Can thyroid surgery be done by keyhole?

[Churchie]

I have been diagnosed as having a discrete thyroid lump (4cm x 3cm x 2cm) which last weeks FNA proved inconclusive. I have a consultation with a thyroid surgeon on Friday to discuss future treatment, whether another FNA, larger biopsy on the lump or larger surgery. I just wondered if thyroid surgery is suitable for keyhole surgey and if anyone has had it done. Worried about losing my thyroid and suffering years of bad health as was extremely ill on thyroxine.

Latest TSH is 12.9 (.35-5.00) and F4 9.9 (9.0-20.0).

Can anyone suggest questions I should ask?

Thanks x

[Clutter]

Churchie, I don't think it is possible to remove a nodule from the thyroid gland leaving the rest of the thyroid in situ. Removing the nodule usually involves removing the entire thyroid lobe (hemilobectomy) ie partial thyroidectomy. The remaining lobe is expected to produce sufficient thyroid hormone for you to be well without thyroid hormone replacement. This works excellently for some people but not so well for others and they will need some replacement. Most of the members who have been biopsied after hemilobectomy have had benign results after several FNAs.

If the nodule isn't causing problems or impacting nearby organs it is possible to watch and wait and repeat FNAs every 3/6 months.

I had an inconclusive FNA and core biopsy but it wasn't repeated as the nodule, which was smaller than yours, compressed my windpipe making breathing and swallowing difficult and hemilobectomy was scheduled. Histopathology was positive for Hurthle cell carcinoma and 3 months later completion thyroidectomy was performed but was clear of cancer.

Hemilobectomy or thyroidectomy doesn't mean you are condemned to a life of hypothyroidism and ill health. T4 monotherapy also made me very ill but I'm fine on T4+T3 combination. If you can't tolerate T4 at all discuss T3 monotherapy with your surgeon/team prior to agreeing to surgery if it's necessary.

Please ask for your vitamin D level to be tested asap as 40% of thyroidectomy patients were found to be vitD deficient in the study below and a course of vitD3 to correct levels prior to surgery is beneficial. Good levels of vitD aid conversion of T4 to T3.

henryford.com/body.cfm?id=4...

I hope the consultation goes well on Thursday, please let me know how it goes.

[Churchie in reply to Clutter]

Dear clutter

Thanks so much for your informed response. It has helped a lot.

At present the nodule is not giving me any problems swallowing or breathing but I do have neck and shoulder pain ( and sometimes earache) - not severe but the muscles seem stiff like you have slept at a bad angle although nothing like the state I was back in July when on Levo.

I am already taking a vit d supplement on the advice of the endocrinologist so yes hopefully that will get better. I have also started taking adrenal extra and nutri thyroid which has helped with energy levels

It seems a lot of information to take in at once so I am pleased to be digesting some infor before Friday

Thanks again

[Churchie in reply to Clutter]

Dear clutter

You were right it seems that you can't just remove the nodule and that a Hemilobectomy is required to remove it. The consultant said that due to the size of the nodule the normal protocol would be to have surgery but when I raised the prospect of how ill I had been on replacement thyroxine and therefore how worried I was she then agreed that it was better to perform another larger biopsy to try and definitively establish whether it is cancer or not before deciding on the surgery option.

I have an appointment back with the endo on the 21st oct so will discuss with her whether I should try again maybe a different brand as some people suggest because I am quite worried that eventually I will need the op as the nodule is likely to grow apparently and then I will be stuck not being able to take thyroxine.

Thank you again for your response

X

[Clutter in reply to Churchie]

Churchie, if your thyroid levels don't require medication now it's quite possible that you won't need medication after a hemilobectomy. If you require Levothyroxine now, but can't tolerate it, you may find you are able to do so with some T3 to calm the side effects of T4. If you still can't tolerate T4 then T3 monotherapy should be prescribed. GPs and endos can prescribe T3 although some CCGs only permit it when directed by an endo.

I hope you can work something out with your GP or endo or you might consider self medicating with T3.

If the larger biopsy is not benign it is likely that they will want to do a complete thyroidectomy.

Let me know how you get on the 21st.

[Churchie in reply to Clutter]

Hi Clutter

Strictly speaking I should be on Levo at the moment so I think it likely that I would need that after a hemilobectomy. I have read you advising others about vit d, ferritin, folate and vit b12. Please could you tell me what the optimal readings of these should be as I want to have them checked at the next blood test. I am already on vit d tablets but want to work on getting the others optimal as opposed to just within range.

Many thanks

[Clutter in reply to Churchie]

Churchie, ferritin is optimal 70-90, vitamin D 75-200 preferably high in range, B12 >500 but towards the top of range is preferred by many and folate mid to top of range.

[Churchie in reply to Clutter]

Thanks