Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Radioactive iodine vs. surgery
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Radioactive iodine vs. surgery

I had the sudden onset of a mass in my left neck. I was refered to an endocrinologist. My TSH was 0.20 (ref. range 0.34-5.60) and my T4 was 0.9 (ref. range 0.6-1.2). Repeat TSH 9 days later was 0.10 and the T3RIA was 173 (ref. range 87-178) the antibodies were within the ref. range. Ultra sound impression: a lobulated mixed ecogenic mass measureing 3.5 x2.8 x.3 within the midportion of the left thyroid lobe that demonstrates flow within the solid component.  Two small subcentimeter cysts within the right lobe.
Thyroid scan and uptake:  Thyrid imagining demonstrates focal area of intense acvitity involving the left thyroid lobe corresponding to the dominant nodule noted on ultrasound. There is faint visualization of the right thyroid lobe. Impression: The complex nodule noted in the left thyroid gland demonstrates increased activity consistent with a hot thyroid nodule on scintigraphy. Calculated thyroid uptake is within the normal range.
My doctor called me and said I could either take "a blast of radioactive iodine" or surgery but did not  give me the benefits or drawbacks to either. Could you tell me the pros and cons of radioactive iodine vs. surgery?
Thank you.
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These are the treatment options -- surgery is the most definitive but has the inherent risks of anesthesia and surgery itself (damage to parathyroids and voice). Removal of half the thyroid in this case carries about a 25-30% chance of developing hypothyroid.  RAI is less invasive and the first choice of many endocrinologists for this case -- >85% chance of cure of the hyperthyroidism (low TSH) and about a 50% chance of hypothyroidism after treatment.  Could also take anti-thyroid medications (ie tapazole) to block the over-production, but this does not solve the underlying over-active nodule and has many side effects.  I would recommend either surgery or RAI -- there is no one right answer, it's personal preference.  Your doc should give you more info on these options -- also check out aace.com and thyroid.org.
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
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