Thyroid nodule - operate or alternatives?

Hi - I had a 5cm right sided thyroid nodule found accidentally on a CT scan for another issue. This was found Aug 2016.

The ENT surgeon said that I should have a thryoidectomy.

I'm a bit concerned about having a thyroidectomy, as I have no idea what it entails after - and how it could affect my health.

Does anyone have any experience of thyroid nodules.

- Do they grow / need surgery?

- Are there alternatives?

- What happens after a thyroidectomy?

Thanks :)

9 Replies

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  • Londonboy99,

    A 5cm nodule should be fine needle aspiration biopsied to check for malignancy. 95% of nodules are benign but 5cm is a large nodule and that increases the risk of it being malignant.

    If the nodule is benign you should be able to have a partial thyroidectomy to remove the lobe which the nodule is on (hemilobectomy). The remaining lobe will be expected to produce the thyroid hormone required. If not, Levothyroxine will be prescribed.

    If the nodule is malignant several risk factors including type of cancer, size of tumour and your age will determine whether a hemilobectomy or total thyroidectomy is required and, if total thyroidectomy is done, whether follow up radioactive iodine ablatement is required to destroy any thyroid cells loosened during surgery. After a thyroidectomy for thyroid cancer high dose Levothyroxine is usually prescribed to suppress TSH <0.1 as making sure there is no TSH stimulation reduces the chances of cancer recurrence.

  • Thanks Clutter - very helpful mate.

    What causes thyroid nodules - I have read about autoimmune conditions..... should these be tested for?

  • Londonboy99,

    No one really knows why nodules develop.

    Some GPs won't test antibodies unless TSH is abnormal. If you have been diagnosed with hypothyroidism you could ask to be tested for thyroid peroxidase antibodies.

  • I read all this stuff about diet on the internet - how it can reduce nodules. Not sure about any of that.

    So for a thyroidectomy, what should I expect after the operation? Someone said weight gain from thyroxine pills - pain, complications, etc...

  • Londonboy99,

    There's a lot of woowoo stuff posted on the internet. Diet won't shrink thyroid nodules. Levothyroxine will sometimes shrink nodules but if your thyroid levels are within range you won't be prescribed Levothyroxine.

    I had very little pain after thyroidectomy. I was provided with copious amounts of pain relief in hospital and to take home after discharge and didn't need much of it. I had no complications. I originally had a hemilobectomy and when pathology confirmed Hurthle Cell cancer I had a thyroidectomy through the same scar. Healing was good and the scar is barely visible.

    There can be complications, loss or damage to the parathyroid glands and damage to the vocal chords are the most common but an experienced thyroid surgeon should manage to avoid this. Ideally your thyroid surgeon will perform around 200 thyroidectomies a year as this reduces the risks of complications.

    I was prescribed Liothyronine (T3) the day after surgery as I would be having follow up RAI. I was recovering nicely on Liothyronine (T3) for 3 months but felt very unwell when I was switched to Levothyroxine after RAI. I lost over 7kg which I most definitely did not want to lose. Levothyroxine on its own caused me very unpleasant side effects but when I added T3 it calmed the side effects. I've been well for 3 years on a combination of Levothyroxine and T3. Many people do very well on Levothyroxine so don't assume that Levothyroxine won't work for you. If it doesn't you can buy T3 or NDT online and self medicate.

  • That is so helpful to read. I believe my T3/T4 levels are OK (last tested Aug 16), but I do seem to get colds / sore throats more often - and my neck thyroid area does sometimes have a dull ache.

    The biopsy was borderline back in Aug - not cancerous but not normal.

    They recommend a hemi +/- total, and I have been nervous - hence posting.

    Are there any side effects of the Levothyroxine/T3?

  • Londonboy99,

    My FNA biopsy was inconclusive and it wasn't repeated because the decision had been made to remove the nodule to ease my breathing and swallowing. You can ask for the FNA to be repeated.

    Well there were side effects for me on Levothyroxine only as I mentioned above. I've had none with T3 but other people do.

  • Thanks - it is scarey contemplating the op, so I appreciate the comments.

  • londonboy99, If you have no symptoms then you should do nothing. I am surprised the doc said you should have an operation without any obvious reason for it as it is a highly dangerous procedure and should be avoided unless your very life depends on it. I have no knowledge of whether a goitre can be brought under control by drugs.

    My 1st goitre in 1989 had developed to the stage that I had difficulty beathing, was perpetually tired and had started to lose all hope before the doc was prepared to operate. The partial thyroidectomy left me virtually immobile, unable to work, for 3-4 months before the remainder of thyroid started to work properly again.

    My 2nd operation in 2005, to again save my life, was abandoned when the surgeon cut my throat and realised what had to be done was beyond his abilities.

    As a result of the THIRD operation for a multinodular goitre, EIGHT MONTHS LATER, in 2005 I seemed to do well for the first few months then the residual symptoms of being without any thyroid at all and on levothyroid monotherapy started to bight and it took me 8 years on continuous worsening symptoms before I abandoned all hope of getting proper treatment from the NHS and started taking NDT/Thyroid-s brand.

    You must discover your options and take the most appropriate choice. Read all you can on the subject but be fully aware of what will happen as a result of that choice. The subject matter is complicated and the results can be catastrophic. Never trivialise anything you are about to do.

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