I had thyroid cancer. Is it follicular adenoma or carcinoma?

Question

Hello doctor,

Twenty years ago, I had a total thyroidectomy for follicular and papillary thyroid cancer. I also had three surgeries to remove benign lymph nodes. My levels had been pretty steady until the last one and a half years.

I am post menopausal. I am now with the highest TSH value of 13.1. I did not even miss any dose. I am eating very healthy and doing a workout. My TSH works best for me at 2. Now I am on 112 mcg Synthyroid.

My doubts are as follows.

Is thyroid cancer in any way related to adenoma?
Is follicular nodular hyperplasia similar to an adenoma?
Can FNHs show up in multiple areas of the body?

My first true diagnosis was thyroid cancer, later HRS and FNH in the left lobe of the liver. The hyperattenuating mass was 0.7 x 0.2 x 0.3 inches and changed to 0.8 x 3.7 x 0.4 inches in the last scan.

I also have a benign tumor and cysts in the ovary. The thyroid nodules are reactive and enlarged lymph nodes in the neck.

My dad had kidney cancer, prostate and melanoma. Now, he is fighting CLL. My son, who is 10, had several 1.1 inch + lymph nodes in the neck removed.

His doctors went on thinking it was lymphoma due to its size. It was benign, but he had a Streptococcus bacterium. He also has cysts on his thyroid, which are under observation. Is there some relation or syndrome possible for this?

Please explain.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concern.

Following total thyroidectomy, you will be kept on lifelong thyroid replacement therapy, and if the therapy is inadequate, TSH levels will rise. For long-term monitoring and to check for recurrence, measurements of thyroid-stimulating hormone (TSH), thyroglobulin, and antithyroglobulin antibodies titer are necessary.

Treatment consists of Levothyroxine in a dosage of 1.1 to 1.5 mcg/lb/day, which should be 56-79 mcg in your case. Yes, FNH liver (focal nodular hyperplasia) exists, and it is an asymptomatic benign tumor of the liver.

The primary difficulty is to differentiate it from adenomas and liver cancer, which can be done by MRI, multiphasic CT, and histology. Once confirmed, no need for resection.

Thyroid follicular adenomas are real benign tumors. Neither pre-malignant nor carcinomas in situ, but its differentiation from follicular carcinoma is difficult and needs partial thyroid lobectomy and isthmusectomy for confirmation.

Ovarian cysts in females are more common. Good to know about your son not having lymphoma, but it is reactive lymphadenopathy.

Coming to thyroid cysts, thyroid cysts are often thought to represent a benign degenerative disease. They need an evaluation with a thyroid profile to know hormonal status, an ultrasound of the neck, a biopsy of the nodule, and the most definitive test to determine whether a nodule is benign or malignant because of a positive family history of cancer.

I hope this helps.

Feel free to reach out in case of any further queries.

Thank you.