# Upcoming surgery. Got questions, need answers!



## Mardiacarr (Mar 1, 2014)

Hello there! I have a few questions that I'm hoping to get answered.

I was diagnosed with Hashimoto's last October. After undergoing a biopsy because of a nodule on my right thyroid gland, it resulted as malignant. My doctors tell me that I need to have a partial thyroidectomy... Possibly a TT if they find cancer. I'm curious to know how long the procedure takes in general. Also, for those of you who had a partial become a total, how long did it take for the surgeon to find the cancer? Is it like, while they have you on the operating table, take one out, examine it, and then decide to take the other out? I'm a little confused about that part of the surgery. I felt like I would be able to get a better response from those who have experienced this... Thanks for your time.


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## Octavia (Aug 1, 2011)

Hi, and welcome!

Okay, hang on a second... you said that the biopsy resulted as malignant, but you'll get "possibly a TT if they find cancer." Um...malignant IS cancer. So was your biopsy malignant or not? If it for sure was malignant, then you need the total thyroidectomy, not the partial.

But to answer your question... during the surgery, the surgeon will send the tissue to the pathology lab for a "frozen section" examination, which is a quick look-see to check for cancer. The frozen section results are wrong (false positive or false negative) frequently enough that many surgeons don't trust them at all, unless there as absolutely, unquestionably, clearly visible cancer, with 200% certainty. My frozen section during my PT was negative. But a week later, I found out that my REAL pathology showed papillary cancer, so I had to have a second surgery to remove the remaining half of my thyroid.

Ideally, you'll avoid that second "completion" thyroidectomy. And you can avoid it if your FNA for sure shows cancer (in which case, you know going into the surgery that you need to get the whole thing out in the first place). My FNA was inconclusive, so we weren't sure what we were dealing with. Then with the false negative for the frozen section, I got the double-whammy that lead to the need for the second surgery a couple of weeks later.

But this isn't about me...it's about you. Can you find out for sure what those biopsy results were?


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## Mardiacarr (Mar 1, 2014)

Thank you for replying. The results on my biopsy is malignant. A malignant nodule on my right thyroid gland is what I've been told. I have been scheduled for a partial because my left gland is perfectly fine. The surgeon and endocrinologist have mentioned that there is a possibility that I will get a TT (this is where I'm confused) if the cancer has spread or I guess when they perform the frozen section that you mentioned. My endocrinologist said that he doesn't know if I have cancer or not... When they perform the surgery, that is how they will find out for sure. So is this a lie? A way to soften the blow? Or is this possible? Based on what I've read from others' experiences, I'd rather get the TT so that I can move on and not risk the chance of having to undergo another surgery if I only get the PT.


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## joplin1975 (Jul 21, 2011)

Usually what happens is, like Octavia mentioned, you go in with inconclusive results and the frozen section is used to determine if it is malignant or not. Since you know yours is cancer, they'll go in and see if the other side looks effected and, if so, remove that.

There's been a push lately to be less aggressive in their treatment of thyroid cancer and many surgeons are leaving a lobe in. So, it's not *wrong* nor are they lying to you, but....if I were in your shoes, I'd just insist on the total.

Aside from removing the risk of a second surgery, I think it makes getting your meds right easier (you should ask if you have antibodies and if yes, then definitely get the other side removed - antibodies mess up the results of your bold tests and make things challenging). Also, they use a blood test called thyroglobulin for long term monitoring to make sure you don't have a recurrence. Thyroglobulin is produced by thyroid cells so if you have the other side remaining, you'll always have high levels of Tg. When you leave the other side in, you are sort of stuck in a guessing game. That is, I know if my thyroglobulin is ever over 2.0, then I have a problem...the cancer is back. If you leave your other side in, there's no a cut off number that will cause concern. It turns into a guessing game wherein they say, well, the thyroglobulin is high but is this a normal high for this person or do we have a recurrence?


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## jenny v (May 6, 2012)

I may be biased because I had my whole thyroid removed, but....if you have Hashimoto's and a malignant nodule on one side, I would be pushing big time to just remove the whole thing. Here's why:

1. It is much easier to get your levels under control after surgery if the whole thyroid is gone. As you probably know, with Hashi's your antibodies can wax and wane, meaning your thyroid can go dormant and you need more medication and then suddenly it kicks into gear and you need less medication. I would think it would be easier if the whole thing is gone and you've got a clean, stable slate to start with.

2. I'm not a doctor, but where I come from "malignant" means cancer.

3. Why leave a lobe in and then constantly have to worry that cancer shows up in that lobe later on? And then you have to go through the surgery all over again.

It's definitely your choice and something you'll want to talk about with your doctors, but I would lean towards pushing for the total, IMO.


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## Mardiacarr (Mar 1, 2014)

My doctors have been a bit vague and the closer I get to my surgery, the more questions I find myself asking. 
So because I have a malignant nodule, that means I have thyroid cancer? I know my endocrinologist mentioned something about papillary... It's been a few weeks since I had been diagnosed and it was so quick and to the point and the way he phrased it made it seem like I don't have cancer. Just that there was a possibility. No one has told me straight out "you have thyroid cancer".

Also, I'm going to try to talk to my surgeon and see if I can just get a TT. I feel like I'd be better off without it based on what all have said and from the stories of others. I'd much rather undergo that then have to be a part of the waiting game.

Thank you all for your responses. It has helped.


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## joplin1975 (Jul 21, 2011)

Yes, you have cancer. It sounds like papillary, which is the most common, lowest growing, and easiest to treat.


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