I wrote about my thyroid surgery at the beginning of June and haven’t talked about it much since. A lot has happened since then and we finally have all of the answers that we will have for now.
It’s a long story…so here’s the short version. In the words of my surgeon – cancer is a scary word, you had thyroid cancer, we removed it and you are going to be ok… By definition, thyroid cancer is cancer, but it doesn’t spread as easily and is treated differently. Thyroid nodules are common and 95% of them are benign.
The beginning part of the summer and now the rest of the story.
When I scheduled the initial appointment with the surgeon they told me that they would need the slides from my fine needle aspiration biopsy. There wasn’t time to have them transferred so I had to pick them up. The pathology lab at the hospital where I had the initial procedure is in the basement…in the same hallway as the morgue. When you picking up your own biopsy slides to hand carry to a surgeon to discuss your future, let’s just say that experience didn’t make me feel any better.
Scott went to the surgeon with me and the appointment started with a brief exam and then she sat down and asked if anyone had discussed the pathology report with me (I only knew there were concerns, but nothing specific from the test). She went on to explain that the results were inconclusive but they were rated into percentages and I had some level of choice in how we would proceed.
For the samples on the left side where there were several 1 cm nodules, there was a 10-15% chance there was cancer so I could have done molecular testing to confirm and if the testing was negative I would have needed to be tested every year to ensure there weren’t any changes. However, there was a 3 cm nodule on the right with a 70% chance of cancer. And I could have still chosen additional testing at this point, but the risk wasn’t worth it. I quickly decided that surgery was the only choice that made sense.
The surgery went as well as it could – my entire thyroid was removed, along with a small sample of one parathyroid, and some lymph nodes to be tested. The surgeon talked to Scott after the surgery and told him that she would be surprised if it wasn’t cancer. The biggest risk factor in thyroid surgery is damage to one or both vocal chords – I was very happy to wake up and find that my voice had not been impacted. I spent one night in the hospital and went home the next day to rest and recover. I started my thyroid hormone replacement pills which I will take as soon as I wake up every day for the rest of my life.
One week after surgery I returned to the surgeon’s office for a follow-up. She assured me that my incision looked good and we went over the cytology report. None of us were surprised that the large nodule on the right was cancer, but I wasn’t expecting to hear how widespread it was – 8 samples throughout my thyroid. So removing it was 100% the right decision. On the positive side, the parathyroid and lymph node samples were clean.
I left that appointment with a plan to discuss next steps with my new endocrinologist.
Treatment for thyroid cancer can take two paths:
1 – Remove thyroid and treat with radioactive iodine – the iodine will be absorbed by any remaining thyroid cells and poison the cancer. Iodine is not absorbed by any other organs so it is an efficient method of dealing wth any remaining cells.
2 – Remove thyroid and monitor
My endocrinologist ran some blood tests including a thyroglobulin test to measure the amount of thyroid tissue remaining in my body. The levels came back incredibly low. That result combined with the fact that the cancer was discovered and removed before age 45 (barely) means that we are taking approach number two. My thyroglobulin levels will be monitored and I will have annual ultrasounds – if either of those tests indicate that thyroid tissue is increasing then radioactive iodine is still an option at that point.
I had my three month post-op appointment with my surgeon last week and she declared that my neck is healing as it should and discharged me as a patient. My TSH levels are on target which means the medication is working and my calcium levels are normal which means that my parathryoids are still functioning correctly. I have an ultrasound scheduled for next summer and in the meantime I get back to normal life.