# Surgery - what questions do I need to ask?



## CMantz (Jun 4, 2010)

I am meeting with a surgeon on Friday to discuss surgery.

I had a RAIU two weeks ago and it showed that I have a cold nodule. I had a ultrasound last week. The impressions from the test say "Multinodular goiter. The largest nodule is in the lower pole of the left lobe measuring 14mm x 14mm x 12mm and containing internal color flow."

My endo suggests surgery as the first choice due to the chance that it could be cancerous.

He did not rule out ATDs although he did say that I would be on them most likely for the rest of my life. He would require a FNA first and if it was not cancerous he could treat with ATDs. However, the nodule would require continually followup with FNA and ultrasounds to watch for any changes. Not to mention that long term ATDs could cause liver issues. At some point the ATDs could stop working and I would require surgery and depending on my age at that time, surgery would pose more risk.

Another option was RAI but again, I would require followup with FNAs to make sure there are no changes and he did say after RAI, the cells would become atypical and would therefore make it harder to distinguish them from cancerous cells.

So, it looks like surgery would the best option. They would do pathology at the time of surgery and depending on the results I may have to do RAI afterwards. After surgery I would be released to my primary care doctor to due labs and prescribe thyroid replacements.

What questions do I need to ask the surgeon when I see him on Friday?

Thanks for any input
Chris


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## desrtbloom (May 23, 2010)

I have an appointment with my surgeon on Tuesday and would like to know the same. Also, I would like to know what you do to prepare for the surgery. I was told ten days prior you are put on medication, but is there anything else? Is it just one medication?

Thanks!!!

Patti


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## Lovlkn (Dec 20, 2009)

1. How many TT do you perform weekly? (answer should be 4-5)
2. Will you put me on SSKI drops prior to surgery? (they make the thyroid less vascular and easier to remove)
3. How big will the incision be? (don't want any surprises here, an incision for a TT can be 1" to 4"+)
4. How will they close the incision? (internal stitches and glue, external stitches or staples)
5.Will they send you home with your replacement medications or can he write you the prescription before you leave the appt?( ask for the dose based on your weight 1.7mcg of replacement per kilogram of weight, replacement should be started within a week of surgery)
6. Have they had any complications with their surgeries? (ask the obvious and see what answer you get - complications can be a cut vocal cord which is rare but it does occasionally happen - look for a reaction)
7. How many days will I be in the hospital (considered out patient with an overnight recovery most times)
8. What restrictions will there be? (usually driving until you are off pain meds)
9. What pain meds will I be taking (to be sure you are not allergic to anything they might prescribe, Stay ahead of the pain and take them often the first 2 days post op then you should be able to go to Motrin)

I think that about covers it.

Please let us know how you are doing after your surgeries.

Lovlkn


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## Andros (Aug 26, 2009)

CMantz said:


> I am meeting with a surgeon on Friday to discuss surgery.
> 
> I had a RAIU two weeks ago and it showed that I have a cold nodule. I had a ultrasound last week. The impressions from the test say "Multinodular goiter. The largest nodule is in the lower pole of the left lobe measuring 14mm x 14mm x 12mm and containing internal color flow."
> 
> ...


Chris, you lucked out with a most knowledgable and caring surgeon. You will be spared much angst and inconvenience not to mention probably never really feeling well. So getting the thyroid ablated (surgical removal) is your best option, I personally believe.

I did not have surgery, therefore I am not in a position to help you with questions but plenty of others here will be able to help with that.

Is a date set?


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## CMantz (Jun 4, 2010)

Thank you Lovlkn for your list of questions. Some I hadn't even thought about particularly the SSKI. Also Andros, thank you for your support.

I will post tomorrow after the appointment to let you know my thoughts on this Dr.


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## Andros (Aug 26, 2009)

CMantz said:


> Thank you Lovlkn for your list of questions. Some I hadn't even thought about particularly the SSKI. Also Andros, thank you for your support.
> 
> I will post tomorrow after the appointment to let you know my thoughts on this Dr.


You are welcome.


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## desrtbloom (May 23, 2010)

Thank you sooooooooo much for the questions!!! You guys ROCK!!!

Patti


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## hillaryedrn (Dec 14, 2009)

Awesome information guys!! You will get a good feel for your surgeon in the initial appointment. If you aren't comfortably with him/her, find someone else. There really isn't any 1 way to decide if they are right or not, but you will know. See how they react to you asking questions. Do they stand up against the wall away from you, or are they seated and looking at you? Just little things like that. I'm not saying that you need to be best buds with your surgeon, but this person is going to be cutting on you, and I'd think you'd want to be comfortable with them! LOL!


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## CMantz (Jun 4, 2010)

I met with the surgeon today and it went really well. I have to decide if and when and get back to him.

We pretty much covered all the questions. He said he usually does 4 TT a week and he said those patients with GD are more difficult surgeries do to the nature of the gland....he described it as being "mushy" and can tend to be bloody.

He immediately discussed risks with the primary being the nerve damage which he had an issue with on a surgery just yesterday. He said if a surgeon tells you they have never nicked a nerve then he feels like they are probably leaving alot of tissue and not doing a good job. He is also a specialist in speech issues so if there is an issue with vocal cord damage there are some procedures that he can do to help elevate the issue.

As far as incision, he said it all depends on the size of the gland. Mine is about 5" wide. And since I don't have wrinkles yet, it will be noticable for awhile. He glues his incisions. Pain is minimal but he will prescribe narcotics if needed.

He spent over an hour with me. I didn't feel rushed and he had a great "bedside manner".

He said my nodules were not too big and I could stay on meds but it would take continued followup every year. If it hadn't been for my nodules he would not even recommend surgery.

I have made an appointment with another surgeon in St. Louis and I see him on 7/15. In the meantime I will probably schedule the surgery for 7/20 here...I can always cancel it.

But for now...I am not going to worry about it too much. I am going on vacation next week and want to enjoy it. I probably won't get to Hawaii again any time soon. The whole family is going and the kids are super excited. Going to Kauai...can't wait.


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## Andros (Aug 26, 2009)

CMantz said:


> I met with the surgeon today and it went really well. I have to decide if and when and get back to him.
> 
> We pretty much covered all the questions. He said he usually does 4 TT a week and he said those patients with GD are more difficult surgeries do to the nature of the gland....he described it as being "mushy" and can tend to be bloody.
> 
> ...


Wow! Hawaii!!! I have always wanted to go. Have a blast!

Surgeon sounds really good. You are smart to talk to another. This way you have something with which to compare!


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## hillaryedrn (Dec 14, 2009)

Sounds like you have a great handle on things! Enjoy vacation!


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## Lovlkn (Dec 20, 2009)

CMantz said:


> I met with the surgeon today and it went really well. I have to decide if and when and get back to him.
> 
> We pretty much covered all the questions. He said he usually does 4 TT a week and he said those patients with GD are more difficult surgeries do to the nature of the gland....he described it as being "mushy" and can tend to be bloody.
> 
> ...


So what did he say about putting you on SSKI drops?

Pain will be severe the first 24 hours (but you're in the hospital all doped up so you won't feel it) and moderate the 24 hours after that - be sure and get the pain pills.

The only reason I know the pain was severe is because my nurse never came back to give me pain meds 10 hours after my surgery and I went all night without any - ouch!

Have a great time in Hawaii!


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## CMantz (Jun 4, 2010)

He said he doesn't do the SSKI drops. He didn't feel any meds before surgery would be necessary since I have been on MMI and would be "normal" by the time of surgery.

I am seeing another doctor in St. Louis on 7/15.

Honestly the way I feel today...I don't give a crap what happens. Just someone tell what the hell to do and I'll do it. I couldn't even decide what I wanted for lunch today...how the hell am I suppose to decide what to do about my damn thyroid.


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## CMantz (Jun 4, 2010)

Well I am relunctantly back from Hawaii :sad0049:

Yesterday I met with another surgeon. This one is from Wash U (St. Louis). I am about 2 hours from St. Louis but this surgeon and Barnes Hosp is in my network, I have decided to have the surgery there. Might as well considering they are highly ranked nationally.

Basically this surgeon does a near TT. They leave a little tissue near where the nerve connects to the vocal cord so as to reduce the chance of damaging the nerve. He said it has been 8 or 10 years since he last had a surgery in which he damaged the nerve. He does 1000's of these surgeries so I feel very confident in his abilities.

He will put me on the SSKI drops 7 days prior to surgery. The incision should only be about 4-5 cm.

Now it is just a matter of getting it scheduled. I am ready to get this behind me.


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## Andros (Aug 26, 2009)

CMantz said:


> Well I am relunctantly back from Hawaii :sad0049:
> 
> Yesterday I met with another surgeon. This one is from Wash U (St. Louis). I am about 2 hours from St. Louis but this surgeon and Barnes Hosp is in my network, I have decided to have the surgery there. Might as well considering they are highly ranked nationally.
> 
> ...


Whooooooooooooohoo!! And I trust your trip to Hawaii was magnificent?

Please let us know when you are scheduled. Glad you are going on Lugol's so you don't dump!


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## CMantz (Jun 4, 2010)

Yes Kauai was fabulous. Funny thing is that I never really thought going to Hawaii was that important to me. There were so many other places that I thought seeing would be more important...Europe, Ireland, Rome, etc.

But let me tell you...the North Shore of Kauai was unbelievable. I feel in love and can NOT wait to get back there. The weather was great (we didn't even sweat for 7 days) even with the daily rain showers. The scenery was GORGEOUS. The town of Hanalei (made famous by Puff the Magic Dragon) was soo cool. I have been telling people that I want to become a hippy and live on the beach in Hanalei. The only drawback was it is EXPENSIVE there. I couldn't believe the cost of groceries! The cost of living there is very high. People moving over there now can't afford to by a home. The run down (and I mean really run down) start at 300-400k. The people that have been there 30+ years are lucky enough to own homes. But the majority of the people are land rich and cash poor.


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## Andros (Aug 26, 2009)

CMantz said:


> Yes Kauai was fabulous. Funny thing is that I never really thought going to Hawaii was that important to me. There were so many other places that I thought seeing would be more important...Europe, Ireland, Rome, etc.
> 
> But let me tell you...the North Shore of Kauai was unbelievable. I feel in love and can NOT wait to get back there. The weather was great (we didn't even sweat for 7 days) even with the daily rain showers. The scenery was GORGEOUS. The town of Hanalei (made famous by Puff the Magic Dragon) was soo cool. I have been telling people that I want to become a hippy and live on the beach in Hanalei. The only drawback was it is EXPENSIVE there. I couldn't believe the cost of groceries! The cost of living there is very high. People moving over there now can't afford to by a home. The run down (and I mean really run down) start at 300-400k. The people that have been there 30+ years are lucky enough to own homes. But the majority of the people are land rich and cash poor.


I have always wished to go there and I am glad I could share vicariously in your trip. Yes; I have heard about the cost of living out there. What a shame!


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## CMantz (Jun 4, 2010)

Surgery scheduled for 8/24. Now I just get to wait.


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## Andros (Aug 26, 2009)

CMantz said:


> Surgery scheduled for 8/24. Now I just get to wait.


That is totally awesome and we shall wait w/ you. A reminder will be appreciated when the surgery date arrives so we can be on your cheering team at that time.

Are you excited?


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