Thyroidectomy

[ceegee]

Hi,

I am scheduled for a partial thyroidectomy on the 19th for a suspicious finding from a FNAB.

Ultrasound results of 07/06: There is a 3.7 cm nodule in the right lobe and a 2.1 cm nodule on the isthmus.  These were not present on an ultrasound done 02/05.

FNA results: Follicular lesion The specimens conatain microfollicles and scant colloid.  A follicular neoplasm could not be ruled out.  Clinical correlation is advised.

Therefore the frozen section surgery. I understand all this, but in reading the ultra sound reports I found that my left lobe has increased in length from 4.8 cm in length and 2 cm in AP thickness in 2/05 to 12.7 cm in length and 2 cm in AP thickness.  That is almost 8 cm or three inches!

I go back for a pre-op appt on Wed the 13th.  Should I ask about this?  Especially since I have been on synthroid since 03/05 shouldn't my thyroid be shrinking instead of enlarging?  And finally since my left lobe seems to be growing, should I just ask for a total thyroidectomy even if the results are benign?

Thanks for your help and answers.

[Intrigue]

Yes, it's called a substernal goiter....a goiter that grows downward instead of outward.  The reason why the doctor questioned the size of your left lobe is that 12.7cm is extremely large and one that size would definitely cause significant breathing/swallowing problems.  Even at 9cm/8cm, I struggled terribly.  Could you look at your ultrasound results and confirm the size for us?  If it truly is that large and you're experiencing problems swallowing and feel a fullness in your throat, I just can't fathom how the doctor could feel justified not doing a TT -- goiters rarely stop growing (as evidenced by yours just this past year) and, if he doesn't remove it now, he'll have to at some point.

Your doctor's statement about not removing it all due to the parathyroids sounds like something an inexperienced doctor would say and that's why the other poster asked how experienced your surgeon is.  Is he/she an ENT with significant experience in thyroid removal?  If not, run don't walk to an experienced thyroid ENT.  Also as the poster said, we have four parathyroids, you only need one, and the chances of parathyroid damage actually increases as a goiter grows larger because removal becomes more difficult, especially with a substernal.  I lost two of my parathyroids due to the struggle of removing my goiter, but my other two are now working fine. Not doing a TT based solely on the reasoning of preserving the parathyroid isn't logical, especially when a patient is experiencing swallowing problems from a grossly enlarged thyroid lobe.

I'm rambling here, haha.....please do let us know what the surgeon says after your appointment!  :-)

Intrigue

[ceegee]

I do appreciate all of your comments.  I think my surgeon is  experienced.  He was recommended by my endo, and is with the same group of surgeons who did my breast lumpectomy.  He drew me pictures and told me everything that could go wrong.  I think he was leaning towards a total, but I looked at him like a scared kitten, so he said he didn't have to take it all out, but that it might have to all come out at a later date.  He also mentioned then that the only reason to not take it out would be to preserve the parathyroids, not that it would automatically damage them but it might.

It was after that visit that I looked at the ultra sound reports myself, and yes the ultra sound result does say 12.7 cm.  I don't know if that is what they meant to type, but that is what it says.  I will check that out on Wed too. The surgeon commented about the left lobe being so big and was suprised that the legions were on the right.  

I will ask for a total at my pre-op, as Charley said, "knowledge is power".

[ceegee]

I just got back from my pre-op.  I didn't see my surgeon as he is not in this week, but I did see the resident who works with him.  The resident told me I couldn't get a more experienced dr with thyroidectomies in this area.  He said my surgeon performs more than any other surgeon in the area and that he keeps up on all the new practices and such.  He said I should feel very confident in his hands.

As for the 12.7 cm.  The resident said that was correct and that my surgeon will talk to me Tuesday before the surgery and that together we can decide on a total if that is best in my case.  He seemed to think that the surgeon would not have a problem taking it all with the growth factor considered but he didn't want to speak for him.

Again thanks for all your support and suggestions, I felt very prepared for my appointment and felt I asked pertinent questions.
I also feel better about the surgery now.

[charley1986]

Hey,
So glad that you feel comfortable and know that you will have an experienced surgeon.  I know how much more comfortable I felt after asking questions and wanting to know the #'s regarding his surgeries and complications.  Knowledge is power - and you now have that relief!  Good luck to you - let us know how it goes!!!
Charley

[grandmare donna]

Hi. This is my first time on this site. I am going for a full throid surgery in October. I have a substernal goiter. My doctor has told me that they will have to open me up through my chest cavity. I have read alot of your questions and answers and haven't came across anyone having open chest surgery for this. Has anyone had this done?

[ceegee]

Had the TT on Tuesday.  Everything went well, the surgeon said it was a big big mess so he just took it all out.  Since he did take it all out he didn't do a frozen section in surgery he just sent it all to pathology.  He said he didn't think it was cancerous, but will get the results back tomorrow, Friday.

I feel pretty good, I don't have much of a voice and I have a dull headache, maybe from the anesthesia, but other than that I feel better than I thought I would.

Thanks for keeping me in your thoughts.