound yesterday with the radiologist and also with Dr. XXX. This study and the one you had previously are similar. Basically the whole gland is enlarged and quite heterogenous. Also the thyroid gland has sort of an irregular contour. Really there is no distinct nodule per se although the radiologist could appreciate what was previously measured and he thought nothing had changed. So our recommendation is for you to get surgical removal. another biopsy will not be helpful at this time. I have also reviewed your labs and it appears you need a bit more synthroid so i will increase your dose from 100mcg daily to 112 mcg daily. Your Tsh was 4.32 (0.4 – 4.0mclU/ml) and your free T4= 1.4ng/dl (0.8 – 1.9ng/dl)..” She also said that I have Hashimoto thyroidite but surgery is suggested due to my FNA results and the history of radiation exposure. Since I was not very enthusiastic in having part of me separated, I started a little self-education course using Thyroid Disease Manager and other websites. To my present understanding FNA is informative only when it is applied to a defined nodule. In my case, nodule was not present, so it seems that the main indication for the surgical removal of the thyroid is based on questionable biopsy. Please, tell me what you think about the balance between risks of surgery and risk of cancer in my case.

Alexandr Chanturiya, PhD

Response

Considering that your radiation exposure was probably small (Do you know exact data?), that there is no discrete nodule, that you do have Hashimoto’s, and that the first biopsy was not diagnostic, another approach would be to follow the situation with repeat US and FNA. A diffuse thyroid cancer is possible, but uncommon. However, if a second FNA reveals the same histology, rather than findings typical of Hashimoto’s, it will be difficult to avoid a decision for operation since your MD does not want to miss a possible malignancy.

L De Groot, MD