BlisteringSh33p

The Big Day

Well, today's the day. I go in for a total thyroidectomy. I had been having pain in my arm which led me to an orthopedic surgeon. He diagnosed it as a cervical nerve problem. He ordered a MRI to confirm the diagnosis and pinpoint the location. On the MRI they spotted a mass on the left lobe of my thyroid gland. An ultrasound showed that it was not a cyst (if it had been, then it would have been known to be benign). Off to my "regular" surgeon, who performed a needle biopsy (they insert a large needle through the skin into the mass under ultrasound and suck out bits). The needle biopsy pathology report came back as "highly suspicious" with two types of possibly cancerous abnormal cells present. If the biopsy had been benign, they would only have removed the one lobe, just to make sure that it didn't enlarge in the future and cause difficulty swallowing or breathing. But the suspicious findings indicate a removal of the entire thyroid gland. This means synthetic thyroid hormone therapy forever. In addition to the normal possible complications present with any surgery, this one has some added bonuses:

• Possibility of damaging the laryngeal nerve that goes to the voice box. If damaged, it causes a hoarse voice, likely permanent.
• Possibility of damaging the parathyroid glands. These are small glands just behind the thyroid that control calcium absorption. If damaged, calcium isn't absorbed efficiently resulting in the need to take large doses of calcium supplements, again forever.
• Possibility of traumatizing the parathyroid glands. This is a little more common, with the effect of needing the calcium supplements, but only for a limited period of time.
• Bleeding is more dangerous. Unlike the abdomen which has a large cavity for any internal bleeding to enter, the neck is a small enclosed space. Internal bleeding there builds up and constricts the airway.

The current tentative diagnosis is papillary carcinoma. This is a very survivable cancer, with a long-term mortality rate not too much different from the general population. The actual final diagnosis can't be made until the full-tissue biopsy of the removed gland is performed. If it does come back as cancerous, there will be treatment with radioactive iodine. The thyroid gland has a large affinity for iodine. So the iodine will be absorbed by any leftover glandular cells that either weren't removed (it's not possible to get every cell) or that have migrated anywhere else. They will also be able to detect (via the radioactivity) if there are any cells which have migrated.
All in all, I've been pretty okay with it. I know intellectually that this is not a rare condition and that it has a good long term prognosis. But it's still difficult to not be weirded out about having the dreaded C-word somewhere in my body. I also worry about being able to get health or life insurance if I change jobs. That's in addition to the worry about causing anxiety in my wife, my kids and my family.

Labels: medical, surgery

posted by Sh33p @ 00:41