ENT or General

[bst52]

I have Hashimotos and recently underwent a biopsy for large nodule which must be removed due to atypical cells.  Is it better to go with a general surgeon in my small town or with an ENT doc in a larger town with a larger hospital?

[ladybug_62301]

i read most of the about conversations.  I have a nodule on the right side of my thyroid. The day after my second ultrasound my thyroid swelled up and has been swollen ever since, that was 12-19-08.  I have had the mucus problem, it seems like it does not want to go away. I have also had pain in my neck. I have had alot of other symptoms also.  When ever i ask my doctor a question she can never answer it.  She finally recommended my to see a ENT which is also a endo doctor.  I can not see the endo dr. till march 24.  Good luck to those that are or have had surgery.  Hope things go well for everyone.

[jackson3]

Sorry I haven't written back sooner.  I came down with strep throat and couldn't find the energy to check my emails.  First, I want to say that my sore throat was worse than they thyroid surgery.  I only had a sore neck for about 3-4 days, no intense pain at all.  I took off 10 days of work because my doctor told me the recovery was 1-2 weeks.  I actually was up and moving around pretty normal the next day.  I had to spend one night in the hospital.  I went in a 11 am on a Wednesday and left at 8:30 am on Thursday.  I was sleepy after surgery for about 2 hours and then I was completely wide awake and feeling good.  I didn't need a tube.  My doctor said there was a possibility that I would need one, so that is probably up to your doctor. I am not a diabetic, but my blood sugar was high (they think due to the steroids or the sugar in the i.v.).  I just had the left side taken out, so I hopefully won't need medication.  I am supposed to follow-up with my primary doctor this week or next week to have my thyroid levels checked.  My ENT doctor told me he would see me in 6 months.  I think that I might need to have ultrasounds done on the right side to make sure that the nodule on that side isn't growing.  The FNA said that the nodule was benign, so we left that side alone.  I wanted to tell you what my doctor said about thyroid cancer and atypical follicular cells.  He said that thryoid cancer is very slow growing, so there isn't a huge rush to have the surgery.  He told me after my 1st FNA that I could take it out or wait and repeat the FNA in 4 months.  I didn't want to appear like I was a hypochondriac, so I repeated the FNA.  I did tell myself if it came back abnormal again that I just wanted to take it out.  So, it came back abnormal again, but this time I felt he was trying to convince me to watch and wait again.  He kept telling me that even if it was cancer, if  it wasn't growing that it wasn't harming me.  I was so mad and frustrated.  I told him I understood that the chances of it being cancer were 20% (he said "or less") but I just wanted to have peace of mind.  He then agreed to the surgery and it was about a month wait for the surgery.  During the wait, I had so many thoughts on whether or not I was doing the right thing.  Now that it is over and I know it is benign, I do feel relieved.  I don't feel mad that I had it out for "nothing."  I can actually think about other things and not feel anxiety over this anymore.  I also wanted to say that I don't have any bad side effects from the surgery.  I actually feel like I have more energy.  The scar is a little red on one side and a little hard and lumpy still.  It is low enough that regular shirts cover it.  Hopefully, I answered most of your questions.  If you can think of any others be sure to ask.

[daisy924]

I agree with you both on the waiting thing.  It seems that doctors do not have the same sense of urgency that we patients do.  I'm sorry, but if there is a chance of cancer in my body then I want it out right away.  I would think the diagnosis of atypical cells would at least speed things up a little.  I'm still waiting on my surgery date...it's been 2 1/2 months since my enlarged thyroid was discovered.  I'm almost out of patience.  bst52 I know your surgery is this week and I will be thinking of you.  als3672 please let us know when you get a surgery date.  I know this is a stressful time for us all.  Keep positive thoughts.

[als3672]

Yes, it sounds like what was explained to me.  To be honest, I was so relieved to get the results of the biopsy and move forward in all of this that I don't remember a lot of what was said and I certainly did not ask as many questions as I now have.  I don't recall him saying that the frozen section would only immediately identify papillary, but I do remember he said that there would be some result we could get right away and the others would not be until later.  I can't even imagine having to be opened back up!!  You would think in this day and age there would be an easier way to do it!!  

I agree about there not being a lot of concern around when the surgery is happening - I was supposed to get a date today and like everything else with this "fiasco", it did not happen - sometimes it feels like you are the only one concerned about it (other than my family, of course)!  But, certainly in the medical community you feel like  just a number a lot of times.

I also am not clear on whether I will need to see an Endo. or not after the surgery - the ENT said only if I needed the full thyroid out (planning for half, but depends on how it looks in there)...but, then it's not like "thyroid disease" just disappears, do I have to wait for another nodule or what?  What type of follow-up has been discussed for you?  Are any of your levels off?

If it helps, I understand your frustration and fear and feel for what you are experiencing!

[bst52]

since your memory is still fresh.  How much pain were you in after the surgery and how long did it last.  You are diabetic too?  Also would like to know if they put a tube for drainage and how long did that stay in?  How long were you in the hospital for?  How groggy were you after the surgery and did they get you up right away?  I have had problems with anesthesia in the past by waking up screaming and yelling.  I have warned everyone about this.  Please answer my questions.  Thanks.

[bst52]

Yes it does help to know there are others like us.  I am having my surgery 2/6 at 8:15am.  I went to a general surgeon who didn't require any type of pre-op testing.  Went to an ENT and had pre-op ekg, chest x-ray, blood work and asked so many questions.  He said that he would go in and take out right lobe and do a frozen section where I guess a pathologist would determine if cancer or not.  He said that this would only work for papillary but that it really would take a week to get full results for follicular and if positive would go back in and take out the other half.  That was my understanding of the procedure. Is that how it was explained to you?  Seems like nobody is really concerned about whether or not my surgery is today or next month.  I am just so frustrated and scared by all of this.

[als3672]

Your posts have been very insightful this evening!!  I also have atypical cells in a large nodule on my left lobe.  I saw an Endo. for the biopsy and did not get a great feeling from her on that visit and then waited over 14 days and did not receive any biopsy results and had an appt. set-up with the ENT b/c we assumed the biopsy was benign but b/c the nodule is causing symptoms (cough, breathing problems, pressure) I likely needed it out anyway.  However, once the ENT got a hold of the biopsy results it said I had atypical Hurthle cells of undetermined significance.  Thus, leading the ENT to say it def. needed to come out for further testing.  I don't have an exact date for surgery - should find out tomorrow.  I know the left is coming out, and then he'll determine what it looks like once in there re: the right / isthmus.  Also, if the results don't come back on the tissue during the surgery and it would be malignant, then they would have to go back in - that is my understanding anyway.  After surgery, I don't know if I will have to find an Endo. or not - ENT said it depends on the outcomes - I just know I won't go back to the one who still has not returned my calls or called me regarding my "Indeterminate" biopsy.  

It helps to know there are others out there struggling with many of the same issues - thank you for sharing!!

Jackie - thanks so much for your encouragement and info. - it makes a scary time a little less scary to hear from those going before me - I look forward to your answers to daisy924's last post!  

BST52 and Daisty924 -  I will be praying all goes well for you this week!

[daisy924]

Jackie thank you for your words of encouragement.  I'm glad that everything is going well for you since surgery.  How was your recovery?  Were you up and about pretty quickly?  Much pain?  Bst52 I will be thinking of you this week.  I'm sure everything will go fine.  Please keep in touch.

[jackson3]

Hello!  I just had a left hemithyroidectomy done on 1-7 for atypical cells in my left nodule.  I also have a nodule on the right side that came back benign.  I used an ENT for my surgery and he did a great job.  My doctor has specialized in head and neck surgeries unlike a general surgeon.  My final pathology came back benign, but did say I have a multinodular goiter.  I was also very anxious before the surgery and just wanted it over with.  I do feel so much better now that I know if it was cancer or not.  I will still have to monitor the right side for any growth, but at least I don't feel the threat of cancer hanging over me. I am supposed to see my primary care doctor next week to check on my labs.  So far I feel fine.  I did have a blood sugar of 274 the night of the surgery, so that was unusual.  They said they gave me a large dose of steroids back in surgery, so that could be why.  I hope I don't have a new problem to worry about. Well,  I feel for both of you and wish you both a lot of luck.   If you have any questions about the surgery or after just ask.  I am only 3 weeks out of surgery, so I still have a fresh memory of all of it.  Talk to you later!

Jackie

[bst52]

anybody out there in the southern new mexico area with thyroidectomy???

[bst52]

My surgery is set for 2/6. It will be a partial with frozen section and then if they see any other signs will go ahead and remove all of my thyroid.  The way that my biopsy results were presented to me really scared me.  I would love to have another endo but the one here is the only one in town.  After this surgery I am going to be seen in the hospital by another endo in the town I am having my surgery in so that he can monitor my calcium, blood sugar, etc.  I am hoping that once I get to see him as an inpatient he will agree to see me on a regular basis even if I have to drive the hour to get there.  It is nice to talk to someone else having the same type of problems as it seems as if nobody understands what I am going through.

[Thypatient]

Sounds like both of you are moving in the right direction and I wish each of you well.

Good luck.

[daisy924]

It sounds like you are comfortable with your decision and that is what's most important.  Thanks for mentioning the nerve monitoring system...I will have to ask my ENT about that when I see him.  I went to the Dr. a few months ago with a visibly enlarged thyroid.  The labs came back with a TPO of 360 (normal is <120).  My TSH over the last 8 years has been between 2 and 6...high normal mostly.  I have had pretty much all the hypo symptoms but was always told my thyroid was normal.  I assume that all this means Hashimoto's but to be honest, my Endo and I (just had 1st appt. last month) never discussed it.  We spent the entire time talking about the large nodules in my neck.  My US came back Multinodular thyroid.  I have large nodules on each side and am having a Total Thyroidectomy.  I don't have a date set yet but hope it will be soon.  Do you have a date for your surgery yet?  Are you having a total or partial thyroidectomy?  I read in one of your prior posts that you have had neck and shoulder pain.  I too have had off and on neck, shoulder, ear, throat, chest and headache pain.  I am convinced it is all thyroid related.  I am hoping that once my thyroid is out I will feel much better.  I am also nervous about the surgery...it's nice to have someone to talk to.

[bst52]

Thank you so much for your answer.  I am new to this town and it is very small so I am limited with docs.  My endo is also new here and the only one in town.  I am not so sure about him yet.  He referrred me to a general surgeon which was ok but then I went to an ENT who had a great personality and assured me that he has done plenty of thyroidectomies.  I decided to go with ENT who is an hour away but mainly because he also stated that he uses an electronic nerve monitoring system which the hospital here doesn't.  I am just so upset and frustrated by this.  Do you have hashimotos also? Multinodular thyroid?  I am really scared of surgery and hope someone out there can also help with this decision.  Thanks for your support.

[daisy924]

I don't have a specific answer to your question, but I also am getting ready for surgery due to large nodules with atypical cells on biopsy.  I have been referred to an ENT but haven't met with him yet.  The atypical cells make me nervous and I definitely want someone experienced.  At this point I am trusting my Endo (who I really like) that he has referred me to someone good.  It's definitely a difficult decision.  I will see how the appt. with him goes and how I feel once I meet and  talk with him.  What is most frustrating to me right now is the wait.  I just want to get this whole thing over with right now.  I hope others will respond with info to help your decision making a little easier.