Another Gimp Story: Thyroid Lobectomy
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When it rains it pours. That’s been my life in 2009. This year will go down as the year that my life was turned upside down and rebuilt from scratch. Not only have I moved to a new town and changed jobs, but I’ve had my share of medical issues. My left ACL was torn and rebuilt, I took a silly fall which resulted in a small scratch that turned into a huge infection, and now I will be having a thyroid lobectomy.
Lets rewind to 6 years ago. It was the end of the school year and I was visiting a doctor (a PA to be exact) in Boulder because I had an unimaginably painful sore throat. While I was swallowing, she noticed a small lump in my neck. She said, “Do you have a thyroid nodule.” “Huh?” She recommended I get the lump checked out by the Boulder Medical Center’s endocrinologist.
So, I did. The endocrinologist I saw there was an unpersonable old man who had a very matter-of-fact way of treating a thyroid nodule. He basically told me that I had a tumor in my thyroid, which may or may not be cancerous- like it it was no big deal. As I spiraled through the emotional roller-coaster of how this was going to impact my life, the doctor decided to do biopsy. He told me it came back with only cystic fluid, so the tumor must be benign. But then he came out with this- “Oh, but you need to take thyroid medication for the rest of your life.” Typical doctor. Like it’s no big deal I’m on some medication for the rest of my life.
He put me on Synthroid, a thyroid hormone. Basically, he was treating me with thyroid hormone replacement therapy. Your thyroid produces hormones which are eventually involved in regulating your metabolism. By replacing this hormone, a message is sent back to the thyroid that there’s enough in your system, so it doesn’t need to produce as much of this hormone. Essentially, the thyroid barely does any work anymore. It’s put on retirement. The theory behind this is by preventing the thyroid from having to do much work, the thyroid nodule will hopefully keep from growing any larger.
So, I stayed on this plan for a number of years. But the move to Crested Butte made me seek out new health insurance and new doctors. In June, I saw Dr. Maruca, an endocrinologist located in Grand Junction. He took one look at my old medical records and basically told me they were a load of horse-crap. My old endocrinologist simply didn’t keep good records. There was no record of the original size of the tumor, to compare and see if it was growing. And I distinctly remember doing two biopsies in Boulder, yet record of the second had mysteriously disappeared.
But, the worst news was that my old biopsy was in fact inconclusive. Dr. Maruca explained to me that to have a true idea of what is actually in a thyroid nodule, solid components need to be obtained from five different sections of the tumor. Well, I remember the biopsy needle poking into my neck five times (how could I forget that!), yet it came back with mere blood smears. There were no solid components. So, in essence, whether the tumor was malignant or benign was inconclusive. Yet, my doctor at the time decided to tell me it was benign. Because of this, Dr. Maruca suggested that I have another biopsy. Believe me, I wasn’t thrilled about having a needle poked into my neck five times again. But, I saw the value in it. Plus, due to my ACL surgery earlier this year causing me to meet all insurance deductibles, the otherwise costly biopsy would be basically free.
I did the biopsy and then went home. I kind of put the whole thing out of my mind. Though, I was expecting a phone call. But, doctors rarely call when things are fine. They just don’t. So, that’s what I assumed was going on. I assumed my test results were fine. But then one afternoon at the end of June I checked a message on my voice mail and it was Dr. Maruca himself. “This can’t be good,” I thought to myself. So, I called him the next morning.
Dr. Maruca basically informed me that the results of my biopsy had come back from the pathologist having a specific kind of cell that may or may not be cancerous. He went on to explain that you can’t tell if this cell is cancerous until you take a larger sample, which would involve thyroid surgery. “There’s about a 1 in 20 chance that it’s cancerous,” he said, “I think you should just have your whole thyroid out.”
The thought of having my whole thyroid removed was not new to me. This was presented to me as an option by my old endocrinologist, although he did not recommend it. Thankfully, I was able to work past Dr. Maruca’s matter-of-fact statement that I need to have surgery to remove my whole thyroid and ask the right questions. He investigated my medical records further. And I did some research on the Internet. With all that is at stake between cancer vs. my metabolism being messed up sans-thyroid I decided that the best route for me was to have a partial thyroid removal.
Today, I visited Dr. Harthorne, an otolaryngologist/surgeon in Grand Junction who will be performing my surgery. I was able to set a surgery date- it will be Monday, August 3rd. And he was able to answer the last few remaining questions I had about the procedure. Based on the research I’ve done and what Dr. Hartshorn explained to me, I will do my best to explain the procedure.
The surgery is done with general anesthesia. They pump your neck full of saline, so this can make your neck very sore. But, this allows them to make a smaller incision which will scar less. The saline will be used to expand the working area. They will take great measures to protect my parathyroid gland, which regulates calcium levels, and also my vocal cords which can easily be damaged in this surgery. The surgery will last somewhere between 1.5 – 3 hours.
The thyroid is divided into two lobes on the right and left side of your neck, connected by something called the isthmus. Since the tumor lies my left lobe, this half will be completely removed. Thyroids are a unique organ in the sense that they have a huge blood supply. Blood is always being fed to the organ. This makes removal of a partial lobe basically impossible. They can’t remove just the tumor itself because the thyroid tissue around it will bleed too much. This internal bleeding can cause a lot more problems than actual removal of the thyroid itself. So, if a tumor is found in a lobe, the whole lobe must be removed.
Remember, the reason why they are removing this left thyroid lobe on me is to be able to take a better look at the tumor. They want to determine if it’s cancerous or not. So, they will take out the lobe, remove the tumor, instantly freeze it, and then slice it. This is called a “frozen section”. They will send this frozen section down to pathology where they will run tests to decide if it is benign or malignant. If it is malignant, the other half of my thyroid will need to be removed, on the spot. If the tumor is benign, or even if it is questionable if it is benign or malignant, they will leave the right half of my thyroid in tact. Here, there is a small risk that I may need to have another surgery to take out the right half of my thyroid – if the tumor is questionable, and they have to do more extensive tests that cannot be done within the timeline of my actual surgery. But, this is a small risk.
When the surgery is all said and done, there are risks of certain side-effects. Aside from the normal problems with possible nausea and infection associated with all surgeries, I will likely have trouble swallowing and eating for a few days. But there are two relatively common side effects that pertain directly to this surgery. One is damage to the parathyroid gland. This gland regulates calcium levels. There is one of these glands on each side of your neck. With a partial thyroid removal this is hardly a problem, because if one parathyroid gland is damaged, the other just takes over. But, another main risk is damage to the vocal cords. Vocal cords can be severed in this surgery, which results in completely losing the voice, permanently. But, this risk is rare. More common is damage to the vocal cords which causes them to become temporarily paralyzed. It is not uncommon for people who’ve had thyroid surgery to lose their voices for somewhere between 1 and 3 months.
I must say, this vocal cord thing is my greatest concern. I suppose I can handle losing my voice for a couple of months. But, to lose it permanently would be devastating. I mean, I can’t be a teacher if I can’t talk. It just won’t work. But, the doctor saw my concern about this and elaborated . He explained that there are two vocal cords and the likelihood of both being severed is very very rare. He said that the vocal cords work by kind of squeezing together back and forth. If one is severed, a gap occurs which prevents the full squeezing from happening. But, a plastic implant can be surgically placed there to allow the other vocal cord to squeeze it instead, making it so you can have your voice back. Knowing this bit of information has calmed me considerably.
If I have half of my thyroid removed, I don’t need to spend the night in the hospital. But, if it turns out that I need to have both lobes removed, I will have to spend one (or more if my calcium levels are not right) nights in the hospital.
Generally, the first few days after the surgery will suck, obviously. But, it seems that most people continue regular activities within 2-3 weeks after surgery.
Check back, for more blogs about this. I’ll be doing some blogs about how the actual function of the thyroid as well as what my life will be like with only half a thyroid.
For those who care, I found this to be one of the best sources of information about the surgery I’ll be having.
Texas Center for Facial Plastic and Reconstructive Surgery
Thanks for reading!
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