# My appointment with surgeon



## McKenna (Jun 23, 2010)

It went very well!
He will do a TT. He was more concerned about the nodule, rather than the fact that I'm hypo/hyper or my symptoms. He does not agree with a lobectomy, like the other endo recommended.

He does a lot of TT, at least 3 per week. He's only had one person with permanent voice damage, and that was 6 months AFTER her surgery so they don't know if that is the reason why. He's had 4 people with temporary damage, but their voices came back. He's never had someone with a parathroid problem afterwards. He closes with internal sutures and glue outside. Overnight stay in the hospital and the drain comes out 4 days after that. I think I covered all the questions I had read on here.

He said to call his surgery scheduler when I'm ready to do it. I'm going to the endo tomorrow to talk about the hyper stuff (he wanted to see me) and I'm going to tell him I'm getting the surgery and go over with him about dosing the Armour afterwards.


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## McKenna (Jun 23, 2010)

I had my appointment with the endo today and he didn't even give the high TSI a second glance. I told him that I knew a healthy person should not have any, and he asked me who told me that. I said I read about it. He told me that range was below 125 and I was fine at 103. No change in meds. Uggg! He agrees with removing the thyroid b/c of the nodule and apparently we have a high throid cancer rate in my area and the nodule is big and we didn't get a result from the FNA. He didn't seem too concerned with the "rare fibrous substance" from the FNA.

So, I'm scheduled for a TT on September 9th. This should also help with not having the hyper/hypo swings from the Hashi's, right? Maybe I can get some peace and get regulated on my Armour.


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## Andros (Aug 26, 2009)

McKenna said:


> I had my appointment with the endo today and he didn't even give the high TSI a second glance. I told him that I knew a healthy person should not have any, and he asked me who told me that. I said I read about it. He told me that range was below 125 and I was fine at 103. No change in meds. Uggg! He agrees with removing the thyroid b/c of the nodule and apparently we have a high throid cancer rate in my area and the nodule is big and we didn't get a result from the FNA. He didn't seem too concerned with the "rare fibrous substance" from the FNA.
> 
> So, I'm scheduled for a TT on September 9th. This should also help with not having the hyper/hypo swings from the Hashi's, right? Maybe I can get some peace and get regulated on my Armour.


Oh, brother. Hope he takes the time to update himself on TSI. Since you are having the gland yanked, I guess it is no big deal and all will be sent out to pathology which I am going to wait w/bated breath to hear the results of that.

Oh, you are going to feel so much better once you get your sea legs back after the TT. Will you "remind" us about the 9th? So we can keep you in our thoughts and prayers on that day?


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## Lovlkn (Dec 20, 2009)

Good news - Sounds like your surgeon has it going on.

Did he mention how big the incision would be? I did not have a drain but know they are common.

Keep the incision iced and it will feel better.

What do you want the endo to change about your current meds?


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## McKenna (Jun 23, 2010)

He said the usual incision he makes is about 2 inches. He closes with internal sutures and glue on the outside. 


> What do you want the endo to change about your current meds?


 I wanted him to acknowledge the TSI-hyper stuff and see if that had any bearing on my current meds.



> Keep the incision iced and it will feel better.


 Will do, thanks for the tip. Any other tips, send them along! I'm happy to see an end in sight, but also nervous.



> Oh, you are going to feel so much better once you get your sea legs back after the TT.


 Keep reminding me please! This morning is rough again.



> Will you "remind" us about the 9th? So we can keep you in our thoughts and prayers on that day?


 I will, thank you!


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## Andros (Aug 26, 2009)

McKenna said:


> It went very well!
> He will do a TT. He was more concerned about the nodule, rather than the fact that I'm hypo/hyper or my symptoms. He does not agree with a lobectomy, like the other endo recommended.
> 
> He does a lot of TT, at least 3 per week. He's only had one person with permanent voice damage, and that was 6 months AFTER her surgery so they don't know if that is the reason why. He's had 4 people with temporary damage, but their voices came back. He's never had someone with a parathroid problem afterwards. He closes with internal sutures and glue outside. Overnight stay in the hospital and the drain comes out 4 days after that. I think I covered all the questions I had read on here.
> ...


Find out if you need to be put on Lugol's solution so you don't dump during and after surgery.

Graves disease (adjunct iodine/iodides) (Grade: B) 
Graves disease is an immune-mediated disorder that causes hyperthyroidism. Thyroid-stimulating immunoglobulins bind to the thyroid stimulating hormone (TSH) receptor and mimic the action of thyroid TSH, and stimulate thyroid growth and thyroid hormone overproduction. Standard treatments for Graves disease target the thyroid gland (rather than the source of the disorder), and include antithyroid drugs such as propylthiouracil or methimazole, radioactive iodine to ablate (destroy) thyroid cells, or surgery to remove thyroid tissue. Beta-blocker drugs may be used to control symptoms. Iodide preparations can be used to suppress thyroid hormone release from the thyroid, such as strong iodine solution (Lugol solution), potassium iodide (SSKI), and iodinated radiographic contrast agents (sodium ipodate). Patients undergoing thyroid surgery are commonly treated preoperatively with antithyroid drugs to achieve a euthyroid state, then SSKI.

http://www.wellness.com/reference/vitamins/iodine-i/

I am happy for you. This is good and I am glad you are getting the whole thing out.


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## McKenna (Jun 23, 2010)

> Find out if you need to be put on Lugol's solution so you don't dump during and after surgery.


I did ask him if I needed meds before surgery and he said no. I don't have an official diagnosis of Graves and he didn't comment on my high TSI level, even though I pointed it out a few times.
What can happen if I dump? Get really hyper? Is there anything else I can do?
One thing the ENT did was to numb my nostrils and use a scope to go down my nose into my throat to check my vocal chords. He had me make some sounds and said they looked good. Has anyone had that before? It only took 30 seconds.

Do you think I was on my way to full-blown Graves? The only eye symptom I had was blurry vision and a pressure feeling in my eyes. And a lot of headaches, mostly on the top of my head around my eyes and temples and across the bridge of my nose. I have it now. I don't have the skin rash. All along, my symptoms have been mostly hyper but my numbers show hypo.


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## Andros (Aug 26, 2009)

McKenna said:


> I did ask him if I needed meds before surgery and he said no. I don't have an official diagnosis of Graves and he didn't comment on my high TSI level, even though I pointed it out a few times.
> What can happen if I dump? Get really hyper? Is there anything else I can do?
> One thing the ENT did was to numb my nostrils and use a scope to go down my nose into my throat to check my vocal chords. He had me make some sounds and said they looked good. Has anyone had that before? It only took 30 seconds.
> 
> Do you think I was on my way to full-blown Graves? The only eye symptom I had was blurry vision and a pressure feeling in my eyes. And a lot of headaches, mostly on the top of my head around my eyes and temples and across the bridge of my nose. I have it now. I don't have the skin rash. All along, my symptoms have been mostly hyper but my numbers show hypo.


If you are really hyper, dumping is the same as thyrotoxicosis. If your labs look good, perhaps you won't need to worry.

I think you were on the way, yes. Wah!


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## McKenna (Jun 23, 2010)

I got new labs this week since I saw the endo. He always requires labs to be done before coming in to see him.
My THS went up a bit but my free T's also did. The T's had gone down while on synthroid.
These are the new ones:
TSH 3.22 .450 - 4.5
FT4 1.21 .82 - 1.77
FT3 2.8 2.0 - 4.4

From 2 weeks ago:
TSH 3.15 2.0 - 4.4
FT4 1.17 .82 - 1.77
FT3 2.6 2.0 - 4.4

Andros, since you are on Armour too, what is a "normal" dose for total replacement. Does it go by weight? I'm looking ahead to after the surgery so I have some idea. I know a lot can be dosed by symptoms too, I'm just wondering about a ball-park.


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## Andros (Aug 26, 2009)

McKenna said:


> I got new labs this week since I saw the endo. He always requires labs to be done before coming in to see him.
> My THS went up a bit but my free T's also did. The T's had gone down while on synthroid.
> These are the new ones:
> TSH 3.22 .450 - 4.5
> ...


Armour is a completely different med. The proper protocul is to start the patient on 1/4 grain (15 mg.) if the patient has pretibial myxedema. If not, the patient should be started on 1/2 grain (30 mg.)

Then the patient should lab every 8 weeks and Armour is titrated upward if indicated usually by 1/4 grain to 1/2 grain depending on labs and clinical presentation of the patient.

One grain of Armour is 60 mgs. One grain contains 38 mcgs. of T4 and 9 mcgs. of T3.

As far as I am concerned there is no equivalent even though others think so. And that is because we are dealing w/ T3 which is very potent and powerful.


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## Lovlkn (Dec 20, 2009)

McKenna,

What meds are yo taking and how long have you been taking them?

Definitely insist on the SSKI drops also known as Lougels - it makes the thyroid easier to remove, firms it up and makes it less vascular.

Lovlkn


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## McKenna (Jun 23, 2010)

I was originally on synthroid, 25mcg for one month, then I had a really hyper experience and he took me off it. This was a little over two weeks ago.

Then I was put on Inderal 20mgs 2 X per day for the heart palps and have been on it for two weeks.

The endo then put me on Armour 15 mgs every other day and I've been on it for a little over one week.

The Inderal and Armour are the only meds, but I do take Vitamin D, Magnesium and Vitamin C.

I will talk to my family doc about the drops. He's usually much better about giving me what I want.


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## Andros (Aug 26, 2009)

McKenna said:


> I was originally on synthroid, 25mcg for one month, then I had a really hyper experience and he took me off it. This was a little over two weeks ago.
> 
> Then I was put on Inderal 20mgs 2 X per day for the heart palps and have been on it for two weeks.
> 
> ...


Right; as you know, because I always suspected hyper, I have felt you should not be on thyroxine replacement. Your labs are skewed because of the antibodies and autoantibodies i.e. binding, blocking and stimulating. I have seen it thousands of times.


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