Thyroid cancer...

[assman]

Not me but someone close to me.

Folicular with an N-RAS component showing in the genetic testing.

Recommendation- Total Thyroidectomy with possible radioactive iodine to follow surgery dependent upon the results of the biopsy. Lymph gland scan shows moderate inflammation and enlargement but surgeon ( listed as #1 in his field ) doesn't believe there is lymphatic involvement at this time.

Dr highly credentialed with an international & famous clientele who have come for surgery by him.

To me the big question is... take the lymph glands? It seems like a no brainer to me but he says otherwise


Anyone been down the thyroid cancer road? Any info appreciated

[crackboy]

my cousin recently went through treatment for thyroid cancer.

had the thyroidectomy with iodine treatment. didn't seem too terrible on her. and seemed to recover pretty fast.

radioactive iodine is pretty nasty so there will be isolation during and after treatment

[Gepeto]

first wife went thyroidectomy and radioactive iodine , lymphs left in place. Recovery was not what you would expect when discussing resultant damages - after affects. Severe hormonal impact. Took years to balance. Should I be more descriptive? Voice changes, hair growth, permanent emotional adjustments (dissimilar to menopause) ... went off to be a balloonist in florida.

Recovered many years later. She tried to come back once but it was over. Eventually got married and had three kids.

I would want a more definitive reason why not to remove the lymph? Otherwise, they go.


apologies to your friend - if this is a little to real world info

[The Tortoise]

radioactive iodine is pretty nasty so there will be isolation during and after treatment

It isn't that nasty and the current practice is to send patients home with limited precautions.

OP, if you have any safety concerns about the I-131 therapy let me know, it's part of what I do.

From what I've been told a thyroidectomy followed by I-131 therapy has a high success rate.

[XXX-er]

A buddy had half the thyroid removed a couple years ago, they are doing great now but they ended up having to swear off Gluten

[PowderHorse]

One of my best friends wad diagnosed with it well over 25 years ago and it looked grim for a year or so. She had a lot of flesh removed from her neck but she kicked ass and is still alive, going on 50 years old. Not aware of any dietary changes.

vibes and hopeful for a good outcome, sounds like they've come a long way on that stuff.

[The Tortoise]

I would suspect that the biggest advancements have been in the area of hormone management.

[Gepeto]

I would suspect that the biggest advancements have been in the area of hormone management.

Not meant to sound cynical - I would hope so too.

[old goat]

To me the big question is... take the lymph glands? It seems like a no brainer to me but he says otherwise

Because of research you've done or because it just seems logical?
It's been many years since I've done any thyroid surgery but from what I can glean from the internet, lymph node removal is based on the opinion of the surgeon examining the lymph nodes before or during surgery. Lymph node metastasis is less common than metastasis elsewhere in the body and the RAI is expected to destroy any small metastases either in the nodes or other organs in most cases.
How old is the patient--it seems the outlook and staging depend on whether they are older than 45 or not. Good luck.

[peck257]

my horse had dick cancer. Cancer sucks. Hope for the best. If its me, get that fucking shit out of me.

I will die of pancreatic cancer.

[assman]

Because of research you've done or because it just seems logical?
It's been many years since I've done any thyroid surgery but from what I can glean from the internet, lymph node removal is based on the opinion of the surgeon examining the lymph nodes before or during surgery. Lymph node metastasis is less common than metastasis elsewhere in the body and the RAI is expected to destroy any small metastases either in the nodes or other organs in most cases.
How old is the patient--it seems the outlook and staging depend on whether they are older than 45 or not. Good luck.

Patient is 55 in remarkably great shape. I wonder about the safety of leaving the lymph glands in place because of the scan showing enlargement and what i have read.
The surgeon is considered the best out there however because of that suffers from a bit of a god complex and does not like answering questions. the lady in question does not want to push him because he will be cutting her next week and doesn't want to piss him off. if it were me I would want answers as to why they should be left in place.

[bagtagley]

Something this serious, I'd never hesitate to get second opinion. Any doc that scoffs or objects may not be worth it.

[MagnificentUnicorn]

How did you come to the conclusion that the doc is the best in his field?

[assman]

How did you come to the conclusion that the doc is the best in his field?

2 docs told her to get to him fast.He is head of surgery for the hospital which is probably the go to hospital for cancer east of the Mississippi, head of national head & neck surgeons organization, lectures worldwide on the subject.

My impression is he knows wtf he is talking about but... he talks to you and doesn't like interruptions during his discourse and after, is out the door. It goes so far as to rub off on his staff who are aloof and slightly arrogant even though they don't do much beyond answering phones and coordinating insurance coverages

With his credentials I guess it's ok to trust his decision making but a little convo as to wtf is in his mind would relieve a lot of stress

[MagnificentUnicorn]

2 docs told her to get to him fast.He is head of surgery for the hospital which is probably the go to hospital for cancer east of the Mississippi, head of national head & neck surgeons organization, lectures worldwide on the subject.

My impression is he knows wtf he is talking about but... he talks to you and doesn't like interruptions during his discourse and after, is out the door. It goes so far as to rub off on his staff who are aloof and slightly arrogant even though they don't do much beyond answering phones and coordinating insurance coverages

With his credentials I guess it's ok to trust his decision making but a little convo as to wtf is in his mind would relieve a lot of stress

I'd suggest a second opinion. What hospital? Just curious. There are lots of excellent surgeons out there that don't work in academic institutions.

[assman]

He is actually the 3rd opinion. Lymphs were discovered during a scan he requested prior to PAT

The lady in question does not feel comfortable releasing the hospital & Dr's name. To say she is sweating this in an understatement

[MagnificentUnicorn]

Probably Sloan-Kettering or Hopkins. What was wrong with the first two surgeons?

[irul&ublo]

He is actually the 3rd opinion. Lymphs were discovered during a scan he requested prior to PAT

The lady in question does not feel comfortable releasing the hospital & Dr's name. To say she is sweating this in an understatement

Then why doesn't she just ask him?

[assman]

The largest Thyroid nodule is located in the isthmus slightly toward the right. There are 4 other smaller nodules 2 each located within the "wings" of the thyroid. A needle biopsy of the isthmus nodule and subsequent genetic testing showed probable follicular cancer with N-RAS showing strongly and almost a ghost trace of KRAS

The first Dr suggested removal of the isthmus and rt wing leaving the left intact. the 2nd suggested a complete thyroidectomy.

The tiebreaker was the god like surgeon. The advantage of using him is there is an inhouse team of endocrinologists,oncologists etc that are all skilled and work together. the other two Dr's would have required going to a recommended endo after the surgery.

The surgeon's creds and the team approach were what sealed the deal.


Irul... the question was asked and the response from his assistant was... "he doesn't feel as though the lymph glands are involved at this point. He spoke with the radiologist and they are on the same page"

A legitimate answer but when your ass is on the line, sometimes an in depth response is needed to relieve anxiety.

[iceman]

If they're not involved she's better off keeping them. If it turns out they are involved they can be removed later. While a second procedure isn't optimal, neither is unneccessary surgery. What you're getting with this Doc is his skill, his knowledge and his judgement. It's why you went to him. I would think long and hard before dismissing his opinion.

[assman]

If they're not involved she's better off keeping them. If it turns out they are involved they can be removed later. While a second procedure isn't optimal, neither is unneccessary surgery. What you're getting with this Doc is his skill, his knowledge and his judgement. It's why you went to him. I would think long and hard before dismissing his opinion.

Definitely not dismissing his opinion but having been down the cancer road with many relatives, questioning everything is the smart move. example... my mom was being treated for cancer and receiving chemo. She was told that every scan showed the tumors were shrinking and everyone was feeling good about it. One morning, she couldn't get out of bed without losing her balance and falling down. Back to the hospital she went where she was told " it has metastasized to your brain and the chemo doesn't work in the brain" She was dead within 3 months. WTF why wasn't this mentioned? Why wasn't the brain scanned during chemo to make sure it was clean?

Ya gotta ask and ya gotta question.

[iceman]

I agree with that completely but you gotta do something too, and since you seem confident in saying that this is the best guy I don't really get why you don't want to do what he's saying, particularly when it's the least invasive option that you've been presented with. I'm not a doctor and I'm not invested in this but you asked for opinions and that's mine.

[assman]

I agree with that completely but you gotta do something too, and since you seem confident in saying that this is the best guy I don't really get why you don't want to do what he's saying, particularly when it's the least invasive option that you've been presented with. I'm not a doctor and I'm not invested in this but you asked for opinions and that's mine.

yeah that is the way i am leaning also. She does not want to face the possibility of additional surgery for something that could have been gotten the first time around, I get that but she is in the best of hands that she could get so at some point you need to let them do the job you are paying them for.

I threw it out on here because so many folks here have been down similar roads.

[riser4]

when your ass is on the line

then you call assman!

[old goat]

Sounds like the radiologist called the nodes enlarged and the surgeon looked at the scan and didn't think the enlargement was enough to raise concern of metastasis. In the case of a radiologist and a surgeon disagreeing on something the surgeon is going to operate on and has operated on many times before the surgeon's opinion is the one that counts. The radiologist will always overread the xray and the surgeon knows what he's looking for. If the surgeon doesn't feel the nodes need to come out based on the xray and his exam I would go with that, subject to evaluation at surgery. I spent a good part of my career calming down people who had been told things were bad based on an xray that I didn't think were bad after I saw the films myself. And I was never wrong. (see below re god-like surgeon). Lymph node removal is not without a risk of complications. Total thyroidectomy seems like the way to go, based on my googling (like I said I haven't done any thyroid surgery in a very long time.)

That said, I wouldn't worry about pissing off the surgeon--it won't affect how he does the surgery. The advantage of a god like surgeon is that they don't care what you think of them so you can question them, ask for a second opinion and they're so confident in their ability that your doubting them doesn't even register. So don't hesitate to pin him down, but I suspect he'll say something like what I said. Most guys like that will open up if they're confronted strongly enough. That personality type, which I am very familiar with from looking in my bathroom mirror reacts well to strength in others and badly(meanly) to weakness. And with 3 opinions I don't think getting more will clarify things.

Finally, technical skill and experience are even more important in thyroid surgery than in other kinds of surgery. You want to minimize the risk of damaging or removing the parathyroid glands, which control the calcium in the body and which are small and not easy to identify; and you want to avoid injury to the nerves to the vocal cords which are small and also not easy to identify--at least for the nonexperienced surgeon like myself.