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Suspicious thyroid biopsy - surgery recommended?
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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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Suspicious thyroid biopsy - surgery recommended?

Was diagnosed with two nodules 5 weeks ago, went for fine needle biopsy and came back suspicous, dr recommends it now be removed, he then set up an appointment to see a surgeon in weeks for a total thyroidectomy.  How urgent does this need to removed?  How long does it usually take to get scheduled for suregery?  I have non refundable airline tickets for a planned vacation in early november, will they be able to wait or will i have enought time to recoop?
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97953_tn?1193367871
Suspicious nodules need to be removed.  Not knowing the details, it is hard to comment on all your questions.  In general, a total thyroidectomy is recommended and should be done within 2 months of a suspicious FNA - usually the sooner the better, but remember in most cases (if this is cancer) thyroid cancers are slow growing.  

Scheduling surgery depends on where you are and the surgeon - we usually can schedule surgery within 2 weeks on the FNA.  Recovery time varies from person to person and may take up to 2-3 weeks but most of my patients are back to work in about 7 days.  The interesting part will be in the event that it is a cancer -- will you be on thyroid hormone or not in preparation for radioactive iodine?  I would not recommend a vacation without a thyroid gland and not on thyroid hormone....  In the even that you have to cancel air tickets, most airlines require a note on MD letterhead for a refund which should be granted in your case.

Timing of these things can be tough and really depends on your surgeon, endocrinologist and hospital.  Good luck.
16 Comments
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Avatar_n_tn
i have a similar situation.  i am scheduled for surgery this week.  i thought it better to eliminate the chance of cancer rather than take chances.  (I am otherwise very healthy and my thyroid gives me no problems).  I would think they would be only removing 1/2 of your thyroid unless they know it's cancer.  Ask lots of questions.  I did.  (And don't read too much online!  People with bad experiences will scare you).  Good luck.  I know what you're going thru.  Take care of yourself. :)  We're never given more than we can handle.
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Avatar_n_tn
Hi From what i've read,it is usually done as out patient.It just depends on the surgeon.To the time it is set up depends on the surgeons schedule.Recovery time depends on you and your body nobody is the same.Didn't you ask your other doctor any questions?Your other doctor could have answered them for you all so.But I know how it is,finding out you need surgery,every thing in your brain goes blank and for good reason.Every one gets scared at some point in there life and this is one of them.You could ask the surgeon if it needs to be done right away or if it could wait until after your trip.If the surgeon feels it shouldn't be put off,ask him if he can schedule you quicker so that you can get a jump start on your recovery.And all so,see the surgeon before you go on your trip.I wish you all the best.Take care of your self.TNT406.
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Avatar_n_tn
I had surgery in July of this year for removal of one lobe of my thyroid, also because of a 'suspicious' biopsy report of a nodule. I also had difficulty swallowing and hoarseness.  I'm not sure why you would be scheduled for a total thyroidectomy. Usually they do one lobe, check pathology, and then remove the other if the first shows cancer.  I would encourage you to seek a second opinion based on this.

I spent one night in the hospital; was back at work in 2 1/2 weeks. I just had my first lab (TSH) test done a couple of weeks ago, and unfortunately, my remaining thyroid tissue did not step up and make enough hormone,  as hoped.  So I am now on synthetic hormone. But I felt better as soon as I started: more energy, less anxiety.

Based on my experience, I would recommend you taking your trip before surgery. This is major surgery and even though you're up and around in a couple of days, it takes a few weeks before you're back to your normal self.  Even fun vacations are tiring.

Good luck and keep us posted.

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97953_tn?1193367871
Suspicious nodules may mean lots of things -- if it is a follicular lesion without atypical cellular features then a lobectomy can be done in most cases.  However, with atypical cellular features - I usually recommend total as the risk of cancer is about 50% and it is better to have one surgery than two.....
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Avatar_f_tn
Here is a little more background on me, 33 yr old female, no family history of thyroid problems.  I was diagnosed with a nodule by an allergist during a general exam, then sent for U/S, then sent for FNA, I have one on the rigth 2cm x 2 cm x 1 cm, one on the left about 1/2cm.  The fna came back suspicious, it hasn't been repeated the endocrinoligist recommends thyroidectomy instead of messing around with it, this was last week I got the results, surgeon appt isnt' until oct 6th.  We had a family orlando vacation scheduled since early summer for nov 3- 12th.  So this completely has blindsided me.  I'm thinking I will probably need to cancel the vacation and count my losses.  I guess I won't know for sure until I see the surgeon on Oct. 6th.  I am a stay at home mom with a 6 yr old and  a 4 yr old and that is the other dilema on finding someone to watch the kids.  Thanks for all of your replys.  Endocrinolgist says this thyroidectomy is really up to me, his recommendation, he said feel free to get a second opinion, or wait the 4 months for another u/s and fna, but he scheduled the referal to the surgeon.
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97953_tn?1193367871
depends on the "suspiciuos" part (ie depends on the pathologist) -- I would take it out and with the nodule on the other side, it may be reasonable to do a total thyroidectomy -- if your endo gave a 4mo follow-up option he/she may not be that worried BUT I cannot comment without looking at the FNA.  The Orlando trip in most situations can be done with the surgery upon return......
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Avatar_n_tn
Hi there. I am actually having surgery this Friday. I am so sad and scared. My first biopsy was benign, then I had one 2 weeks later and the biopsy said "insufficient material." They just found the nodule in Aug and after 2 FNA's it is still there. It has started to hurt. I can feel it when I speak and my neck is definately swollen. Surgeon says it may be a build up of fluid. When it hurts I think that means cancer. And it has definately grown on the inside. Should I approach this surgery thinking the results will be cancerous? I am also scared about my voice. I talk for a living :) I am a clinical social worker in Private Practice. I did take off 2 full weeks. I hope that is enough.What do you guys think?
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Avatar_n_tn
my surgery is thursday and i'm a counselor who works in a school.  we have a lot in common.  my mom taught me a long time ago not to worry until you have to.  i have not focused on the outcome of the surgery at all, just exercising as i have been and being good to myself.  why worry for something that may never materialize?  if it does, i'll deal with it then when i have no "out".  keep me posted as i will you.  Good luck. Glad I'm not in this alone :)  Hopefully, it'll be good news for both of us :)
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97953_tn?1193367871
pain and increase in size after an FNA may mean a little bleeding into a cyst or nodule - this is not an indication it is cancer.  These often will resolve over several weeks - however after 2 insufficient FNAs, the nature of your nodule is still unknown and it may take a surgery to make a definite diagnosis  -- unless there are nodules on both sides, would only take out the side involved -- typically minimal risk of vocal cord problems - should be back to work in 1-2 weeks.
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Avatar_n_tn
Hello all-  I'm in the same boat  "suspicious"  also doing a 2nd opinion.-- - my "suspicious" nodules were diagnosed in July and now it's Sept and still waiting for my 2nd opinion date to come. but in the meantime -- I've been counseling with a homeopathic/holistic Dr.   She has, and since my last visit to her; to try some homeopathic medicines;; I just took my first crystal dose and now its 5 days later and I must say (unless this is in my head)  the nodules are smaller (by touch) - and less painful-  and her recommendations are -to stop Drinking COffee completely- it's not the Caffiene but the beans that do some over reaction to the thyroid.    And on top of all of this; to remove all peppermint, eucalypst, Menthol cigarettes;minty toothpaste - anything that is peppermint related.   Tho; caffiene is ok -- but to drink it in other forms such as tea or cola drinks.  but also OK for other type of mint related (wintergreen, lime mints) -- but to ditch Altoids completely;   stop all sugar-free anything -- from Decaf Coffee to Diet pops and teas.    

I hope a little of this is helpful;  Plus I'm also perimenopausal(46) and also saw my OB-GYN and he believes I should have a 2nd opinion and not to do something drastic as surgery and then to be on medication on the rest of my life.  
That I should be retested in 1 year.   All my TSH-T3-T4 are all in the normal range.  

My Endo; of course; was ready to do surgey in a few weeks after my diagnosis ;  but couldn't give me concrete advise why.  Just that it looks "Suspicious"   Just kinda shrugged his shoulders - and said that time is open.  This is a very reputable Endo or I would have never gone to him.  He really didn't seemed to be all that concerned either; and that in itself made me "suspicious" of the "Suspicious Nodules"   So I am being "suspicious" and waiting ....  

Not sure if this is helpful.... but personally- I wouldn't cancel my vacation.

Go for that second opinion -- seriously I would; I would go on vacation and enjoy yourself and have a great time.!

Take care and let us all know what you decide!

Jem
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Avatar_n_tn
had my surgery on 9/29.  other than throwing up from the morphine, it was a piece of cake.  very tired (slept 15 of 24 hours yesterday), but other than a bad headache today, i am okay.  very little neck pain.  the worrying was far worse than the reality.  let me know how your surgery goes! i hope all the best for you.  PS:  looks like no cancer!
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Avatar_n_tn
I just had my surgery on Friday. It went well, but they told me I had a follicular tumor. Doc. said he had to wait to hear from pathology for final results. His initial impression is that it was benign. Do these kind of tumors often come back malignant after further eval?? He said if it did I would have to go back to have rest of my thyroid removed.
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Avatar_n_tn
Sandandscared,

Been thinking of you.  I'll pray for good results!!  Glad you got thru the surgery ok.  Got my stitches out today and the official word that everything was benign.  I will say this, getting my endurance up has been slow.  Did 3 hours at work today and that was enough.  I'll probably do the same for the rest of the week.  I will not push too much.  I hope you will take care of yourself and do the same.  Let me know what your pathology report says.  Good luck!!!!!
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Avatar_n_tn
Hey WorryWart:
I got some sad news today. My surgery was Friday. I had 1/2 my thyroid taken out. I have a follicular tumor. The pathology showed 1m of cancer. Now I have to decide what to do next. I am going to a top endo. tomorrow. I may have to go back to surgery to get rest of my thyroid out. It is a lot to take in. I am actually feeling a lot of pain in my next. That's probably because I keep talking :) Dr. Mark, what are your thougths. Literature supports both, leave 1/2 thyroid alone and take synthroid. The other side says take other side of thyroid out.
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Avatar_n_tn
sad and scared,
i guess the good news is thyroid cancer grows very slowly and if you opt to get it out, you should have a clean bill of health for a very, very long time.  i am still on the mend and know what a long road it can be and i would not want to go thru surgery again.  can you wait awhile until you get your strength back and then re-visit the issue when you're stronger emotionally and physically?  Keep me posted.  i will say a prayer that you will know what to do.  i'm glad they found it early.  do everything you can to make an informed decision.  you're gonna be okay.
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Avatar_n_tn
Sad & Scared,
Any word?  Been thinking (praying) for you.

worrywart
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97953_tn?1193367871
Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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