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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Considering Thyroidectomy
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
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.
Considering Thyroidectomy
by wmtti86a, Dec 08, 2005 12:00AM
Hi Dr. Mark,
I'm considering a thyroidectomy and wanted your opinion.
I was diagnosed with hypethyroidism in September. I recently found out that this may have been a misdiagnosis due to the fact that my lowest TSH has only been .17, and that my Free T's have always been in range. I have toxic multinodular goiter (4 nodules on my right lobe > 1 cm, and 1 cyst on my left lobe > 2 cm). I have multiple other smaller nodules, as well. My last endo had me on a fairly high dose of MMI. I recently switched to a new endo, who has completely taken me off of MMI. He told me I have 3 options: (1) Take a watch and wait approach, where I will need to get ultrasounds done every year. (2) RAI, which may or may not shrink my goiter to an acceptable size. Also, since my uptake is only slightly elevated (30%), I may have to repeat the process. (3) Surgery (subtotal thyroidectomy). I'm in my mid-30's and just want a permanent solution at this point. I have not felt well since all of this started, most likely due to the anxiety this is causing. As an FYI, my grandmother had her thyroid removed in her 30's.
My questions are:
(1) For the most part, are people who have their thyroid removed able to successfully regulate their thyroid hormone levels and lead a complete and full life?
(2) Is there any danger to completely stopping MMI, without a weaning off process? To make matters worse, I got a head CT scan recently, due to migraine headaches, and was given iodine contrast. This made me nervous, since I thought I was not supposed to have large amounts of iodine.
Thanks
I'm considering a thyroidectomy and wanted your opinion.
I was diagnosed with hypethyroidism in September. I recently found out that this may have been a misdiagnosis due to the fact that my lowest TSH has only been .17, and that my Free T's have always been in range. I have toxic multinodular goiter (4 nodules on my right lobe > 1 cm, and 1 cyst on my left lobe > 2 cm). I have multiple other smaller nodules, as well. My last endo had me on a fairly high dose of MMI. I recently switched to a new endo, who has completely taken me off of MMI. He told me I have 3 options: (1) Take a watch and wait approach, where I will need to get ultrasounds done every year. (2) RAI, which may or may not shrink my goiter to an acceptable size. Also, since my uptake is only slightly elevated (30%), I may have to repeat the process. (3) Surgery (subtotal thyroidectomy). I'm in my mid-30's and just want a permanent solution at this point. I have not felt well since all of this started, most likely due to the anxiety this is causing. As an FYI, my grandmother had her thyroid removed in her 30's.
My questions are:
(1) For the most part, are people who have their thyroid removed able to successfully regulate their thyroid hormone levels and lead a complete and full life?
(2) Is there any danger to completely stopping MMI, without a weaning off process? To make matters worse, I got a head CT scan recently, due to migraine headaches, and was given iodine contrast. This made me nervous, since I thought I was not supposed to have large amounts of iodine.
Thanks
Doctor's Answer
by Mark Lupo, M.D., Dec 09, 2005 12:00AM
, Dec 09, 2005 12:00AM
Usually post surgical control is attainable.
No problem completely stopping MMI in this case if the lowest TSH was 0.17 - in the case of toxic multinodular goiter, wouldn't opt for MMI but I-131 or surgery for definitive treatment.
You're right - iodine not ideal.
Would take a watch and wait and see what happens. You are young and thus without definite thyrotoxicosis (hyperthyroidism with TSH<0.03 and high T4/T3) I would observe -- unless you have symptoms even with mild labs - in which case I-131 or surgery will take care of it usually. If any of the nodules are not clearly "hot" on I-123 would do a biopsy of them. If there is any concern about cancer (low probability) then surgery would be the best route.
No problem completely stopping MMI in this case if the lowest TSH was 0.17 - in the case of toxic multinodular goiter, wouldn't opt for MMI but I-131 or surgery for definitive treatment.
You're right - iodine not ideal.
Would take a watch and wait and see what happens. You are young and thus without definite thyrotoxicosis (hyperthyroidism with TSH<0.03 and high T4/T3) I would observe -- unless you have symptoms even with mild labs - in which case I-131 or surgery will take care of it usually. If any of the nodules are not clearly "hot" on I-123 would do a biopsy of them. If there is any concern about cancer (low probability) then surgery would be the best route.
Member Comments (1)
by Loretta02, Apr 07, 2008 09:27PM
A related discussion, My 2cm cyst lies on the back of my throid (left side) was started.
