Saw The Surgeon

[JLWH]

I saw the surgeon today about my thyroid nodules and the biospy results and would like your opinions.  

First of all, I am in Canada and we don't tend to get our pathology reports the way that U.S. patients do.  But, here is what I was told today.

My first biopsy in Nov. of 2006 on a 1.9 cm partially cystic cold nodule (multinodular goiter the others came back as hot nodules) came back as "normal thyroid cells".  May, 2007, follow up ultrasound, no change in size.  May 2008, "slight growth".  Another biopsy done in August 2008 showed some follicular cells and a couple of Hurthle cells, which was assessed as 95% probability of being benign (not sure if that was on the pathology report or surgeon's interpretations).  All clinical factors favor benign.  

Here's where I'm wondering what I should do.  This surgeon (over 2000 surgeries under her belt over a 15 year period...I asked that much!) said that at this point in time, she favored doing a repeat ultrasound and FNAB in Feb. 09 (6 months after the last biopsy done this year) and see whether there was any further growth or any changes in pathology since one had come back normal cells and this one with "atypia" and since she felt that the chances were only 5% for malignancy given all of the criteria (pathology and clinical, history etc..)  She said that while the only definitive way to rule out that 5% was to do surgery, she felt that doing surgery now was not urgent and could very safely wait that 5 months for another US and FNAB.  IF at that point, there was more growth or pathology that concerned her, she would put me into surgery at that point.  Right now, the waiting time for surgery on this type of pathology and clinical evidence was 3 to 4 months, which would be in Jan. at the earliest anyways.  

So, she has recommended and booked in another US and FNAB first week of Feb./09 and an appointment for 2 weeks later with her for the results.  She said that there was no difference to my safety in waiting that extra few weeks beyond a surgery date to have this biopsy and US done and that if it showed anything different at that point, she could schedule in surgery at that point very quickly.  ????   She did say that IF I was a nervous wreck and would fret and stew for those months, I still have the option of going ahead with the surgery in January but, there was no urgency to this nor, danger to my safety in waiting unless it was mentally draining for me to wait and see.  

I'm not sure what to make of this.  I have asked for a second opinion with another surgeon but, thus far, there has been no appointment set from his office.  

Any opinions?  

[JLWH]

Great idea Utahmom!  Didn't think of that before and you're right!  Any type of cancer and there is no way that I would get it.  

Off to bed for me now too!  :-)  

HUGE HUGS right back at ya!

[utahmomma]

Do get some sleep.  You'll be okay.

Hey, some sage advice that I shared with my sisters before their surgeries???  Since you don't know whether the nodules are benign (fingers crossed!!) or not (god forbid) - this would be the best time ever to look into life insurance.  If (and I hope not) they do find cancer during the surgery or on your next FNA you will not be able to get it.

Not that I sell insurance or anything but it's something that most people don't' think about with this stuff.  Luckily my sisters listened - especially for the three who did find out they have cancer.  My youngest sister (the one with three recurrences) almost didn't get the insurance but is so glad she did now since she now has a toddler and a baby on the way.

Just something to think about.

GET SOME SLEEP (for all of us!)  :-)

Hugs

Utah

[JLWH]

HUGE SIGH OF RELIEF, Utahmom!!!!!!!!!  THANK YOU!!!!!!!!!

I was uncertain about it but, she was SO reassuring that I was in NO danger in following this plan of action and said that unless it was a danger to my mental health *smile...long gone already!* to wait, that was what she recommended and again, reassured me that even if I was one of that 5%, these few months were not any more of a danger to me and my overall outcome, given all of the testings and criteria that were there.  

THANK YOU, Utahmom!  HUGS

I may just get some sleep tonight!  

[utahmomma]

There isn't a problem waiting a few months.  Many of us (in the US) have to go through similar things with our insurance, scheduling a good surgeon (not to mention finding one), scheduling OR time, taking time off work, etc.

Push for the 2nd opinion (it never hurts) but your surgeon you spoke with *is* following proper protocol.

[JLWH]

I should add that she also took into consideration the characteristics of the US and how the nodule presented itself on the US.