Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
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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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I am scheduled for a total thyroidectomy on 1/10/13. About 5 months ago, I discovered that I have a multinodular goiter after having a MRI on my neck for bulging discs. I went to an endocrinologist and he ran blood work (normal TSH and Free T3 and Free T4).

He then sent me for an ultrasound which revealed that what was thought to be many small nodules on the left lobe is actually a solid 3.9cm mass encompassing nearly all of the left lobe. On the right is a solid 2cm nodule and a smaller 5mm one. He then sent me for a biopsy which came back as benign for the left and indeterminate for the 2cm one on the right due to "scattered follicular cells with mild atypia and Hurthle cell features." I was told that it not a neoplasm, however. My endo was going to have me wait 3 months and redo the biopsy and possibly get the Afirma Veracyte test done.

However, I asked him to refer me to a surgeon for a consultation because the pressure in my neck is getting uncomfortable and I have problems breathing when I lay down on my back. (I stopped sleeping on my back 3 years ago when I had a couple of episodes of waking up feeling like I was being choked). The surgeon ran a scope up my nose so he could see down my throat. He said that my thyroid is compressing my trachea and is obstructing 35% of the opening of my airway. He recommended total thyroidectomy but said it is not urgent at this time and that I can wait until it gets bigger and the symptoms get worse. He left the decision up to me. I asked him to schedule the surgery.

But I am having second thoughts and worry if I am making the right decision and worry about the after effects of not having a thyroid. What would you do in this situation? Anyone who had a total thyroidectomy that can tell me what lies ahead for me if I go through with it?
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This is a tough question - you have two potential indications for surgery: indeterminate FNA (and Afirma may not be as accurate for Hurthle lesions) and compressive symptoms.  With bilateral nodules, if surgery if performed, usually a total is recommended.  This is a semi-elective procedure in your case (meaning appropriate, but not urgent).  Most people do well with thyroid hormone replacement (levothyroxine) after a total.
6 Comments
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I'm 2 days post op, the scariest thing is walking into have the surgery but it was quick and I feel ok so far. You will have pain and a sore throat but its not intolerable . Right now I am have issues with the tingling and numbness in my hands neck and face , but the surgeon said my parathyroids are Intact, they probably just haven't come out of the schock of surgery yet.

All I can say is make sure you have a good surgeon and make sure you pay attention to you body's reaction and you should be fine.
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Thanks Veroki! I wish you a speedy recovery. Keep us updated on your progress. Are you able to eat solid foods yet? Any advice about supplies I should purchase before the surgery?
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Thanks for the information, Dr. Lupo! I hope you have a Happy New Year!

Poetaccountant
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1446211_tn?1285702333
I was able to eat Mac and cheese the same day of surgery for dinner.  Soft is good the first couple of days, soup, apple sauce, ice cream. It's now 5 days post op and I'm still In Some pain, mostly a headache which I think has more to do with the hydrocodone than the surgery. Neck feels pretty stiff still though.

As for what if suggest? Buy those calcium and vitamin d chewable s to have on hand for after. Start to wean yourself from the pain meds right away because they give you so little to begin with. I was takingn2 pills every 4 hours, then took 1 every 4 hrs, now down to half of one. Have someone to help you, don't over do it with anything, just relax and take it easy.

Tomorrow I have my post op appt with my surgeon, ill let you know how it goes.
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Thanks for the suggestions! I'm sure my neck will be very stiff since I also have three bulging discs, a herniated disc and foraminal stenosis in my lower neck.

Yes, please keep me posted on your post op and your recovery.

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