Update regarding my thyroid nodule...

[http://www.juno.com/~bhavaniowl]

Hi All,

Several people were interested in an update after my visit to the surgeon
today, regarding my thyroid nodule (possibly cancer).
Instead of giving all the details over and over, I decided to put it in
an email.

First I wanted to thank everyone for their good wishes and support. I am
very appreciative and touched. 

Special thanks to Bhavani for going with me to MGH today.

Here are the key points from todays meeting:

* My original biopsy was "suspicious". The suspicious category reflects
the inability to diagnose follicular 
carcinomas by needle aspiration (FNA) . A suspicious biopsy (follicular
neoplasm) will be found in 10 to 20% 
of biopsies. Ten to twenty percent of these (higher in men and in larger
nodules) will ultimately prove to be malignant.

* Minimally, I will need half my thyroid removed (left side where I have
the large nodule).

* The removed nodule will be sent to the lab (takes about 7 days). 

* Given my previous biopsy, the results from the lab will be either
benign or one of two cancers:

? Benign - 70-75% probability.

? follicular thyroid cancer 10-20% probability (most likely if malignant)
Follicular thyroid cancer occurs most often among individuals between 20
and 60 years of age and accounts for about 10 
percent of thyroid cancer cases. This type of thyroid cancer is more
aggressive and tends to spread through the 
bloodstream to other parts of the body.

Treatment for follicular cancer may include: 
? surgery - to remove the thyroid gland (thyroidectomy) 
? administration of  radioactive iodine - to destroy any remaining
thyroid tissue.

 ? papillary thyroid cancer (small possibility, but should have been
ruled out in the biopsy)
Papillary thyroid cancer is the most common form of thyroid cancer,
accounting for about 80 percent of all cases. 
This form of thyroid cancer affects more women than men.Treatment for
papillary cancer usually involves:

? surgery - to remove part or all of the thyroid (called a thyroidectomy)
? thyroid hormone therapy - to suppress the pituitary gland from
secreting more thyroid-stimulating hormone, 
which may stimulate a recurrence of papillary cancer
? administration of radioactive iodine - to destroy any remaining thyroid
tissue.

* If the lab result for the large nodule is malignant, they will remove
the remaining 1/2 of the thyroid gland that was left.
This means a 2nd surgery would be required. I had the option to remove
the entire thyroid to avoid a second surgery;
however, given the potential benefits for removing only 1/2 the thyroid,
I decided to initially to only remove 1/2.

* I have a small nodule on the right side of the thyroid.

* I had a biopsy of this small nodule today.

* If the biopsy of the small nodule is either malignant or suspicious, I
will have to have the entire thyroid removed.

* If only half the thyroid is removed:
* Likely would not have to take thyroid meds.
* Risks:
* Voice nerve (1) is severed (< 1% chance) - voice is hoarse (there are
treatment options to possibly reverse).
* Internal bleeding in the neck.

* If the entire thyroid is removed:
* Would have to take thyroid meds,
* Risks:
* Voice nerves (2) are severed (1% chance) - voice is lost (there are
treatment options to possibly reverse).
* Parathyroid gland, could effect calcium levels.  Normally temporary,
unlikely to be permanent.
* Internal bleeding in the neck.

* Currently the surgery will be scheduled approx. 6 weeks out (due to
current operations already scheduled).
I mentioned that I prefer to have it done sooner.  If there is a
cancellation it will be moved up.

* I will be staying overnight given the distance from the hospital and
the risk of internal bleeding in the neck,

That's it for now (I think that's enough, no?).

Robert