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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Surgery for Large Substernal Goiter
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.
Surgery for Large Substernal Goiter
by cg01, Apr 08, 2006 12:00AM
I was diagnosed with a large substernal goiter. Had CT scan, Ultrasound and blood work done. Biopsy also done and came back completely negative and I do not have any symptoms such as breathing/swallowing difficulties. I am neither hypo or hyper. However, it has pushed my trachea over a little.
My endo indicated surgery ASAP but I feel I need some time to think about it since I was hoping for just pills to take. It seems goiters runs in my family.
My question is: Is there any other available treatment to shrink a goiter (my endo said medication would not work). And, if not, is it dangerous to put off surgery since I am terrified of having any type of surgery and how long could I wait to have it done?
I would appreciate any comments.
My endo indicated surgery ASAP but I feel I need some time to think about it since I was hoping for just pills to take. It seems goiters runs in my family.
My question is: Is there any other available treatment to shrink a goiter (my endo said medication would not work). And, if not, is it dangerous to put off surgery since I am terrified of having any type of surgery and how long could I wait to have it done?
I would appreciate any comments.
Doctor's Answer
by Mark Lupo, M.D., Apr 08, 2006 12:00AM
, Apr 08, 2006 12:00AM
Surgery is usually not an emergency, but when there is tracheal deviation, the situation needs careful attention. Thyroid meds like synthroid are unlikely to decrease the goiter but may help keep it from growing.
If there are no current symptoms, then another option would be to consider shrinking the benign non-toxic multinodular goiter with radioactive I-131. First would need to do an I-123 uptake/scan (NOT TECHNETIUM) at least 5 weeks after the CT scan (presuming that used iodinated contrast) to see if the goiter will take up iodine adequately to treat it with I-131.
About 2 of 3 patients respond and the average reduction in goiter volume is 40%. In some cases, I-131 causes scar tissue in/around the thyroid and MAY make future surgeries a little mor complicated (but not impossible in my experience).
In the case of low I-123 uptake, some of us are using thyrogen (off-label indication) to augment the uptake prior to I-131 dose.
If there are no current symptoms, then another option would be to consider shrinking the benign non-toxic multinodular goiter with radioactive I-131. First would need to do an I-123 uptake/scan (NOT TECHNETIUM) at least 5 weeks after the CT scan (presuming that used iodinated contrast) to see if the goiter will take up iodine adequately to treat it with I-131.
About 2 of 3 patients respond and the average reduction in goiter volume is 40%. In some cases, I-131 causes scar tissue in/around the thyroid and MAY make future surgeries a little mor complicated (but not impossible in my experience).
In the case of low I-123 uptake, some of us are using thyrogen (off-label indication) to augment the uptake prior to I-131 dose.
Member Comments (3)
by vanessa1978, Apr 08, 2006 12:00AM
I would go for surgery ! I had my operation done 5 weeks ago . When they operated they found my goitre to be bigger thwn they first thought ! and it was pushing on my wind pipe but i had not realised because it had done it gradually over a number of years. When they removed my thyroid my windpipe became weakened and has caused all kind of problems with breathing and swallowing ! listen to your doctor and have it done asap xx
by cg01, Apr 09, 2006 12:00AM
Thanks for all the good advice. I will definitely need to think about my choices.
by Leeky, Oct 15, 2008 10:53AM
A related discussion, I need surgery again was started.
by christine40, Jan 01, 2009 08:30PM
A related discussion, Will my metabolism slow down after surgery? was started.
