# Should I get a second opinion?



## LN_1963 (Jun 23, 2015)

Hello all--

I am brand new here. 

A week ago, I got the completely unexpected news that my FNA came back 95% that I have thyroid cancer.

My doctor works out of Virtua in South Jersey-- but we live close to Philly and I am now wondering if it is worth a 2nd opinion at Penn Medicine. They would have to repeat the biopsy.

Any experiences out there to share?

Lisa


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## Andros (Aug 26, 2009)

Welcome!! Sure ................................Or get a second pathologist to read the original.

Gosh; kind of scary isn't it?

We are here to help and support you best we can.

Others will be along.


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## Lovlkn (Dec 20, 2009)

I wouldn't bother with a 2nd and just have the thyroid removed.

Most FNA's seem to be inconclusive or cancer - there is rarely a beneign report.

Start looking for a surgeon that does 4-5 thyroid removals a week. I used a general surgeon specializing in endocrine


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## LN_1963 (Jun 23, 2015)

Lovlkn.... I like that idea. I am starting to think why not go to the best surgeon... We live right on top of center city Philly.... There has to be someone there with lots of experience. I'm getting a little nervous.

I has another US today to rule out neck mestastis. --- ugh I cannot spell it!

So how do I figure out who?


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## Lovlkn (Dec 20, 2009)

Research general surgeons - at the largest group in Philly. They likely have a endocrine specialist.

My surgeon was new out of residency - had done 500 thyroid surgeries and was trained at the Cleveland clinic. I had a friend who is a nurse anesthetist and she recommended her.

Try this site to locate one in your area. My surgeon was listed #1 for my area so naturally I feel it is a reliable site.

https://www.endocrinesurgery.org/membership/findmember.html


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## LN_1963 (Jun 23, 2015)

Thank you... There is a Penn Medicine guy. Their thyroid center seems to come up often.


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## Lovlkn (Dec 20, 2009)

My suggestion when you meet your surgeon is to have answers to most, if not all of your questions already answered.


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## LN_1963 (Jun 23, 2015)

Lovlkn said:


> My suggestion when you meet your surgeon is to have answers to most, if not all of your questions already answered.


Can you explain what you mean??


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## creepingdeath (Apr 6, 2014)

Mercy Philadelphia Hospital has an Endocrinology team.

Might be worth looking into also.


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## joplin1975 (Jul 21, 2011)

LN_1963 said:


> Can you explain what you mean??


It should give you a good indication of how technically competent the surgeon is.

An easy example is that if they say they use staples to close the incision, you should run. You'll ask the questions and you'll know what answer you want to hear. Another easy example is that if you ask who will handle your post-op meds and they tell you its up to you to find an endo or an ENT or whatever, they aren't giving you complete care. The person who took your thyroid out and therefore made you surgically hypothyroid should be making sure you are cared for after the procedure.

I'll try to go back and edit the other post re: questions with that you should be hearing from a good doctor.


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## LN_1963 (Jun 23, 2015)

Thank you! I see what you mean now.


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## Lovlkn (Dec 20, 2009)

LN_1963 said:


> Can you explain what you mean??


Questions to ask your thyroid surgeon...

Such as.....

How many thyroidectomies do you perform weekly.

Do you use a drain tube? ( good to know - not all do) I did not have a drain tube.

How large will my incision be? This answer can be anywhere from less than 1" ( like mine is) or several inches. Older surgeons make larger incisions. My surgeon was trained minimally invasive only at the Cleveland Clinic.

Do you staple or use glue only to close the incision? I had glue and steri strips.

Have you ever cut a vocal chord? It is a risk - might as well throw that out there and see how they respond. Sometimes a vocal chord will be damaged when they cut the thyroid out as they are very close. Don't worry yourself about it though.

How long will I be in the hospital ( it's usually outpatient but you do spend a night to monitor calcium levels)

Your endo will prescribe replacement med's and because you may have to also do RAI to kill off any remaining cells it will be a good idea to know what they will allow as far as replacement medications from surgery to RAI dose.

Clean your house well before surgery - shop and keep meals in the freezer. I cooked a full dinner the day after my surgery - then all the thyroid hormone burned off and I felt nailed to the floor - you have to prepare for the worst and keep your spirits focused on the positive. Fatigue post surgery was my main complaint but my issue is different than yours - Graves/Hashi's happening at the same time.

All in all - it was a fairly easy surgery - Stay positive!!


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## LN_1963 (Jun 23, 2015)

Lovlkn said:


> Do you use a drain tube? ( good to know - not all do) I did not have a drain tube.


I am SO glad I came here-- such GREAT questions. So what is a drain tube and why is it used? THANKS!


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## Lovlkn (Dec 20, 2009)

LN_1963 said:


> I am SO glad I came here-- such GREAT questions. So what is a drain tube and why is it used? THANKS!


The tube actually sticks out of the incision so fluid can drain out. I don't understand how some use it and some do not - my surgeon did not.


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## VFRgrl (Feb 15, 2015)

My surgeon did not handle my post surgery care (medications) and I consider her to be a pretty good/experienced surgeon- so I don't necessarily think this makes a surgeon not qualified. She was and is in direct contact with the endocrinologist who is handling my post-surgery medications though.

I did not have a drain.

My incision is quite large (about 3"), but I don't think it is because of the skills (or lack of) the surgeon- I had a 8cm tumor on the left lobe of my thyroid that was also substernal and displacing the trachea.

I was in the hospital for 2 nights because my calcium levels were very low


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## joplin1975 (Jul 21, 2011)

VFRgrl said:


> My surgeon did not handle my post surgery care (medications) and I consider her to be a pretty good/experienced surgeon- so I don't necessarily think this makes a surgeon not qualified. *She was and is in direct contact with the endocrinologist who is handling my post-surgery medications though*.


Bolding mine -- I think that's the important part. My surgeon isn't handling my post-op meds either. However, he would not discharge me from the hospital until he had a documented plan on who would handle the meds. There have been posters on these boards who were not set up with an endo/ENT/whomever and the surgeon would not prescribe any replacement meds. I strongly feel that the person who is responsible for removing your thyroid is also responsible for making sure you have appropriate post-surgical care.


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## Lovlkn (Dec 20, 2009)

Surgeons do not prescribe or manage post op replacement medications.

Think about it - surgeons operate. When they have you in their office they are determining if/when/how to operate on you only.

Thyroid surgery patients are usually if not always referred so it is the referring doctors job to prescribe and manage replacement med's.

For the record - I fired my endo and 2 other endo's post TT due to their incompetence on prescribing replacement med's and keeping me in a hypo state despite significant hypo symptoms.

Then I tried 2 GP's and eventually ended up with a OD - but I did show up to him with what I have been taking for the last 5 years.


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## LN_1963 (Jun 23, 2015)

Lovlkn said:


> Surgeons do not prescribe or manage post op replacement medications.
> 
> Think about it - surgeons operate. When they have you in their office they are determining if/when/how to operate on you only.


I partly liked Penn Medicine already because of the connection... when I called to arrange seeing the surgeon, they told me two things that I liked: 1- that she only treats Thyroid Nodules and Thyroid Cancer... any other diagnosis they would find the patient another doctor. 2- they HAD a whole bunch of my records already because the Endocronologist I went to was alos Penn Medicine..

Those two things made me feel positive about the facility and the surgeon (so far)


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## jenny v (May 6, 2012)

I did have a drain and it was a small hole about a half inch away from the end of my incision on one side. It was only in overnight after surgery and it was removed before I left (which was so, so gross). My surgeon believed that drains helped reduce the swelling in the incision area and helped with healing. My neck was still swollen but it wasn't anywhere near as bad as a lady I work with who had a TT, too. My scar is about two inches long, but the surgeon had to make it a little wider than usual due to the size of my swollen thyroid.


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## visc (Feb 22, 2014)

Disclaimer: Never had a TT.

Just throwing this out there... Dont forget there are 4 very important glands attached to your thyroid called parathyroid glands. They regulate calcium among other things.

Thank god they are attached at different locations, I.e. you could loose one or two and you'll be alright. But if you damage them really good than you are in for it, taking calcium tabs every 4 hours or whatever.

Don't be afraid, a surgeon doing hundreds of TTs a year will probably do a very good job. Plus its their job on the line.

Just ask about the parathyroid glands, tell them you need to keep those at all costs. They'll chuckle and talk to you about it I'm sure.


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