My Bulbous Thyroid

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I have a nodule on my thyroid, and this isn’t just any nodule. This is a 7.5 x 3.5 x 4.5 cm nodule. To put that in perspective, a baseball is roughly 7.5 cm in diameter. I have a nodule the size of a baseball on the left side of my thyroid. When I swallow, it is very obvious that my esophagus is pushed over to the right side of my neck. I noticed my neck was swollen on the left side back in April of this year (2016), and, since I was having a few faint symptoms of hypothyroidism (difficulty losing weight, tired all the time, etc.), I went in to my doctor’s office to have it checked out. The doctor confirmed that it felt like my thyroid was enlarged on the left side, and I had all the usual thyroid tests done. Of course, the blood tests all came back in the “normal” range, so no treatment was recommended for the way my thyroid is functioning, but she did order an ultrasound that took place on May 9. The ultrasound results came back and a fine needle aspiration biopsy (FNA) to see if it is cancerous was scheduled on June 1.

I spent the months of April and May reviewing medical information websites to learn all I could about thyroid function, thyroid nodules, hypo- and hyperthyroidism, thyroid cancer, and all the treatment options. I learned that a lot of people have symptoms of hypo-/hyperthyroidism despite normal blood tests, most people will eventually have at least one thyroid nodule (50% of 50 year olds, 60% of 60 year olds, 70% of 70 year olds), more than 95% of thyroid nodules are benign, most nodules are small (less than 2cm diameter), and thyroid cancer is generally very treatable. Thyroid cancer is so treatable because thyroid cells are the only cells in the body that absorb iodine, so a dose of radioactive iodine will kill the thyroid cells (including those that are cancerous), but will not kill other cells in the body. Thyroid cancer treatments are successful 97% of the time. Still, I wasn’t too keen on the idea of having any kind of cancer, so I waited somewhat anxiously for the biopsy and results.

Here are a few of the resources I went to for information:

Endocrine Web

American Thyroid Association

Articles from the National Center for Biotechnical Information (like this one)

WebMD

On June 1, I went to the hospital for my FNA appointment. I laid on an ultrasound table while one technician held an ultrasound wand to my neck so she could see where to jab me (and poke in & out, although it didn’t last to long and there was local anesthetic, it was every bit as horrible as it sounds) with the needle, and the other technician put the sample in a test tube for a pathologist to look at. 6 needles later, I was given a band aid and an ice pack for my sore neck and sent home. I was a big baby with a sore neck for the rest of the day, but by the next day I was pretty much fine. The next day my doctor called to tell me the samples came back benign (WOOHOO!), but they did discover I have lymphocytic thyroiditis, other wise known as Hashimoto’s.

So then I was referred to an otolaryngologist (say that 5 time fast) to see if the size of the nodule warranted removal despite the absence of malignancy in the samples obtained during the biopsy. The next available appointment wasn’t until September 2, so, this time, I spent much of the summer reading about Hashimoto’s thyroiditis and thyroidectomy. Hashimoto’s thyroiditis is an autoimmune disease wherein my immune system is attacking my otherwise healthy thyroid. Thyroidectomy is a fairly simple surgery to remove part or all of the thyroid. It is inpatient surgery under general anesthesia with a 24 hour hospital stay and roughly 10 days of recovery time to be completely healed. Hashimoto’s (which I’ll write about more in-depth another time) is generally left untreated until thyroid function begins to take a turn for the worse. Thyroid function is usually judged by a couple of different tests, and the Thyroid Stimulating Hormone (TSH) test is general used as the standard to show whether it is functioning normally. TSH is actually produced by the pituitary, so this test assumes the pituitary is functioning properly in detecting whether or not the thyroid needs stimulation or not (I may have another rant on this at a later date). If TSH is below the “normal” range, the thyroid is assumed to be overactive since the pituitary isn’t trying to stimulate it. If TSH is above the “normal” range, the thyroid is assumed to be underactive since the pituitary is working hard to stimulate it. In my reading, however, I’ve come across many, many people who are exhibiting symptoms of either hypothyroidism (underactive) or hyperthyroidism (overactive). As I am with many “normal” ranges for lab tests, I’m convinced that normal isn’t normal for each and everybody, just for the vast majority. I’m certainly convinced that my normal isn’t quite the same as the normal range since I do have a few hypothyroidism symptoms despite normal blood tests.

On September 2, I went to see the specialist. He talked with me briefly about my symptoms of a slightly scratchy throat, slight hoarseness, and the constant feeling of a little bit of phlegm buildup in my throat. Then he put a scope up my nose and down my throat to look at my vocal cords to check for compression. While there didn’t appear to be any vocal cord distortion, he did agree that the nodule is large enough it needs to come out. It seemed to me we had both come to that conclusion before we even met, and the appointment was mostly a formality. He talked about the risks involved, including the possibility of damaging the parathyroid glands (they regulate calcium and phosphorous levels in the body, and have to do with nerve function), damaging the nerves leading to the vocal cords, and the usual bleeding/infection risks that come with all surgeries. He reassured me that he has done thousands of thyroidectomies up to this point in his career, and he has never damaged the nerves leading to the vocal cords. I was sent home with the promise that one of his surgical schedulers would contact me.

So, on January 4, 2017, I will have a partial thyroidectomy, with the possibility of a total thyroidectomy depending on what the pathologist thinks when they remove the first half with its tremendous nodule. If half of my thyroid is left after surgery, it may pick up the slack from the half removed and begin functioning normally, or I may need thyroid hormone replacement therapy. If my whole thyroid has to come out, I will certainly need hormone replacement therapy. On December 16, I will have my pre-operation physical. I am trying to get my body in the best shape I can prior to surgery, but I have to say it is really difficult to push play some days, and I’ve stopped being able to get up early in the morning for workouts altogether. Despite being tired and having to find time later in the day, I’ve managed to not miss a workout in 30 days, and I plan on not missing any the next 30 days either. I’ve had good results building muscle and feeling stronger, even if I don’t seem to be losing much fat. I haven’t lost any weight despite sticking to my nutrition plan 90% of the time and my exercise plan 100% of the time, but I’m sure I will see the benefits of good nutrition and physical activity on tests other than weight and body fat measurements. I’m looking forward to my physical and getting this surgery done so I can be done wondering about it all. 29 days to surgery and counting.

Have any of you had a thyroidectomy? Do you have Hashimoto’s? Or do you know anyone that has or does? I’ve learned that even if I’m not one to talk to many people about the stressors in my life, I do benefit from at least reading about similar situations from others. So send me a message or comment below and let me know your stories. I’ll be sure to read and commiserate with you, and I’ll certainly let you know how everything goes at my pre-op physical and the results of my surgery.

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2 thoughts on “My Bulbous Thyroid

  1. Best of luck to you, Neena! My husband also had an ultrasound on his thyroid recently. So far, it’s “just enlarged ” but he definitely had freak out moments about what it could be. I’ll make sure to point him to the resources you mentioned. I look forward to following your progress.

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    1. And best of luck to Arthur! Definitely read up on thyroid issues and keep on top of the blood tests. The good news is that nearly all the time there is no cancer, and if there is, it’s very treatable. And if function deteriorates, hormone therapy is pretty successful.

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