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Fatigue and sore throat
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Fatigue and sore throat

OK So all I know is that I have a large complex cystic and solid mass that has been biopsied and now will be removed.  Since I had my needle biopsy I have found it very difficult to swallow.  I have been resorting to a liquid diet.  I am craving salty foods but the salt irritates my throat even more.  On top of that I find I am more fatigued than ever.  I chalk it up to the reduction in my food intake but still I find the fatiguw level over the past 6 months has gotten worse.  Can anyone give me some tips as to what to expect when I have my thyroidectomey - doctor wants to do total thyroidectomy due to the fact that I am a cancer survivor (unrelated area) and he doesn't want to take any chances.  I am fearful that if my fatigue level is this low now - what will it be like post-op?  Also any suggestions for liquid diets that might boost my energy level rather than kil it?  Thanks in advance for any help
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158939_tn?1274918797
I'm sorry for all you have been through.  I feel for you, doctors found a small complex nodule in my thyroid (no other symptoms or abnormal labs).  My nodule contained papillary carcinoma.

Since you are a cancer survivor, I'm sure this is weighing on your mind.  The good news is papillary carcinoma (the most common thyroid cancer) is very slow glowing and and very treatable.  I'm not sure what type of cancer you had in the past but I have seen some research showing a link between thyroid cancer and breast cancer.

As you probably know, having a "complex" cyst isn't a great sign.  Since your nodule is complex and you are a cancer survivor I can understand wanting to get the thyroid removed (I opted to be aggressive with mine too).  If they do find cancer, your doctor may recommend radio iodine uptake RAI (you may see it called I-131) therapy after (a dose of radiation tied to iodine to ensure it is taken up by any remaining thyroid tissue).  No matter how wonderful your surgeon there will be some thyroid tissue left (too high a chance of serious vocal, nerve, etc. damage to remove all of it).  RAI targets only the thyroid tissue.  My cancer was Stage 1 so I didn't have RAI after my surgery - my levels (TSH) are getting too high now so I'm going through RAI next week.

Your throat will be sore following your surgery and this comes from two main causes.  First, you will be intubated so talk to your anesthesiologist first about the nodule making your throat sore and see if they can use a smaller size tube.  You shouldn't have a scratchy throat.  Second is the actual surgery pain.  What you will experience is pain in the muscles of your neck (the front muscles have to be cut to access the thyroid).  It may hurt to lift your head (roll over on your stomach and push yourself off the bed - don't try to just life your head off the pillow) and when turning it side to side (especially when swallowing).  This should subside over a few weeks.

Many of us who had thyroid surgeries were released from the hospital withing 24 hours of our surgeries but I have heard of others who stayed longer (often with calcium level problems).

I hate to tell you this but plan on being exhausted for at least a few months until all of your treatment is finished and your synthetic thyroid levels can be adjusted.  You will also have to watch for deep muscle cramps if your parathyroid glands are removed or assaulted (very common) during the surgery or RAI.

Following surgery you will be watched closely for signs of thyroid storm, calcium level drops (notify the nurse right away if you experience deep cramping in your legs or arms), etc.  You will probably be on a calcium supplement and thyroid replacement therapy (don't take them at the same time) the rest of your life.

There are a lot of us on this forum who have been through it - ask away because you have lots of support here.

Here's also some good references:  http://www.cumc.columbia.edu/dept/thyroid/
http://www.thyca.org/
http://www.endocrineweb.com/

Right now your sore throat is probably the nodule (and the swelling from the biopsy).  Try liquid nutritional drinks (Ensure, SlimFast, etc.).  

Another thing, you aren't going to like this but watch your carb/sugar levels following your surgery.  Two sisters and I developed diabetes immediately following our thyroidectomies and I have seen others on this forum who have too.  Watch some of the liquid meal replacements, they can be high in carbs if it does become a problem for you.

Sorry this is long but it's a complicated situation.  Keep us posted!  Hang in there - it DOES get better!
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Avatar_n_tn
Thank you for all th information.  It is nerve wrecking.  I go back to surgeon tomorrow and hopefully biopsy results will be available.  I am anxious to move on with this.  I had uterine cancer (small stage 1 tumor) when I was 16.  My mother found a wonderful doctor at Sloane that agreed to remove without doing a hysterectomy.  I am a 25 year survivor with 3 children - ages 19, 16 and 15.  I am going to beat this too but I don't like all the wait and see games.  I want to move on with my life.  I lost my husband the beginning of this year and I have actually started dating a wonderful man who is 15 years younger than me (keeps me feeling young) and I want to progress in our relationship.  We have put everything on hold until we know what course of treatment is needed and how this might affect me physically, emotionally as well as financially.  My concern is whether my job will accomodate me during this "regulation" period.  I commute by train nearly two hours each way to my job.  Obviously the commute will be difficult on me but I might have to just do it to keep my job.  I work for a hopsital and they aren't always the most sympathetic.  SO I fret over it all and hope that tomorrow I have a date to set as my starting point.  Again thanks for the information.  Sometimes it is overwhelming reading all the data out there.
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158939_tn?1274918797
It is overwhelming.  In many ways I'm glad that I had no idea about any of this before my diagnosis.  I had a CT scan that "accidentally" found something abnormal in my thyroid, an ultrasound, then opted directly for surgery.  I woke up to the diagnosis of cancer.  It all happened within just a few weeks and I didn't have anyone to ask questions to.  I didn't even know what an endocrinologist DID until after the surgery.  Straight from my regular doctor to surgeon.

It sounds like you have already decided to get it out.  That is the fastest and most complete way to beat it!  :-)  When are you scheduled for surgery?

I only had one lobe out the first surgery (then all my sisters had their surgeries) - the second lobe came out about a year later.  My personal suggestion, get the entire thing out.  Your growth is large and complex - not something to dance around.

Have you discussed RAI with your doctor *if* it is cancerous?  That will be about 5 days that you will be off work (mine is scheduled for next week and I'll just miss two days of work).

I didn't have great insurance or benefits so I elected to get mine out the day before Thanksgiving.  I came back to work the next Monday.  I felt sluggish and had no energy but it was manageable.  Others have taken longer to get back.  (I lived in turtleneck sweaters that entire winter and spring).  They started me on thyroid replacement in the hospital so I never had a huge drop in thyroid levels.

Take a deep breath - you'll be okay.  It sounds like you and your doctor are on top of it.  This is just a bump in the road.  You've overcome much worse.  Please let me know when your surgery is and keep us all posted!
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Avatar_n_tn
Thanks for the encouragement - I saw surgeon yesterday and he said the biopsy came back fine - benign.  Still with the complexity of the nodule and the rapid growth he left it up to me whether I want to remove now or do the "wait and see" game.  My T3 is on the higher end of normal and my TSH is on the low side of normal therefore meds aren't the option for me - I decided to have it removed now rather than wait another 6 months worrying.  He is strongly pushing that I only have one side removed even though there are small nodules on the other side.  His reasoning is that I would not have to be on meds permanently if part of thyroid remains.  Most likely the surgery will be mid December and he said there is usually 3-4 week recuperation period.  I travel nearly 2 hours each way to my job so he feels that I will need to rest up before returning to work.  I figured that I will have the winter months to hide the scar - any suggestions to reduce the scarring?  I am still preparing myself for the possiblity of cancer at the time of surgery.  I haven't had much luck in my life.  Obviously, I feel if you prepare for the worst, anything less is great!  All the same it is frustrating to have the uncertainity still.  I hope I am fortunate to have a bounce back as well as yours.  Again thank you for the information.  Sometimes I feel like I am alone in this mess.
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158939_tn?1274918797
You are definitely NOT alone in this.

You feeling good about the surgery decision?  I don't know about you but it felt like a huge weight off my shoulders when I scheduled that surgery and getting the cancer diagnosis, and finding out they had caught it at Stage I because we were so aggressive, really was great.

Can I make a suggestion?  Talk to your surgeon and make sure a pathologist will be in the OR.  Ask your surgeon to have the pathologist cut down and freeze the suspicious nodules to look for cancer BEFORE they close you up and wheel you out.  That way if they do discover cancer they can take the other half out right then and there.  (If it is cancer you will need it all taken out)  The pathologist didn't find mine until I was in recovery so I had to have the other half out over a year ago.

As for hiding the scar.  Aside from the turtle necks, scarfs, and chunky choker-type necklaces?  :-)  After the stitches are removed or steri-strips fall off (depending on your surgeon's method of closing the wound) I found that *pure* aloe vera gel applied liberally to the scar (6-8 times a day for me but it is very dry here) really helped.  I scar really badly and all of my abdominal surgery scars are very visible, as is my acne scars, but my thyroid scar is nearly invisible.  It's worth a shot.  Just be patient - it took nearly a year for it to look normal and lay flat.

Your surgery in mid-December should give you some time to recover over the holidays.  Don't push yourself too hard the first few weeks but you shouldn't need to baby yourself either.  Your thyroid levels, hormones, and possibly calcium levels will be a bit messed up so be patient.

Hang tough!
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Avatar_n_tn
thanks for the feebback - I do feel better just knowing that the surgery is going to happen and I can move forward instead of being in this holding pattern.  I know I am going to be self conscious about the scar but I guess it will be my newest "batle wound".  Again thanks and I will check back once surgery is done.
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158939_tn?1274918797
Please do keep us posted about your surgery.  Feel free to ask us as many questions as you may have.  I'm just so glad this forum is here and wish I had it three years ago when I went through it.

hang tough!
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Avatar_f_tn
Hello. I've never posted a question on a website before, but I have always found them and read on issues I am dealing with. I have a couple of questions. Does anyone know what significance a 9mm hypoechoic mass on thyroid with peripheral vascularity has? Also, I have another nodule that is only 5mm that is described as an inhomogeneous mass with peripheral vascularity as well. If anyone has any information I would sure appreciate a "heads-up". I have an appointment with an ENT surgeon on Wed. next week. Thanks!
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