Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Symptoms after thyroid 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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Symptoms after thyroid surgery

My 39-year old daughter noticed a thyroid nodule after the birth of her son six years ago. She had a needle biopsy at that time and a second biopsy two years later. Both were benign. She continued to have symptoms sporadically and had an ultrasound two years ago that was normal. In December 2007 she started having more severe symptoms –constant neck pain, swelling,  hoarseness, tired, etc.,  and finally had a tyroidectomy in April 2007 (no lymph nodes were removed). There was 2cm cancer on the right and less than 1cm on the left. She has Tall Cell variant.  Before her R.I. treatment the uptake showed a “hotspot” to the right of her thyroid. This is the exact area where she continues to have pain that radiates to her ear. She feels soreness, fullness, and can feel a lump (far back). One doctor said it was slightly palpable (this was before her surgery), but the surgeon currently treating her cannot feel anything. Yet, she feels that something is there and she is symptomatic, as she was prior to the surgery.  She had a CT scan this month (August 2007) that was clear, and the ultrasound before the R.I. treatment was clear.  Should she still be concerned, get a second opinion? Is there better imaging, like a PET scan?  How accurate is the CT scan?  I am very concerned since all of her tests prior to surgery were “normal” but she actually did have cancer, so we not as reassured as we would like to be based on the CT scan. Also, I know that tall cell variation is more aggressive.   I would appreciate any feedback. Thank you.
T’s mom
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Make sure she is seeing a thyroid specialist -- check out http://www.thyroidologists.com/doctors.html or thyroid.org

Would wait until 6 months after RAI to do a thyrogen stimulated thyroglobulin level and possibly low dose I-131 whole body scan.  Also an ultrasound -- performed by a doctor who does lots of ultrasound for thyroid and thyroid cancer (not easy to find these doctors).

CT scan depends on the radiologist reading it but should pick up significant problems.

Tall cell is potentially more aggressive and needs close observation.

PET scan is premature at this point, but if there is an elevated thyroglobulin level (blood test) with negative I-131 body scan and negative neck ultrasound, PET can be useful.
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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