Partial vs. Total Thyroidectomy?

[carlottaV]

I recently got my thyroid checked out after a friend noticed the "lump" in my neck had gotten larger. Blood work came back within normal range: TSH 1.34; T4 6.7; T3 152; thyroid peroxidase <10; thyroglobulin <20. Sonogram reported right lobe 8x5.7x4.4 cm with a heterogeneous appearing solid mass occupying most of the volume, measuring approximately 7x3.6 cm. The left lobe measured approximately 4.4x1.1x1.1 cm with two nodules, 6-7mm and 4mm.

I met with an ENT who said the right lobe should be taken out. He basically said a clean biopsy of such a large mass could not necessarily guarantee no malignancy. I asked about biopsying the small nodules, but he said they were too small. I didn't think of asking him about just taking the whole thing out. He had said that after the right lobe was removed, a pathologist would examine it while I was still on the operating table, and the results would determine whether the surgeon closed me up or took out the other side. He also said that after the pathologist's full examination (after the operation), it may be necessary to remove the other lobe.

My friend, a doctor, thinks I should take the whole thing out. He knows someone who had one side taken out and now, years later, there's growth on the other side and doctors want to remove it. He doesn't want me to have to go through the surgery twice. What do I do?

PS I had a nuclear scan done last week (no results yet). Not sure what it will really tell me. The ENT said he wouldn't even have bothered to send me for one -- that it has to come out regardless.

[Venora Moonwind]

It is a purely personal choice to get half or the whole thing. I ended up having 2 different surgeries because the sub sternal goiter was discovered during the first surgery and it couldnt be reomoved without opening my sternum.
If it were me I would opt to get the whole thing out.

Are you having trouble swallowing your food or breathing problems? Since your labs are within range unless you are having quality of life issues  what is the ruxh for surgery .
Have you had  an FNA to see if there are malignant cells. This is something I would request from your doc as well.
Alot of docs arent so concerned as they would be if it were their thyroid.press until you get the answers you are looking for.
There are a few other posters like chitchat nine that have had partials.
She can give the flipside on her choice to only have the partial.
Keep us posted on your progress
Love Venora

[carlottaV]

No quality of life issues (except an ugly neck, of course -- but that doesn't count). Regarding an FNA, the ENT surgeon said that the mass is so large (7 x 3.6 cm) that the results wouldn't necessarily be reliable. He advised that I don't wait until next summer to have it removed (I mentioned that I was a teacher and had to wait for a break), so I'm looking at this December.

This is all very new to me, although I've lived with the visible lump for a while now. Several years ago I noticed it after having a central line in my neck, chalked it up to scar tissue. But earlier this summer my doctor friend made note of it [being larger] and said I should get an ultrasound. And now here I am.

[utahmomma]

I had a small nodule on my right lobe.  Everyone thought I was over reacting but I had a bad feeling about it being "complex" so I opted to have it out.  I talked to the surgeon beforehand and we agreed to have a pathologist in the OR for an immediate frozen "cut down" to look for cancer.   The first cut down was benign so the surgeon closed me up.  After I was wheeled into the recovery room the pathologist found papillary carcinoma.   No big deal - no nodules on the left side.  Right?

Over the next 12 months 3/4 of my sisters were also diagnosed with papillary carcinoma; the other with precancer.  My teenage daughter was also diagnosed with precancer.  I opted to have the left lobe out just 12 months after my first surgery.

Two years later I had a recurrence of the cancer which couldn't have been treated if I still had a remaining lobe.

Your surgeon has a good plan to do the cut down and decide on the remaining lobe in the OR but papillary (and follicular) carcinomas can play "hide and seek" but having microcancers or small focuses within a larger nodule so the cancer may not be found immediately.

If it was me, I'd discuss with the surgeon that if he has *any* doubts about the nodule to just take the entire thyroid - and to also check the lymph nodes very, very carefully.

Just my $.02.

Best of everything to you!

Utahmomma

[ChitChatNine]

Hi and WELCOME.  I agree with Utah ... I had two benign nodules that FNA'd atypical . .they were aprox 2.0cm each.  They were totally benign on the frozen and final pathology report during/after surgery but they found two incidental findings of papillary micro's elsewhere in the removed gland.  This happens often to people who have autoposies done (30% of the time they say it is found) but now I had to decide what to do with the other side which contains a small 4.0mm complex hypoechoic nodule .... It took 6 opinions for me to keep in the other side ( 4 to 2 ) and the other side never started to work again after surgery which happens 20% of the time .. that little tidbit they kind of breeze you thru by saying "usually" the other side works again.  So I'm on synthroid regardless.  But the good news is that after 2yrs the nodule is stable with no change; and I watch it via ultrasounds.  But it's there.

It's a tough call to make but I guess you need to really trust your surgeon and from Utah and my experiences it keeps you abreast of the possibility that sometimes this other type of microcarinomas do pop up after the fact.

Just my $.02

C~

[mlt60]

I just had my right thyroid lobe removed and it took 2 weeks to get a report.  The biopsy results were papillary thyroid microcarcinoma of a nodule that they didn't know was there.  My ENT has said that no other treatment is necessary.  I will see my Endo who I have more trust in to determine if any other treatment is necessary.
I have a question - how does anyone know if the other lobe doesn't also have a small nodule of papillary cancer?  Do I keep the other lobe in?  I was already taking thyroid medication for 20 yrs.  I do not trust the ENT who did my surgery.  Why? I just don't have a good feeling about him. I feel he cut corners and makes his own judgement calls and I am just not sure I like that.  He may be great but not for me.
MLT