thyroid nodules

[wolfnuff]

I recently had a thyroid scan that showed that I have thyroid nodules.  I had a needle biopsy which indicated they are not cancerous.  The nodules are not producing any symptoms at present. I am taking .025mg of daily synthroid. I am thinking of having the nodules removed.  What are the major pros and cons of of surgery of this type and could these type of nodules become cancerous in the future?    

[MANmom]

Hi, There have been lots of changes since this post, I have since found out that the right side contained two Microcarcinomas, papillary cancer, less than 2 mm each (size of the ball on the end of a sewing pin).  Since that diagnosis, I have been told by the ENT not to remove the other side, to watch and wait.  My surgeons told me "take it out!" (all three surgeons!).  We did remove the other side, the big tumor was found there.  The big tumor was 1.5 cm (think big marble), that put me in the radioactive iodine ablation category to kill the remaining tissue.  When the surgeon removed the nodules, he knew I was a singer and a voice coach and left a thin film of tissue around the vocal nerves to protect my vocal function.  He also used a nerve monitor, ask your surgeon if he uses this, there is not a lot of data that it works, but hey, its our life, right?  Because the cancer was actually found in the thyroid tissue and NOT in my nodules, we have to kill off any remaining tissue to make sure I do not have a recurrence.  So I am being starved of synthetic hormone and feeling crappy until I get RAI in late July.  Since the first surgery, I have had good vocal production, like I did not have anything wrong.  The second surgery went much the same, I did not have any touble vocalizing after either surgery THANKS TO MY SURGEON who was the lead Otoaryingology doctor at Naval Hospital where I am being treated.  I have not been feeling like singing too much, but what I have done has been fine.  When I am through with the ablation, I hope to rejoin my semi-pro choir in the fall and restart my lesson schedule in mid-August.  I suggest if you are having surgery to FIND THE BEST POSSIBLE SURGEON YOU CAN, ONE WHO  DOES AT LEAST 50 SURGERIES A YEAR.  Make sure it is he/she who is actually doing the surgery (ask before they put you under!) and also it is helpful to see a speech therapist prior to surgery to discuss which vocalizations to start with when you feel well enough to resume singing (I started mild scales after four or five days).  Keep everything in the "mask", in the front of your mouth...sing scales with a "raspberry or pursing your lips lightly, bbbbbbb...I think you know what I mean.  Also with a whhhooo like sound with lots of air.  I do these when I am out walking in the morning (people must think I am crazy!) and this so far has kept me in voice.  I hope if you do have surgery it will go well, and that you stay in voice!  It was very important to me.  I have a friend in my choir whose mom had ThyCa and had a TT, sang for another 40 years after that until she died...I WANT THAT TO BE ME!  'Course, that would make me 85... =)  Also, they will check your vocal chords if thay have not already, mine were in beautiful shape...which I already knew...I was classically trained, they should be in great shape!  Glad I didn't waste all that money!

[Vocaleest]

I had just been told I have two large(one on each side) and one small nodule in the middle.  In three months I am to see a surgeon - I am also a singer and vocal coach and wanted to know how it affected your voice and how soon were you able to sing again assuming you know how to sing properly with your diaphragm?  Can you let me know?  I would really appreciate it as this is my job.  Thank you

[MANmom]

If the nodules are not producing any symptoms, i.e., swallowing difficulties, hoarseness, I would not do anything except watch them.  I just had my right lobe removed last week, my nodules were large (2.1 cm and under), vascular and solid, the biopsy could not rule out cancer.  I was also having difficulties swallowing and had some hoarseness, and as a singer, I decided to have them taken out, at least three of the four.  My left is still in tact, and there is still a 1cm nodule there, we will watch it and wait for the final biopsy on the three that were removed.  If there is any cancer, of course, the other half will have to be removed.  How big is your nodule?  Do you really want to take out the whole thyroid or just the part with the nodule?  Are they trying to shrink it?  Is is cystic, solid, fluid?  All these things need to be considered.  If you do choose surgery, it is not to bad, mine was easy except for nausea, but after 5 days, I am feeling fine, walking 3 miles, a little tired, but I am one of those who can't sit still.  Nearly no pain.  Don't worry about the surgery, the most important thing is to get a GOOD surgeon.  Get one that does at least 50 thyroid surgeries a year.  The more experience the better.  Good luck!

[goolarra]

I have never heard of anyone just having nodules removed (doesn't mean it doesn't exist).  The usual procedures are a total thyroidectomy or a partial thyroidectomy (often just one lobe).

Do you have Hashi's?  Have you had the antibody bloodwork done (TPOab and TGab)?  Most people with Hashi's have nodules, and the nodules are just watched to make usre they stay consistent with Hashi's.  If you have high antibodies, and you have part of your thyroid removed, it's most likely that you would develop more nodules in what's left of your thyroid for the same reason you developed the first ones - the antibodies.

I'm sure there's no guarantee that the nodules cannot become cancerous, but lots of people keep their thyroids for the rest of their lives, nodules and all.  My endo says he doesn't recommend removing the thyroid unless there is confirmed cancer or the situation is "dire", e.g. a goiter so large it's affecting swallowing, etc. or a hyper condition uncontrollable with meds.

It sounds like you caught your thyroid problem early.  You're on a very low dose of Synthroid.  The medication should help minimize future nodules since your thyroid won't have to try to work so hard.

Hope this helps...good luck,