# Total Thyroid next month...



## AEmedic (Nov 25, 2014)

So, I'm 43 and in the Air force. I was at the ENT last year and he says to me "do you know that you have an enlarged thyroid?" I had no idea...

Turns out that I had a 3.8 cm and a 2.3 cm nodule on the left side and two that were just under 1 cm on the right.

I had a FNA biopsy which came back to be "unlikely" cancer. But the Doc just did the larger nodule. I'm not sure why she just did the one nodule. The plan was to check them again in 6 months. I also learned that my Vitamin D level was 19.9 (treated with high dose vit D for 6 months), which is interesting because it was over 100 in a test done a few years ago...

My other levels were all normal. (Note that my TSH was .93)

8 months later, my US showed that all the nodules had grown slightly, 4 cm, 2.5 cm and the smaller ones on the right were both about 1 cm. My vit D is now 19.6 and my TSH is now .59 which is still in the normal range but dropping. The rest of my levels were still in the mid-range of normal, so nothing to note.

With the growing nodules and reaching the 4 cm threshold, I met with a surgeon who agrees that we should to a thyroidectomy, a total... I had the opportunity to discuss all that I had learned and I proposed the TT and he agreed that it was likely the best option. I got the feeling that if I had asked for a partial, he would have agreed with that as well... Not sure how I feel about that.

We blocked the 18th of Dec for the surgery.

I asked how many of these he has done and he says that he usually does one a month and that he has another one a few weeks before mine.

My primary concern is the risk of vocal cord paralysis, not that I have read about masses of folks with this complication, just because the risk is out there.

Comments, advice, thoughts?


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## Octavia (Aug 1, 2011)

With all those nodules on both sides, I think you're making the right decision to get the total thyroidectomy.

Your concern about vocal cord paralysis is valid, but that's not a common outcome. It's important for you to ask your surgeon how common it is for him/her, and make sure your comfortable with the answer.


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## Lovlkn (Dec 20, 2009)

The rule of thumb would be a surgeon who does 4-5 thyroid removals a week - experience counts here.

Can you get a second opinion from a different surgeon?


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## Octavia (Aug 1, 2011)

Oh, my. I just re-read your note and saw that your surgeon does relatively few thyroidectomies. Sorry I missed that with my first response. That's not what I would call "very experienced" when it comes to these types of surgeries.


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## jenny v (May 6, 2012)

Yikes, one thyroid surgery a month is very low. My surgeon (an ENT) did 4-5 a week. I think I would definitely look for a more experienced thyroid surgeon for a second opinion.


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## joplin1975 (Jul 21, 2011)

Lovlkn said:


> The rule of thumb would be a surgeon who does 4-5 thyroid removals a week - experience counts here.
> 
> Can you get a second opinion from a different surgeon?


This, 100%.

A thyroidectomy is not rocket science, but it does require technical skill, as you are working around a lot of vital structures.

I was the fourth TT surgery *of the day* for my surgeon. I had no complications, no issues with vocal chords (even with a very messy thyroid), and no issues with calcium. Getting a highly technically skilled surgeon is crucial.


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## AEmedic (Nov 25, 2014)

I'm not sure if I can get Tricare to change the surgeon. I will see how that process works tomorrow.

Thats kind of a bummer, I did all that waiting to see this guy and restarting the process will take awhile, but I am sure you guys are right. I don't want just anyone cutting my neck.

I did ask him about having complications and he said that he has never had any issues with vocal cords and only had one patient that had to be on calcium for a week when the parathyroid got aggravated on a messy TT. It all sounded good...


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## AEmedic (Nov 25, 2014)

I did not get another surgeon, the endo and other references in the area really like him and Tricare was not keen on changing. I felt comfortable with him so I am going ahead with the surgery next week. I am interested to know what the path report will have to say...


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