Thyroidectomy


~ I’m grateful to be a ThyCa survivor ~ I’m grateful to be a ThyCa survivor ♥ ~ I’m grateful to be a ThyCa survivor ~ ♥ ~ I’m grateful to be a ThyCa survivor ~ I’m grateful to be a ThyCa survivor ~ My parotid gland still hurts when I eat from the RAI (RadioActive Iodine). I get small bits of food caught in my throat at times. My vocal chords are still a little damaged from the thyroidectomy. My fear wakes up every 6 months when I go for follow-up scans and blood work. I get hot flashes and chills now more than ever. My memory is not was it was before. So I need to remind myself, despite it all. I FOUGHT THE FIGHT. I AM A CANCER SURVIVOR and THRIVER!!!  AND FOR THAT, I AM SO GRATEFUL!!
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It’s easy to crunch the numbers on thyroid cancer and assume it is a disease fast on the rise. Incidence has more than doubled since the early 1970s, and for women, it is the cancer with the fastest-growing number of new cases.

But not every statistic tells the obvious tale. Despite the increase, thyroid cancer — a very treatable disease that develops in a butterfly-shaped gland in the neck — is still relatively uncommon.

Many people develop benign lumps, known as nodules, in the neck, but only one in 20, or less than 45,000 cases a year, are malignant. Even fewer patients have an aggressive form of the disease, which has a survival rate of nearly 97 percent after five years and results in an estimated 1,690 deaths each year. Over the last few years, however, studies showing there has been a significant increase in incidence, and even mortality, in certain groups have caused much debate in the scientific community.

“I don’t think there is any question that there is an increasing incidence of thyroid cancer,” said Dr. Kenneth Burman, chief of the endocrine section in the department of medicine at Washington Hospital Center in Washington, D.C. “But it is not that simple. The question is whether or not it is related to detection and radiological studies, or if it is related to an authentic rise in thyroid cancer.”

It is a question that still remains largely unanswered. Evidence from the Surveillance, Epidemiology and End Results database, a registry of cancer cases that is kept by the National Cancer Institute, leaves little question that there are more cases of thyroid cancer today than three decades ago. But the more important question, as Dr. Burman points out, is whether these statistics indicate a true rise in the disease or are simply a result of better diagnostic tools.

Over the last three decades, ultrasound and fine-needle biopsies have helped diagnose thousands of cases that would never have been found before. In many cases, nodules are discovered by accident during another medical investigation.

A study published in The Journal of the American Medical Association first brought this issue to light in 2006. Researchers concluded that the reported 140 percent increase in thyroid cancer from 1973 to 2002 was simply a result of “increased diagnostic scrutiny.”

They argued that a true increase in incidence would be reflected in every stage of the cancer. But the study showed that 87 percent of the increase was from small papillary thyroid cancer tumors — the most common and treatable type of thyroid cancer — that were less than two centimeters in size. Many of these cases, the researchers say, would never have caused any problems. In fact, studies have shown that thyroid cancer is found in nearly 4 percent of all fine-needle aspiration biopsy specimens.

“These cases have been there all along,” said Dr. Louise Davies, assistant professor of surgery in the division of otolaryngology, head and neck surgery at Dartmouth Medical School. “We just didn’t see them until now. Understanding this requires that you think about the word ‘cancer’ in a different way than we usually do. You can have increased rates of incidence without changing the number of people who die.”

But the mortality rate is a little more complicated than that. Survival rates, after five years, increased 4.7 percent in women, who are three times as likely to develop the disease as men, from 1974 to 2001. In men, however, the annual percentage change in thyroid cancer mortality increased significantly, by 2.4 percent, from 1992 to 2000 — the highest jump of any cancer. That is one reason many other experts argue that diagnostic tools are not the only factor.

“I think it is an oversimplification to say the increase in diagnosis is from the overuse of technology and only relates to small tumors that are insignificant,” said Dr. Steven Sherman, medical director of the endocrine center at the University of Texas M.D. Anderson Cancer Center in Houston. “There is a component that relates to increased technology, but until we can do a better job at predicting the outcomes for individuals who develop cancer we still need to treat each case.”

Physicians are fairly clueless about what else could account for this mysterious rise in incidence. Exposure to radiation from the Chernobyl nuclear power plant accident in 1986 and radioactive fallout from nuclear weapons testing in the 1950s have long been linked to thyroid cancer, but they would not account for all the new cases.

Regardless of the reported increase in small tumors, the standard of care for thyroid cancer remains the same as it was two decades ago. Patients must undergo a thryoidectomy, a surgical procedure that removes all or half of the thyroid gland. Afterward, many patients also require a radioactive iodine treatment, which kills any remaining cancer cells.

Dr. Bryan McIver, a physician in the division of endocrinology, diabetes, metabolism and nutrition at the Mayo Clinic in Rochester, Minn., said of the surgical default, “Even though the evidence does not support that it is beneficial, there is an increasing trend in the U.S., and probably worldwide, to treat all thyroid cancers in the most aggressive way.”

As a result, surgeons like Dr. Davies think the increase in diagnosis does patients with small tumors a disservice. “I don’t think it is helpful when patients pick it up by accident,” she said. “It distracts them from the problem they came in with and leads to unnecessary treatment. The mortality rate of papillary thyroid cancer is lower than the surgical complication rates.”

Since thyroid cancer has long been thought of as a disease that requires surgery, experts are starting to rethink how they approach the rapidly increasing number of small tumors.

“Sometimes I think we are doing more harm than good with these small tumors,” Dr. McIver said. “But there is also going to be a subset of these small tumors that are caught early and would have caused a problem. It’s hard to ignore a diagnosis of cancer.”

This article is from the New York Times

1/29/10

One of my goals the past few months has been to write a “Dear Thyroid” letter and submit it to the Dear Thyroid site.  I finally wrote the letter!! Yay!! I’m so excited for you to read it.  I found it quite therapeutic to write.

I posted my Dear Thyroid letter called “RIP my Thyroid, August 1973 – January 2009” on my blog this week, but I had to take it down. Why? Well after posting it on my blog,  I found out that Dear Thyroid will only publish original content.  (Ok, I get it. Rules are rules!)  I do admit, I did not read all the requirements set by Dear Thyroid before submitting my letter. So I have learned my lesson 🙂

I will post the link to my letter on the Dear Thyroid site as soon as they post it. Stay tuned for details…

3/10/10 UPDATE :  Dear Thyroid still has not posted my Dear Thyroid post so I might post the letter on my blog after all. Stay tuned!

3/22/10 UPDATE TO UPDATE: Dear Thyroid posted my Dear Thyroid letter today!!! WooHoo!! Please take a looksy at http://dearthyroid.org/rip-my-thyroid/and share your comments.  Thank you in advance 🙂

Thanks!

There were so many bills from doctors, hospitals, pharmacies and on and on after all of the medical visits and procedures.  I am so grateful to have health insurance.  The two shots of Thyrogen alone was over $2,000!!!  Just check out this bill…Thyrogen receipt.  Even my doctor was surprised that it was covered by my insurance at 100%. 

Then there was the bill for the Thyroidectomy from the hospital, which was over $6,000!!!  Here it is…Thyroidectomy bill.  After going back and forth, it was all covered by insurance except for $275.  I was more than happy to pay that portion.

There were other bills of course, but those were the big ones through my thyroid cancer journey.  If I didn’t have insurance, I would owe over $8,000.  It just makes me think about all of the people who don’t have health insurance or who have plans with really high deductibles.  I can see how easy it would be to get into major debt due to medical bills.  I’m very blessed that mine was covered.  My heart goes out to all of the people going through there own journies with cancer or other illnesses who can’t pay the medical bills.

On January 29, 2009, I had my thyroidectomy.  Before I went in for surgery, the doctor was not able to tell me if he was going to do a partial or total thyroidectomy because they were not sure if it had spread.  So the plan was to send part of my thyroid over for testing while I was still under.  If the results came back that it was cancer, they would remove the rest.  I knew in my gut that they would end up taking out my entire thyroid. 

Most of my fear was not because of the surgery or even the cancer.  I felt alright about both because I knew that it was what needed to be done and that I would be alright.  My fear went deeper into thoughts about having to take pain medicine after the surgery.  I am a recovering addict and at that time had a little over 4 years and 9 months clean.  I had heard so many people share in meetings about how they had lost years of clean time because they had a surgery and started to abuse the pain medicine.  This was one of my greatest fears.  But I got through it.  I had a great support system of friends and family that knew about my concern.  The doctor was aware that I was a recovering addict as well.  So when I stayed at the hospital the night after my surgery, they offered me pain medicine.  I wasn’t in too much pain and didn’t take it.  The next day my doctor wrote me a prescription for pain meds and I tore it up.  I paid the price the following couple of nights when the pain woke me up over and over.  I managed to get through those times without the pain medicine.  Looking back now, I needed to take it at night.  If I have surgery again and am in a lot of pain, I will take the pain medicine.  I will not put myself through that pain again. 

Here I am 8 months later and my scar is barely noticable on my neck from the thyroidectomy.  My speaking voice is back to normal, but my singing and cheering voice is still damaged.  But the cancer is gone and I am still clean with almost five and a half years.  Miracles do happen!

1 day at a time

 

Thyroidectomy Procedure
Your thyroid is a butterfly-shaped gland in the base of your neck. The thyroid produces hormones that control your metabolism and affects everything from the rate your heart beats to how quickly you burn off calories.
A thyroidectomy, or surgical removal of your thyroid gland, is used to treat thyroid nodules, thyroid cancer, or hyperthyroidism. During a total thyroidectomy procedure, your entire thyroid gland (both lobes and the narrow band that connects the two lobes, called the isthmus) will be removed. During a partial thyroidectomy, only part of your thyroid will be removed. Partial thyroidectomies can be categorized into subtotal thyroidectomies, where one whole lobe, the isthmus, and most of the other lobe are removed, and a thyroid lobectomy, where only one lobe is removed (with or without the isthmus).
A thyroidectomy is surgery and is usually done under general anesthesia, taking several hours to complete. During a thyroidectomy procedure, a small incision is made in the front of the neck and the thyroid tissue is removed. In some cases, you may have to undergo a tracheotomy during or after the surgery, where a tube is inserted in your trachea to help you breathe.

Effects of Thyroidectomy on Voice
One important concern of patients is how a thyroidectomy procedure may affect their voice after surgery. Both temporary and permanent changes in voice have been well documented following thyroidectomy surgery. Between 16 and 40 percent of patients may have temporary changes in voice soon after a thyroid removal surgery and, by three months post-op, between 2 and 20 percent of patients still complained of complications with their voice. Changes in your voice after a thyroidectomy may include hoarseness, easy fatigue, trouble with high pitches and your singing voice, and decreased voice projection.
Although there is some debate regarding why your voice may be affected by a thyroidectomy surgery, the most common causes include damage to your nerves that control your vocal cord, which are located around our thyroid gland; damage to your strap muscles, which function during talking and singing, or vocal folds; changes in your laryngeal mucosa; or changes in your general condition following surgery. Of these possible causes, damage to your nerves is the most likely to cause permanent changes in your voice.
According to various studies, somewhere between zero and twenty percent of patients have any nerve damage at all, and most studies claim less than 6 percent of thyroidectomy procedures result in nerve damage.

Treatment for Changes in Voice
Interestingly, new studies suggest that treatment with certain steroids prior to thyroidectomy procedures may help improve temporary changes in voice, as well as decrease nausea, vomiting, and pain. This may be worth discussing you’re your doctor prior to surgery.
While permanent thyroidectomy effects on voice are rare, there are some ways to treat this condition. Laryngeal electromyography can give information about how the nerves are working, or aren’t working, to control the muscles of the vocal cords, which allows for a definite diagnosis of laryngeal nerve damage. This procedure, along with vidoestroboscopy, which shows your vocal cords in action, and electroglottography, which measures vocal fold vibrations, can be used to make and accurate diagnosis of the problem.
Laryngeal framework surgery, or thyroplasty, can be performed to try to correct problems resulting from a thyroidectomy procedure. Traditionally, laryngeal framework surgery was performed with the hopes of improving the position of your vocal cords so they vibrate better during speaking or singing. This can be used to repair torn, dislocated, or paralyzed vocal cords by bringing them into a better position for a strong voice.
Recently, a technique called laryngeal reinnervation has opened the field to a new treatment option. Although still in its infancy, this surgical procedure may allow for reinnervation of paralyzed vocal cords damaged during a thyroidectomy in which the laryngeal nerves near the thyroid gland were damaged.

Article written by kristenrosenthal on her blog http://www.brighthub.com/science/medical/articles/33442.aspx

According to my doctors, since I had thyroid cancer the best option was to have a thyroidectomy.  I do admit, it was not a pleasant thought to imagine a surgeon cutting my throat open and removing MY thyroid.  I could think of plenty of other things I’d like to spend time doing.  After all, it was my one and only thyroid.  It had been working for me for over 35 years.  But the cancer cells decided to make my thyroid their home.  And it was time for all of it to go!  

So on January 29, 2009 at an extremely early hour, I got up and said goodbye to my thyroid.  I was a little nervous for the surgery but had an underlying calmness.  I knew that it was going to be alright.  Everything works out the way it is supposed to.

I got to the hospital and checked in.  My wonderful Mom came with me and the rest of my family were calling in periodically to see how I was doing.  After filling out lots of paperwork and signing many forms, they gave me the beautiful surgery outfit to put on.  I was stylin’!

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I was ready to go.  Time to say my final goodbye to my thyroid and hello to the thyroidectomy.