Fatigue and sore throat

[prncsstoo2]

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

[utahmomma]

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!

[prncsstoo2]

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.

[utahmomma]

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