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after total thyroidectomy
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after total thyroidectomy

Friday, I had a total thyroidectomy,he told  me my right cervical node was stuck to my thyroid along with scar tissue and inflammation and the nodules. My thyroid test after surgery showed T3 uptake-38.0  T4 14.1   TSH  0.01
Problems after surgery consisted of not being able to drink fluids without choking, and being constantly short of  breath. I ended up with a rash all over my chest and neck and upper arms because of iodine wash during surgery, and when they pulled the drain tube out I constantly itch and the rash is red. They gave me I.V. benadryl and medrol steroids by I.V. but nothing worked and I ended up in the hospital til Tuesday. Friday I find out the pathology reports. I am so nervous. My surgeon sent a ENT to consult with me and he suggested i probably had Hashimotos before surgery,but the surgeon said no. ENT also said my vocal cords were swollen. The surgeon wouldn't tell us whether we were looking at cancer or not,he just said things looked fine and that we'll see the results Friday.What do you think its going to be?
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97953_tn?1193367871
Based on what you described - this appears to be Papillary Thyroid Cancer with lymph node involvement.  Radioactive Iodine is typically recommended in this situation.

A few issues to keep in mind with this

1) Did they get the major lymph nodes out?  Ie, did they do a pre-op ultrasound or CT scan to map out the concerning nodes to be certain they were removed?

2) Did you get any CT with contrast recently?  If so, this may delay I-131 treatment due to iodine contamination.  In this case, would test urine iodine before giving I-131 to make sure the body is not "contaminated" with iodine.

3) Did they put you on thyroid hormone -- some docs are still leaving patients off thyroid hormone for many weeks post-surgery in anticipation of giving I-131.  However, Thyrogen is a medication that can be used prior to I-131 -- with this you do not have to be without your thyroid medication.

4) regarding your symptoms -- the most common thing would be calcium fluctuation -- ask your doctor about this.  Or -- you are not on thyroid meds....
9 Comments
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787406_tn?1339206783
went to surgeon, he said i had pappillary carcinoma(cancer) but they got it all out. # weeks from now i will get a nuclear body scan and they will check and see if i have cancer anywhere else in my body, they then will give me a raioactive iodine pill i will have to take to kill off any remaining thyroid tissue left over from surgery. In the meantime they are looking for a cause of massive amounts of inflammation in my thyroid and neck.
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787406_tn?1339206783
Saw Endo friday and was told i would have to have full body scan and then RAI,it ***** i was hoping i wouldn't have to go thru this. I have no one at home to help as my husband and i are truck drivers,he will be gone. Saturday morning i woke up and bam! I'm nauseated and I'm tired and my legs hurt,oh what fun I'm having. I'd rather be at work!
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787406_tn?1339206783
The Ct i had done was done without iodine as i have a mitral valve that is sensitive to it. Will this affect me getting 1-131 or the iodine. Will i have to be on a low iodine diet since i just had my whole thyroid taken out? Will the 1-131 make me sick afterwards? will there be side effects? I am so scared about taking the unknown. As far as thyroid meds he has decided to leave me off of them for the next 3 weeks. My surgeon said only 1 lymph node was abnormal and stuck to the thyroid,that was on the right and the cancer was on the left. Can you give me an idea of how all this will play out,what they will do first etc.?
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97953_tn?1193367871
Would ask the doctor giving the I-131 about thyrogen.
CT w/o contrast should not be a problem in terms of iodine.
You should follow a low iodine diet for two weeks.
Would consider a neck ultrasound to make sure there are no other lymph nodes
If the cancer was on the left, and a lymph node on the right - this is concerning for more lymph node involvement than one solitary lymph node.....
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787406_tn?1339206783
Please explain pathology report to me:

Gross examination: Received is a right thyroid measuring 5.5x2.5x1.6cm. The margins of the specimen are inked black and the specimen is serially sectioned from superior to inferior,demonstrating a diffuse irregular nodularity involving the entire thyroid. The thyroid is entirely submittedin (A-F)

Also received is a lrft thyroid measuring 4x3x0.8cm. The margins of the thyroid are inked black and the specimen is serially sectioned from superior to inferior, demonstrating a similar white irregular nodularity involving the majority of the thyroid. The thyroid is entirely submitted in (G-K).

Microscopic examination: Sections of the right thyroid demonstrate extensive chronic lymphocytic inflammation with occasional giant cells,consistent with granulomatous thyroiditis(aka de Quervain's thyroiditis). Fibrosis is also associated with the inflammation. No eveidence of a neoplastic process is seen.

Sections from the left thyroid demonstrate similar findings as the right sections. An unremarkable parathyroid gland is also identified adjacent to the left thyroid. Sections also demonstrate a microcarcinoma variant papillary thyroid carcinoma measurin 0.5cm in greatest dimension. The lesion demonstrates classic papillary nuclear features with numerous nuclear grooves, angulated nuclei and occasional intranuclear pseudoinclusions.


Diagnosis:
Throid,right,excision:  Granulomatous thyroiditis with chronic inflammation,giant cells and fibrosis.

Thyroid, left,excision: Granulomatous thyroiditis with chronic inflammation,giant cells and fibrosis; unremarkable parathyroid gland; microcarcinoma variant of papillary thyroid carcinoma.


please explain pathology report and tell me if this warrants havin RAI
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97953_tn?1193367871
This report describes only a single focus of micro (<1cm) cancer on the left.  This is not usually an indication for RAI.

The rest of the gland showed inflammatory changes of thyroidits -- likely the initial indication for surgery I would imagine.
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787406_tn?1339206783
How do they kill off the rest of the Thyroid tissue if they don't do RAI? My endo set the RAI for 4 weeks from now. But your saying i shouldn't have it. What do i do?
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97953_tn?1193367871
I cannot give specific advice.  But with what you are describing, the guidelines suggest there is no benefit from RAI.  There was no mention of a lymph node involved with cancer.  There is no indication to "kill off" the rest of the thyroid with this scenario.  Would consider a second opinion or at least tell the endo that you want to postpone or think about RAI -- in the meantime the endo can put you on medication to stabilize the thyroid.  Also ask the endo what the indication for the RAI is -- there may be something he/she knows that you have not mentioned in this forum.
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97953_tn?1193367871
Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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