Confused about surgery thats already scheduled this week

[riritati]

About a two months ago I began having a bothersome pain on the front of my neck. After finally going to the doctor I got blood work and an ultrasound done and my thyroid levels on my bloodwork were high and the ultrasound found a nodule on the right side. I was referred to a surgeon and had a radioactive iodine uptake test done. Now he awants to remove my right side of my thyroid because he said the nodule is the size of a marble. I'm confused can't he do a biopsy first? He mentioned it was a cold nodule but I went to pick up the results to see if that is what the test indicated.

FINDINGS: There is overall diffuse decreased uptake of iodine by the thyroid gland.
               Relative photopenia in the lower pole of the right thyroid gland likely
               corresponding to the nodule seen on prior sonographic study and may
               represent cold or warm nodule.
4-hour thyroid uptake was estimated to be 0.1%. 24-hour uptake was 0.1%, which is significantly decreased from the normal range.
IMPRESSION:
1.Diffuse decrease in the thyroid iodine uptake. Differential diagnosis includes subacute/chronic thyroiditis or blockage of iodine uptake by exogenous food medicine or iodine. Clinical correlation is suggested. Correlation with TSH and thyroid hormone level also suggested.
2.Relative photopenia in the lower pole of the right thyroid gland likely corresponds to nodule seen on prior thyroid sonography, which may represent warm or cold noduleand evaluation with ultrasound guided biopsy is suggested.

What does this mean should I have the surgery or get a biopsy first? I'm scheduled to go in on tuesday 6/2/2009!

[riritati]

I actually went to my family doctor today and spoke with him about all my concerns. He tells me that he was going to contact the surgeon this weekend to see why he wanted to remove it so soon. I will speak to my doctor on monday. The surgeon told me he wanted to remove it because of the size 1.8 cm and possible cold nodule.  After surgery he will send the sample to be evaluated. I'm concerned about how my thyroid would funtion with one lobe only. I guess i'm just scared at this point.

Thank you for your wrds of experience

Riritati

[utahmomma]

Call your doctor's on-call number and ask to speak with your doctor.  You need to speak in-person or at least over the phone with the doctor before the surgery.

1cm is the "text book" rule but our individual cases don't always follow the rules:

My papillary carcioma was 5mm.  Too small to biopsy yet I opted to just have the lobe removed based on the ultrasound readings (saw that it was a complex, rough, nodule).  Cancer was found post-surgery in pathology.  

Over the next 12 months, 3 of my 4 sisters were also diagnosed with papillary carcinoma (all of their nodules were also less than 1cm yet they all had multiple nodules).  One of those sisters had three areas of papillary carcinoma and two affected lymph nodes.  That sister also had three recurrences with distant metastases which were later treated - AND CURED - with RAI.

During that 12 months I also had my other sister (and my then-16 year old daughter) diagnosed with multiple atypical (precancerous) thyroid nodules.

After all of their surgeries I opted to have the other lobe removed (benign) which I was grateful for because 2 years later I had a recurrence and needed RAI treatment.

Don't rule out anything or cancel anything until you TALK TO THE DOCTOR and find out exactly what he/she is looking at and why he/she that nodule needs to come out so soon.  

The surgery can be postponed but YOU need to go into whatever YOU decide fully informed and comfortable with the decision YOU make.  It's not up to your doctor, or us, it's up to YOU - we're all just here to help you.

My best to you

Utahmomma
papillary carcinoma '03, second surgery '04, recurrence and RAI '06
three sisters with papillary carcinoma (one with three recurrences/RAI including metastases to breast and liver)
another sister and daughter with precancerous thyroid nodules

[898]

If nodule cannot be palpated and smaller then 1 cm no biopsy or surgery is needed at this time. If nodule is larger then 1 cm and solid biopsy is recommended.
The surgery is advised if nodule is large and causing compression
is neoplastic
or it is cancer
The if cause of low iodine uptake is thyroid inflammation, the test for TPO antibodies and ESR rate is necessary to differentiate between subacute [transient] and autoimmune [chronic] thyroiditis.
Get the second high resolution ultrasound or request the images; have the results re-evaluated for size, type and blood flow in the nodule; presence of calcification. During the thyroid inflammation, the so-called pseudonodules can form and disappear.
GET the second opinion before proceeding with the surgery!!!