# Surgery for multinodular goiter



## melissafitz (May 5, 2013)

Hello,

I am new here and am trying to figure out what is going on and if I am on the right path.

I had thyroid nodules that were first discovered about 4 years ago. At that time, there were a couple of nodules that were about 1 and 1.5 cm, along with a few others that were smaller. I had FNA biopsy and was told they were benign. About 1 1/2 years ago, the nodules had grown to 1.8 and 3.8 cm. FNA biopsy again benign. Now, a month ago, the largest nodules have grown to 2.3 and 5.3 cm. Biopsy again was fine. All along, my thyroid hormone levels have been normal (I'm awaiting results from the most recent blood test, but I am not having symptoms that lead me to believe the hormone levels are off).

My (now former) doctor had been telling me that as long as my thyroid hormone levels were fine, I should just continue to periodically have the FnA biopsies. However, after learning this time that the nodules have grown so large, I decided to go see an endocrinologist (also, during the ultrasound, the tech said that my thyroid looked like Hashimoto's, which I realize he was probably not supposed to say, but I thought I should get it checked out).

So, anyway, I had the appointment a couple days ago, and the endocrinologist referred me to a surgeon. She says that because they are large, and growing, it is possible that the FNA could have missed something. And even if they are benign, at some point they are going to start causing compressive symptoms.

This all makes sense to me . . . but, at the same time, it is not what I was expecting. Does this sound right to you? Is there anything else I should be doing or getting checked out? I wasn't able to get an appointment with the surgeon until mid-July . . . .

Thank you for listening . . .


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## webster2 (May 19, 2011)

I believe that you are on the right path. Do the nodules cause you any discomfort? They are large and seem to be growing. I am sure you will get some other responses soon. Welcome and glad you found us!


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## joplin1975 (Jul 21, 2011)

Yes, that sounds absolutely correct.

Regardless of benign vs. malignant, they will cause issues eventually. Getting it out while it still is managable seems very reasonable.

If you have copies of them, post your lab results with the reference ranges. A lot of times normal isn't completely normal.


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## melissafitz (May 5, 2013)

Thank you both for your replies. I really don't want surgery, but the rationale that was explained to me did seem to make sense. It is really helpful to get some additional input from you, though.

As for whether the nodules are causing discomfort . . . not really. Occasionally, I feel just a tiny bit of an ache where the smaller one is located. The smaller one is sort of in the middle of my neck and I can feel it and was aware of it. I was surprised to learn, though, that there was another one that was larger that I wasn't even aware of. It is sort of down near my clavicle and I wasn't even aware it was there. The endocrinologist seemed surprised that I am basically asymptomatic, given the size of the nodules . . . .

I just had my blood drawn the other day, and do not have results back yet. But my lab results last time (about a year ago) were as follows:

TSH w/ Reflex to FT4 TSH, 3rd Generation w/reflex to FT4: 0.86 (Ref range 0.40-4.50)

Thyroglobulin Antibodies: <20 (Ref range <20 IU/mL)

Thyroid Peroxidase Antibodies: <10 (Ref range <35 IU/mL)

TBII: 1 (Ref range < or = 16%)

I'll be interested to see what comes up with the latest testing. I'm glad to have an endocrinologist do the testing this time . . . the previous testing was all done with my GP.


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## Octavia (Aug 1, 2011)

I agree that you are on the right path.


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## melissafitz (May 5, 2013)

Thank you.

Seems like I should start mentally preparing myself for the idea of having surgery . . . .


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## webster2 (May 19, 2011)

It is not so bad as far as surgeries go, really.


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## melissafitz (May 5, 2013)

Thank you again . . . it is good to hear that the surgery is not too bad.

I have another question. Assuming I have this surgery (which looks fairly likely), what is the usual recovery time. I am a speech pathologist and work with young children (mostly 2 and 3 year olds). It is not a terribly physically demanding job (though there is a fair amount of getting up and down from sitting on the floor), but I do need use of my voice (a lot of talking in a very animated way, or singing in order to hold the attention of these little guys). I'm wondering how long it might take for my voice to get back to normal. I suppose the surgeon will tell me, but I am just wondering what to expect . . . . I know there is a (small) chance of vocal damage, but barring that, wondering about how long I might expect to be off work.


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## webster2 (May 19, 2011)

The recovery time is about or week or two, getting the replacement correct can take a little longer. I am a librarian and see quite a few children each day. I didn't wear a scarf when I went back to work and some of the kids couldn't seem to get over my scar. I really wanted to tell a tale that had to do with overdue books, when they asked what happened, but I didn't.

When you do meet the surgeon, you'll need to ask how many surgeries they do per week , and what precautions are taken to avoid nerve damage.


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## joplin1975 (Jul 21, 2011)

I took two weeks off, but could have gone back after a week. Yes, getting the meds right can take some time and is a slightly different (but related) issue.

Your surgeon should use a nerve monitor to make sure s/he does not damage your voice. My voice was not impacted.


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## melissafitz (May 5, 2013)

Thank you again, so much, for your replies.

So good to know to ask about the nerve monitor during surgery. Thank you for that!

The endocrinologist absolutely sung the praises of this surgeon and says he does thyroid surgeries frequently (he is at UCLA). But I will ask him. When I made the appointment, they said they didn't have anything until mid-July, but they could get me in with someone else sooner. After hearing how good this surgeon supposedly is, I said I would wait! But you have definitely given me good info to ask about when I meet him.

That is too funny about wanting to tell the kids about overdue books, haha. The kids I work with have special needs and don't communicate too well, though I suppose some may notice. I'm thinking I may want to keep it covered as their way of "commenting" would likely be to put their hands right on it!!!


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