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My recent events:

Had a large nodule that I have been watching via ultrasound for the past several years. My Nov 2017 ultrasound revealed it had grown and a new nodule showed up. In Jan 2018 I had a FNA on the larger of the two nodules which came back benign. Met with surgeon regarding surgery because large nodule was pushing on my trachea and causing some issues. Scheduled a left thyroid lobectomy for Feb 15.

Had a post-op meeting with my surgeon today and the pathology report shows the smaller of the two nodules (3.7 cm), the one I did not have FNA on, shows Encapsulated, Follicular Variance of Papillary Carcinoma with Invasion of and Through Tumor Capsule into Surrounding Thyroid Focally. Phew, that's a lot! Bottom line, it shows cancer. I was not expecting that news at all. I meet with my endo in two weeks and will have follow-up blood work done 4 weeks from today. I am not on any meds at this time.

So a few questions I have:

~ Does this mean I have cancer or that I HAD cancer, or neither?

~ Surgeon thinks she got it all (even though she did not know I had a malignant nodule until the report was finalized). Will I likely need the other side removed?

~ What are the chances of RAI or is it too early to tell?

I am just trying to figure some things out before I speak with my endo.

Thank you in advance for your time.
 

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Well...

Here are my thoughts in no particular order:

- A 3.7cm nodule is not small! That's quite big!!

- I'm confused on why it is listed as encapsulated but also have invasion into thyroid capsule -- that sound contradictory.

- The American Thyroid Association has pulled back on their recommended level of aggressiveness for surgery and RAI, but as far as I understand, yours certainly qualifies for being more aggressive. A cancerous nodule over 2cm with local invasion -- particularly if it is follicular variant -- generally results in a total thyroidectomy. I would certainly get a second opinion if your doctor does not recommend a second surgery.

- RAI (for cancer treatment) should only be done after a total thyroidectomy. The ATA continues to recommend RAI if your nodule was over 2cm and/or if there are multi-focal points of cancer.

-There's an ongoing conversation in the thyca community about the whole did I have cancer vs. do I have cancer thing. There's no right answer. What I can tell you is that no surgery can get every thyroid cell -- cancerous or not. It's just not a "clean" surgery. RAI usually gets most of it, but recurrence can and does happen. Some studies put that number at as high as 30% while others say its more around 10-15%. The really technical answer is, if after your follow up bloodwork and ultrasounds, you do not have any clinical signs of cancer, then there is "no evidence of disease" or NED.
 
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