Thyroidectomy

[mtnbikerskierchick]

Well, 2009 has turned into a year of medical issues for me. First, ACL recon surgery. Then, last week, I fell in a driveway of all places, got a few scrapes and contracted a cellulitis infection (staph or strep) that seems to be lingering despite high doses of 2 antibiotics. And now, the thyroid.

I have had a thyroid tumor for at least 6 years.... that's how long ago it was noticed. The nodule is in the left side of my thyroid. I saw an endocrinologist for a few years. He did 2 biopsies and decided the nodule was mostly cystic fluid. Then, due to my employer, I had to switch to Kaiser. Kaiser ignored the nodule... didn't give it the time of day. But, then I quit my teaching job, and have an individual health plan now.

So, a couple of weeks ago I went to another endocrinologist. In my opinion, I have a lot more confidence in him than I had in my other endocrinologist. He decided to do yet another biopsy. So, I did it. And the pathologist reported a specific cell that has a 1/20 chance of being cancerous.

The problem is, it's hard to know for sure if it's cancerous, because they would basically need to take the whole nodule out and look... which leads to a thyroidectemy. And it's hard to compare these results compared to my old results because my old endocrinologist did terrible biopsies. When they do the biopsy they are interested in the solid components. My endocrinologist before only obtained 2 solid component samples... not really enough to make a definite malignant/benign diagnosis. I didn't really know this at the time. But, working with my new endocrinologist, I see this is the case.

My old endocrinologist also took poor records. So, it's hard to tell for sure whether the nodule has been growing or staying the same. Currently, I am on thyroid hormone suppression therapy, which makes it so my thyroid essentially does less work, making it so that the nodule is less likely to grow.

At any rate, my new endocrinologist is really leaning for me to get my thyroid out. I'm a little leery of it. But, basically, I've been told that a lot of people with nodules eventually have the thyroid removed. I've pretty much decided on a thyroidectemy, but I think I want just a partial thyroidectemy- where my left thyroid is removed (the tumor is only in the left side and my right side is completely clean) and my right remains.

I feel like a 1/20 chance of cancer is worth getting the half of the thyroid removed to have a better look, and basically eliminate the chance that it is cancer or could mutate into cancer. Since I've met my insurance deductible with my ACL surgery and since I am still recovering from that and am still limited in my activities, I can't think of a better time to have a surgery like this than now. The surgery will basically be free.

So, I was wondering if any maggots have gone through something like this before? How was the surgery? How long did it take to recover post-op? My doc says I'll be back to normal activities in a few weeks.... and I feel like that's reasonable. But, my main questions are, how much time should I take off from work? Sounds like even eating/talking can be painful for awhile?

Thanks for all your advice

Edit: I seem to remember a thyroid thread a few years ago, but when I searched I couldn't find it. So, sorry if this is a repeat!

[splat]

I have a high thyroid awareness because I got nuked when I was a kid by being born downwind of the national plutonium processing center in Hanford, WA. Been suing the govt for over 30 years along with 2700 other people. Everyone in my family has had their thyroids fail, except me and I think I can attribute some particular medical conditions to it's slow deterioration. I was just on the phone talking thyroid with my gf when I saw this post. It's a super important organ for every facet of your well being. I think I'd go on a anti-cancer diet before I let some doc take it out.

[bklyn]

Have you had any type of childhood exposure, like Splat?
I have a friend who had thyroid cancer, and the cause can be traced to some medical procedures she underwent as a child.

It's so hard to decide how to proceed in this case. Can you get a second biopsy? Is there any way to get a more refined answer on whether or not it is malignant?

I went through a saga this winter with a false positive cancer diagnosis. It sucks, but you should push to get more information before major surgery. It's very easy for them to take your thyroid and close the case. Get another biopsy or any other test that will tell you if surgery is necessary, preventative, or simply convenient.

[mtnbikerskierchick]

I have had no childhood exposure, that I know of. But it's interesting that girls that are a couple of years older than me also had thyroid tumors, diagnosed all within a year of mine. Since then, they've had their thyroids removed. One underwent a radioactive iodine treatment that was supposed to shrink the tumor, but basically killed her thyroid instead. Radioactive iodine doesn't sound like the route I want to go, and my doc didn't even really talk about it. At this point, I just kinda want the thing out- preventing future suspicion, ect.

One problem is that the specific cell I have can possibly mutate into cancer at an unknown time, apparently.... and they need a lager sample of the cells to even determine if it's cancerous which leads to at least a half of a thyroidectemy. Personally, I don't think I have cancer right now. But, removing the tumor will prevent it from happening. I will not be having my whole thyroid removed, just the half with the tumor in it- hopefully. Right now, it's my understanding that they'll do a test on the spot after removing my left lobe of my thyroid to see if it's cancerous. If it is, they'll have to remove the right part of my thyroid as well. But, I've been really insistent on keeping at least half of my thyroid. It sounds like (from research I've done) that half of the thyroid will take over the whole function of the thyroid if necessary. Still, I will likely remain on levothyroxine, as a thyroid hormone replacement therapy, to prevent new tumors from forming. But, I will not be solely dependent upon it.

[mysteryzombie]

perhaps get treated with classical homeopathy with a GOOD and VERY EXPERIENCED classical homeopath?

[sierraskier]

I am actually going through something similar right now. most of the thyroid is definitely enlarged and has been for at least a year. I had radiation therapy about 15 yrs ago so it's no a huge surprise and has a tendency to totally kill the thyroid. at any rate, I've seen a surgeon and and endocrynologist. head & neck surgeon who comes highly regarded from several different docs and basically specializes in thyroid wants to take the whole thing out, doesn't think leaving any tissue is a good way to go since potential cancer/mutations/etc could have already spread microscopically to the rest of the tissue and would be impossible to detect in biopsy. had good biopsy which was non-malignant, however he still thinks whether it be now or later, thyroid will probably eventually have to come out as even if it is non-cancerous, it is likely that it will either enlarge further or mutate later in life causing problems and need to be removed anyway. having a 2nd surgery to remove the rest of the thyroid later would agreeably be pretty stupid. many people are naturally hypo/hyper thyroid and take medication to regulate thyroid anyway. must keep in mind surgeon also gets paid when he does surgery. endo does not think that it is as critical to have thyroid removed, and it can be watched. it has been about 6-8 months since and I believe it has enlarged further. again, docs were fairly confident in biopsy results however I'm just about at the point where I'm going to have to come back to this and re-assess.

you have to look at the alternatives of 1) leaving yourself open risk of cancer/non-malignant tumor and the potential complications of that or 2) just having the thing removed and taking thyroid medication. #2 is definitely not ideal but better than #1 I think. obviously everyone has unique circumstances and their own risk assessment, but I would definitely get a few opinons about leaving partial thyroid. some things to think about:

+ biopsies (all kinds) are only about 85-90% accurate, never 100%, really you are sticking a needle into a haystack and pulling a VERY small sample out of thousands (maybe hundreds of thousands) of cells

+ thyroid nodules are apparently very common in general population (~40-50%), and only a small percentage tend to develop into cancer

+ all of the percentages that you hear from doctors and/or people like me are based on historical data, and at any point in time you can be one of the 1% or 5% (been there)

if I were you, I probably would watch it and if it doesn't enlarge further, affect your thyroid function, or constantly have you wondering/freaked out, then I wouldn't have the surgery. if I was going to have the surgery then I would probably just have the whole thing removed. that's just me...

[splat]

perhaps get treated with classical homeopathy with a GOOD and VERY EXPERIENCED classical homeopath?

Here is that homeopath - Just google David Russel, Arizona homepath.
He travels city to city, so he probably hits Denver on his rounds.
This dude brings back people from death's door on a daily basis.
I'm talking people who got nowhere with conventional medicine.

[mtnbikerskierchick]

Yesterday, I visited Dr. Hartshorn, an otolaryngologist/surgeon in Grand Junction who will be performing my surgery. I was able to set a surgery date- it will be Monday, August 3rd. And he was able to answer the last few remaining questions I had about the procedure. Based on the research I’ve done and what Dr. Hartshorn explained to me, I will do my best to explain the procedure.

The surgery is done with general anesthesia. They pump your neck full of saline, so this can make your neck very sore. But, this allows them to make a smaller incision which will scar less. The saline will be used to expand the working area. They will take great measures to protect my parathyroid gland, which regulates calcium levels, and also my vocal cords which can easily be damaged in this surgery. The surgery will last somewhere between 1.5 - 3 hours.

The thyroid is divided into two lobes on the right and left side of your neck, connected by something called the isthmus. Since the tumor lies my left lobe, this half will be completely removed. Thyroids are a unique organ in the sense that they have a huge blood supply. Blood is always being fed to the organ. This makes removal of a partial lobe basically impossible. They can’t remove just the tumor itself because the thyroid tissue around it will bleed too much. This internal bleeding can cause a lot more problems than actual removal of the thyroid itself. So, if a tumor is found in a lobe, the whole lobe must be removed.

Remember, the reason why they are removing this left thyroid lobe on me is to be able to take a better look at the tumor- specifically the harthel cells they are suspicious of from the biopsy. They want to determine if it’s cancerous or not. So, they will take out the lobe, remove the tumor, instantly freeze it, and then slice it. This is called a “frozen section”. They will send this frozen section down to pathology where they will run tests to decide if it is benign or malignant. If it is malignant, the other half of my thyroid will need to be removed, on the spot. If the tumor is benign, or even if it is questionable if it is benign or malignant, they will leave the right half of my thyroid in tact. Here, there is a small risk that I may need to have another surgery to take out the right half of my thyroid - if the tumor is questionable, and they have to do more extensive tests that cannot be done within the timeline of my actual surgery. But, this is a small risk.

When the surgery is all said and done, there are risks of certain side-effects. Aside from the normal problems with possible nausea and infection associated with all surgeries, I will likely have trouble swallowing and eating for a few days. But there are two relatively common side effects that pertain directly to this surgery. One is damage to the parathyroid gland. This gland regulates calcium levels. There is one of these glands on each side of your neck. With a partial thyroid removal this is hardly a problem, because if one parathyroid gland is damaged, the other just takes over. But, another main risk is damage to the vocal cords. Vocal cords can be severed in this surgery, which results in completely losing the voice, permanently. But, this risk is rare. More common is damage to the vocal cords which causes them to become temporarily paralyzed. It is not uncommon for people who’ve had thyroid surgery to lose their voices for somewhere between 1 and 3 months.

I must say, this vocal cord thing is my greatest concern. I suppose I can handle losing my voice for a couple of months. But, to lose it permanently would be devastating. I mean, I can’t be a teacher if I can’t talk. It just won’t work. But, the doctor saw my concern about this and elaborated . He explained that there are two vocal cords and the likelihood of both being severed is very very rare. He said that the vocal cords work by kind of squeezing together back and forth. If one is severed, a gap occurs which prevents the full squeezing from happening. But, a plastic implant can be surgically placed there to allow the other vocal cord to squeeze it instead, making it so you can have your voice back. Knowing this bit of information has calmed me considerably.

If I have half of my thyroid removed, I don’t need to spend the night in the hospital. But, if it turns out that I need to have both lobes removed, I will have to spend one (or more if my calcium levels are not right) nights in the hospital.

[mtnbikerskierchick]

Well, I'm now over 48 hours post-op. Surgery went well- there was no cancer, and I still have half of my thyroid in tact. I'm feeling quite well and in a couple of weeks it will be almost as if this never happened I've written A LOT more details about the whole experience on my blog, for those interested or undergoing similar experiences. Check it out here.

http://www.14erskiers.com/blog/?s=th...hsubmit=Search

[Lost Boy Knee]

That's great news MBSC. So happy to hear that your surgery went well and you are cancer free. This was the best possible outcome. I hope you feel better and better every day.

Eating lots of ice cream for that sore throat?

[mtnbikerskierchick]

Eating lots of ice cream for that sore throat?

I was yesterday, but today I don't need it! My throat really isn't sore anymore and I don't have trouble swallowing most things, unless it's really hard or abrasive (crackers suck). My main complaint now, believe it or not, is congestion. I feel like I have a horrible chest cold- people say it's from the anesthesia. I'm really susceptible to getting bronchitis and not looking forward to that, if it comes. Coughing is quite painful right now.

[Lost Boy Knee]

You should mention your chest congestion to your doctor. Even if it's common for you normally, post surgery you are likely to suppress your coughs and that can make it more serious. I'd definately let him know.

[Jos]

Thanks for this thread MBSC. Glad to hear the surgery went well.
I just found out I have multiple adenomas on my Thyroid ~ and being referred to a specialist. I had a Discectomy at C5 last year and my health has generally slid ever since. The last thing I want is my neck cut open again. How long were you on the thryoid meds?
Good luck. Would be interested to hear how your recovery goes. Keep posting.