# Question about lymph nodes



## ariabel (Jul 29, 2013)

Hi everyone.. I've been stalking these boards for about a month, since I was diagnosed with PTC. I am scheduled to have a TT on 8/20.

Of course I have a million questions, but I'm getting the sense that I just have to wait til after the surgery to get most of the answers.

However, I do have questions about encapsulated nodules and also about lymph nodes.

I see a lot of people say the cancer in their thyroid is encapsulated. I was wondering how they knew this? Was this told to you after the ultrasound was done? Or was it not known until after the surgery?

Also, my doctor has me going in to have another ultrasound done on my lymph nodes so he has an idea of what may be there prior to going in for surgery. I have yet to find anyone mention this additional ultrasound, and am wondering if I'm just being charged for an additional procedure?

I'm also feeling very much like this is an unnecessary procedure. I'm hearing "It's no big deal" and "it's a simple procedure" from so many people that I'm wondering why all of this is necessary. If thyroid cancer grows so slowly, why is it so necessary to remove the thyroid? I'm so freaked out about being on medication for this forever, and also about gaining weight. I'm already a type 2 diabetic and I'm so scared I'll gain weight and the diabetes will be even harder to control!!!

Comments? Answers? I'm so annoyed by this!!!


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## joplin1975 (Jul 21, 2011)

As far as I know and understand, one cannot say a tumor is encapsulated with 100% certainty until after surgery. I could be wrong here, but there are so many limitations with imaging that I didn't get any "final answers" until after pathology was complete.

I had a lymph node mapping u/s prior to surgery. At that point, I had three nodules known to contain cancer, all over 2cms. PTC "likes" to migrate to the lymph nodes so many surgeons do mapping u/s prior to surgery when there are large and/or multiple nodules...the expectation is metastatic disease in the proximate nodes.

FYI: My u/s showed completely normal sized nodes. Once he was in my neck, my surgeon felt the thyroid looked unhealthy enough that a central neck dissection was also warranted (that is, he also removed the ten lymph nodes, five from each side, closest to the thyroid). Three of the nodes were positive for cancer, despite not showing up in the pre-op mapping u/s, nor the pre-op RAIU, nor the initial u/s.

A central neck dissection is, relatively speaking, easy. It's time consuming for the surgeon, but I had no issues from it. However, once you start doing dissections in levels farther out, it becomes a more complicated surgery with a slightly longer recovery time. Therefore, if your pre-op node mapping u/s screams "PROBLEM!!!", I'm sure your surgeon will want to forewarn you.

There's some movement be more conservative about thyroid removal. A watch and wait approach. But that REALLY depends on how far the disease has progressed. If we are talking about a 3mm spot that someone happened to hit on a FNA, it might make sense to watch and wait...it might make sense to only remove a lobe. However, if you have large and/or multiple nodules, the general advice is to remove the entire gland. While slow growing, PTC, as mentioned, does like to travel to lymph nodes. And once in the nodes, it can get into vital organs like lungs, liver, and bones. Once in those organs, it becomes very difficult to treat and people's quality of life decreases significantly (read: The Fault in Our Stars). Therefore, the idea is to "get it while it's easy."

I can honestly say popping a pill every morning hasn't really impacted me. I pop the pill and go. I did struggle with weight after my TT but that is only because I was started on an obscenely low dose of synthroid.  Ask your surgeon about his/her plans for post-op medication, Properly medicated, people without thyroids don't have much difference in every day weight struggles as people with thyroids.

I hope that helps!


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## ariabel (Jul 29, 2013)

Thanks for the quick reply  It's nice to have someone to talk to about this because my friends all seem to "know someone who had thyroid cancer and it was no big deal." I'm so sick of hearing that!!!

My nodule is 2cm. There is another tiny one on the other side

I'm scheduled for the ultrasound tomorrow, and the surgeon told me to call him Friday so he can give me the results - so at least I only have 2 more days to wait for that.

So here's a really vain question - when they ended up doing your neck dissection, did the incision get a lot bigger? I was told mine would be no bigger than 2".


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## joplin1975 (Jul 21, 2011)

No, not for the central neck dissection -- it's quite small. It's certainly not over two inches. On the 29th, it will be two years since the surgery and you can barely notice it. (I can take a picture if it'll make you feel better!) Just make sure your surgeon uses glue or stitches -- no staples! -- and you'll be pleasantly surprised.

With the more extensive neck dissections, some times the scar is larger. There are all kinds of "levels" if dissection as as you get farther away from the central area, the incision some times has to be bigger. I would be VERY surprised if you needed anything more than a central dissection, if that.


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## mombg20062009 (May 4, 2013)

I also had an ultrasound/FNA on 2 lymph nodes before surgery. The FNA showed no cancer, but I did end up with 7 out of 10 lymph nodes taken out during surgery to be found with cancer. After the RAI, I had another ultrasound where I was found to have 2 additional lymph nodes that are suspicious. Now, I am being referred back to the surgeon for more surgery. So, my point is hopefully they will be able to find any "abnormal" lymph nodes to remove during surgery so that you won't have to have additional surgery later on! Good luck. I know how hard it is to wait!


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## ariabel (Jul 29, 2013)

It is reallllly hard to wait. I had the ultrasound yesterday, and the office told me today they already have the results - but of course I have to wait for the doctor to give them to me. My stomach is in knots!

It seems like most of the time the surgeon really doesn't know what is in there until they go in.. so I don't know what the real effectiveness of the US is. Hopefully they do find something (or nothing!) so I will not have to have more than one surgery.

I'm confused, though...If they don't take out cancerous lymph nodes wouldn't the RAI kill them without surgery?


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## joplin1975 (Jul 21, 2011)

Yes, generally, RAI will kill remaining cells.

With that said, the more cancer left, the more radiation they use. The more radiation, the higher risk for secondary cancers and other side effects. So there's a balancing act there...the ideal is to remove as much as possible surgically, and then use as little RAI as possible.


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