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Benign Thyroid Nudule Surgery
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Benign Thyroid Nudule Surgery

I have a benign thyroid nodule that is large and encompassing the right side of my thyroid.  My Dr. recommended surgery to remove the tumor.  He stated that the thyroid will not be removed and I will not have to take medicine for the rest of my life.  He stated that I do not have to have it, but he would do it.  Surgery seems kind of drastic.  Does anyone out there know if that is the right thing to do, or if the surgery is unnecessary?
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Avatar_f_tn
Surgery can be a little drastic, but if your nodule situation is right you do have some options, with doctor approval.  That is, unless the nodule is so large that it presses on your windpipe and/or the esophagus, it will cause difficulty breathing particularly when you lie down at night and/or swallowing food. In these situations thyroid surgery removes the pressure in this area of the neck.
Another new surgery option, if available in your area, Outpatient Laser Surgery in which patients received light sedation (i.e., Valium), and the procedure typically takes 30 minutes. This is compared to traditional surgery, which involves general anesthesia, and requires at least an hour.  However, both types of surgery have the potential for nerve damage, but it's less common in the laser surgery.

A more popular option has been medical therapy, consisting of oral thyroxine therapy to suppress pituitary secretion of thyroid-stimulating hormone, to thereby hopefully shrink the nodule. However there are controversy about TSH suppression.

Another option is to do nothing except to be examined annually about every six months to determine whether the clinical characteristics of the nodule have changed. If the nodule is the same size or smaller after six months, yearly follow-up is then recommended. However, if the nodule enlarges despite treatment with thyroxine,  would suggest that it may have become malignant and should be removed . It should also be emphasized that most benign nodules do not shrink with thyroxine therapy, and fewer such nodules are treated in this fashion. Cysts never  respond to thyroxine.

In some cases RAI is used for hyperfunctioning andenomas or multinodule goiters, causing the nodule to shrink and symptoms to subside.

Alcohol ablation for small, hyperfunctioning nodules which are injected with ethyl alcohol to help shrink the nodule and improve symptoms.  However some people might need up to 8 injections which are usually given at two months intervals.  This procedure doesn't cause hypothyroidism.  However there are side effects, but only last a few days.

Keep in mind, that most benign nodules can grow, generally very slowly, over time In women, nodules often cease growing after the onset of menopause.

You need to discuss all options with your doctor and chose the one that best fits your nodule situation.

Good Luck!


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158939_tn?1274918797
Quick question (and I don't want to sound flippant) but how do you know it's benign?


I'm curious because my sisters and I were told our nodules were "probably nothing" and it turned out to be much more.  I'm NOT trying to frighten you - I'm just curious why your doctor pronounced it "benign".  Did you have an ultrasound and/or biopsy?  Have you had all of your thyroid levels checked?


BTW:  If (and only *IF*) you ever do need thyroid surgery, it is one of the easiest surgeries that my family members or I have undergone.  
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Avatar_n_tn
Thank you for the advice.  I know that it is benign because I had a biobsy.  Part of the reason they want to take it out is due to the fact that there is still a very small possiblity that the biobsy didn't get all of the nodule due to its size.  My thyroid levels have come back normal, which is another thing I don't understand.  I do not have trouble swallowing and it is not yet pressing on anything but I have been advised to have the surgery.  Does anyone think that I am taking an unecessary risk by having it?  Do the benefits outway the risks?
Thanks again for the advise- I really appreciate it.
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158939_tn?1274918797
Deciding on surgery is a decision that YOU need to make based on medical advice and your gut feelings.


A couple of personal experiences:

Two of my sisters had biopsies - both biopsies were "normal" - both had cancer.

My labs (and 3 out of 4 of my sister's labs) were always "normal" - the other one had slight Hashimotos.  All of our nodules were found on ultrasounds - NOT through any blood work.

My youngest sister (23 at the time) had the largest nodule and her cancer had spread more than the rest of our cancers.


Since you had a biopsy, I'm assuming that an ultrasound was found and a nodule located (otherwise, why biopsy - right?!?!).  How was the nodule described?  Was it solid, fluid-filled, or mixed?  Was it "hot" or "cold"
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Avatar_f_tn
At what size do they do biopsy?How big were your nodules?What's considered normal (0,05,1mm if they can measure precisely)interval change in six months(for thyroid nodules)?
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158939_tn?1274918797
I'm not a medical professional - unfortunately just a professional patient.  :-)

I believe they can ultrasound any size nodule if it warrants it.  Don't go off the size of the nodule though - a small nodule doesn't mean it's cancer free.   My 16-year old daughter had the largest nodules (4 of them) in the family and hers were "precancerous".  

I had the smallest nodule (4mm) and it was papillary carcinoma.

I don't believe there is an acceptable level of "normal" nodule growth but you need to talk to an endocrinologist for sure.
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Avatar_n_tn
It doesn't matter the size.  Generally, they will do the biopsy after an ultrasound is performed.  If the ultrasound comes back as a "cold" nodule, which mine was, they will perform a biopsy.  I have a single, solid nodule that the dr. described as 'large' encompassing the whole right side of my thyroid.  My surgery is next week. They are leaving the thyroid in tact and I will not need medication.  FYI-  my dr. stated that synthroid (I think that is the name of the medicine) does not help shrink the nodule as it has in the past, which is another reason for my surgery.
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Avatar_n_tn
Thanks so much for the advice.  I will diffinately talk about a contingency plan.  One last question.  How is the recovery?  I have a 10 month old.  Will I be able to take care of her after the surgery?  If not, about how long will it take for me to be able to do so?
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158939_tn?1274918797
Good luck with your surgery and keep us posted.  You are in good company here.
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158939_tn?1274918797
A couple more things.  Talk to your surgeon right before they wheel you into surgery about contingency plans.  I asked my surgeon to remove the entire thing if cancer was found (unfortunately the pathologist didn't find it until I was in recovery).  I ended up having two separate lobectomies.

If it's a benign nodule, great: things went as planned.  If it is more serious, your surgeon will know how aggressive you want to be with the surgery.

Watch for muscle cramps following surgery - sometimes parathyroid glands are damaged or removed during thyroid surgery and your body will be trying to figure out how to process calcium.  If you start to get painful cramps (usually legs), let your doctor or a nurse know and ask to have your calcium levels checked.  It's a common side-effect and is usually short termed.

Your neck may be stiff for a month or so as the muscles on the front of your neck will be cut.  I found it easiest getting out of bed to roll over and then lift my head up (raising your head up from a pillow is difficult for a while).

After the surgeon clears you in your follow-up visit and all your sutures, steri-strips, or stitches are removed or dissolve, I found that Aloe Vera gel on the scar three or four times a day made the scar nearly disappear.

Keep us posted.
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158939_tn?1274918797
Everyone is different with the surgeries.  I had both of mine on Thursdays and was back to work with the first one the following Monday.  With the second one I was back the following Wednesday.

My daughter was up and about within two days, all four of my sisters were back to their lives withing 3-4 days.  The biggest problem we ALL faced was the cramps and calcium problems from the parathyroids (whether or not we had them removed).

I've seen other posts where people were down after this surgery much longer.  Like anything, it's very individualized.

Is your doctor planning to start you right on thyroid replacement medication or does he/she feel you will be okay without it (since you aren't having a TT).

You're going to be tired and sore so get help with your 10 month old for a few days.  You're going to need some rest but you shouldn't be flat on your back.

Don't forget the calcium (and don't take calcium with your thyroid medication if they put you on it).  Let us know and good luck!
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Avatar_n_tn
I recently had a 6 month followup ultrasound of what appeared to be a benign appearing multinodular goitar. I've been taking levothyroxine since that initial ultrasound. The doctor said on my recent followup that there are now coarse calcifications in one of the nodules. I am scheduled to have three nodules biopsied, the more concerning one being the calcified one. Has anyone had a nodule with calcifications before? Should I have pushed for biopsy 6 months ago. No particular nodule was bigger than the next but they all a least measure 1 cm or more. They opted out of biopsy 6 months ago because they said they were all so similar in size that it didn't warrant it at the time. My labs have been consistently normal after the first month of taking the meds and they continue to be so. I was also told initially that it was just post pardum thyroiditis and that it would resolve on its own most likely after a year. I had Gracie in September 05 and still have muscle pain, sleep 2 hours a night, and muscle weakness. We can't tell if it is thryoid related, reproductive hormone related, or just the pure depression of it all.  Just when I thought I could handle these symptoms, they called about this biopsy. I would appreciate any education,story, or prayers.
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158939_tn?1274918797
Sorry - I just saw your post.  You might want to post an entire new question to the forum so everyone can see it and respond.

I'm sure you are aware of the implications of having a calcification on a nodule.  Yes, it's frightening but NOT THE END OF THE WORLD.  I would recommend a biopsy but please remember, even if it is "negative" that does not rule out thyroid cancer.  It may simply mean they didn't get the right spot on the biopsy.  Two of my sisters had negative biopsies and still had papillary carcinoma.

*IF* it is cancer please know that it is the most treatable - and curable - type of cancer you could have.  There are LOTS of us on this forum who have been through this.

You asked for stories:  My nodule was found accidentally on a full-body CT scan.  It was tiny but I followed the radiologist's advice and talked to my regular doctor.  He ordered an ultrasound and the result was the small nodule was "complex" (mixed solid and liquid).  My doctor asked if I wanted it biopsied but I told him I just wanted it out (I had a bad feeling about it and everything I read pointed towards the possibility of cancer).  I had it out, it was cancer (Stage I - being proactive pays off).  A few months later my youngest sister was in a mild car accident.  She was x-rayed for whiplash and they saw a small nodule in her thyroid.  Because of my cancer she had it biopsied - the result was negative.  She decided to be aggressive, hers was Stage II papillary carcinoma.  The other three sisters had thyroid ultrasounds (even though EVERY doctor told us it wasn't hereditary) - all had suspicious nodules.  One opted for a biopsy - again negative and again - papillary carcinoma.  End result:  Five of us sisters - four with cancer, one precancerous.  Had my daughter's thyroid checked - huge nodules, hers were also precancerous.  All of this was within one year.  By the way - don't go off of labs to decide whether or not it is cancer - MOST thyroid cancer patients have normal labs.  We did.

Your sleeplessness could be any of those things you mentioned, or a combination of all of the above.  I do have to admit though, balancing out my thyroid levels (with Synthroid) has helped my depression considerably and nearly erased my sister and daughter's bipolar tendencies.  However you may have postpartum depression and may need to have that addressed at the same time.  This stress isn't helping that situation at all either.

Get the biopsy then sit down and have a very long, serious talk with your family and your doctor to decide the next course of action.  You have a pretty good reason to be aggressive *IF* this is cancer and that reason sounds like she is a beautiful little girl!

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Avatar_n_tn
Hi Everyone need input from all of you. Had a stent put in heart artery a year ago and few weeks later suffered a stroke. Its been a bad year . Afew weeks ago went for my 6 month carotid and a enlarged lymph node was noted in left lobe of thyroid. I was sent to ENT surgeon who made me have ultrasound of thyroid which revealed a 2cm lymph node lateral to upper pole in left lobe of thyroid. I am having a needle biopsy 12/20/06. Have to be off all my blood thinner meds for 5 days. ENT dr. said he doing biopsy to see if its lymphoma or thyroid cancer Please give your input only symptoms are mild night sweats and sometimes a twisting pain in left side of neck. have to go now waiting to hear from all of you.
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158939_tn?1274918797
Arley,

Go to the forum main page and hit "Post a Question" - cut and paste your question there under a new subject.  Everyone is going to miss your post on this thread and there are a lot of good people here who can help you.

Good luck.
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