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Thyroidectomy or Hemi...best option?

Posts: 4
Joined: Nov 2007

I have 5 nods, two on one side that are ventricular cells and can't be determined as benign until removed. My surgeon recommends that I have at least the left half removed. The right has two nods as well, including the biggest one. It seems to make more sense to have the whole thing removed at once since I have so many nods that will always need to be monitored. AND since the possibility of it coming out as cancerous would lead to another surgery. Any advice on those living without a thyroid, opposed to those who still have half? I'm looking for positive and negative aspects of both scenarios. Thanks!!!!

Rustifox's picture
Posts: 120
Joined: Mar 2005

Not advice per se, but maybe some things to think about, scowlgirl.

Make certain that your surgeon has alot of experience in thyroids - the more experienced the surgeon, the better. If it is thyroid cancer, thorough surgical exision, with care not to disrupt parathyroids (if possible) and care with the larynx are really, really important. Not every surgeon is good at this.

I did have the lobectomy (one lobe of thyroid), and did end up having to go back in for the second surgery to have the rest removed. They did find malignancy in the first half; the second half was benign (but with malignancy confirmed, the safest way to ensure it doesn't come back, and to treat it, is to ablate all thryoid tissues.) I wasn't thrilled about going back for that second surgery... if I could have chosen to do it all at once, I think I would have.

The rationale behind keeping one lobe is that sometimes (not always, so not a given, either...) the remaining lobe will 'take up the slack' for the missing lobe, and provide enough thyroid hormone to keep your body functioning. It is possible, but many who have had one lobe removed will need slight supplementation with levothyroxine/replacement thyroid hormones such as synthroid or the like.

Some of us experience little trouble with replacement hormones; others can have some issues with trying to keep those hormones in proper balance, and working well with our metabolism (ie heart palpitations or agitation of heart conditions, hormonal fluctuations from pregnancy or menopause, etc). I am one that has had some pretty significant trouble trying to balance the replacement hormones - but others find they feel better than they ever have before, and have no trouble at all.

I have to say, though, if it were me, even with trouble balancing my hormones - with nodes in both lobes of the thyroid, particularly with the largest node in the side that they plan to 'leave', I personally would likely want to have both lobes of the thyroid removed, if all evidence and tests point towards a possible malignancy. You may want to consult with an endocrinologist, too, even on a pre-operative basis; endo's are the best authorities when it comes to thyroid cancer.

If they have already done a radioactive iodine scan on you, and the nodes point to malignancy, and/or the biopsies have been inconclusive, it's certainly a concern to remove 'healthy' thyroid tissue. But as you are aware, certain types of malignancy will only show as malignant if they have broken through the thyroid capsule itself (ie follicular adenoma is benign until it does this). Tough call - but do make sure that you have an excellent surgeon who really knows what he/she is doing when it comes to thyroids; proper surgical technique is really important - if you aren't totally confident with your surgeon's recommendations, please consider getting a second opinion, or discussing your options with an endocrinologist. All the best to you, and I hope all goes well, whatever you decide to do.

Posts: 9
Joined: Sep 2002

Hi Scowlgirl, it is a lot easier to do a lobectomy than a full thyroidectomy, but if it should come to it, a "completion" thyroidectomy to remove the second lobe is considered to be "re-operative" surgery and involves a somewhat increased risk of voice and/or parathyroid damage and thus requires an especially competent surgeon. So, I fully agree with Rustifox' advice to check out your surgeon and make sure that s/he is an experienced thyroid surgeon. Confusingly, any qualified general surgeon can remove a thyroid, although some are board certified in head and neck or ENT surgery. In your shoes I would look out for an experienced thyroid surgeon at the outset, one who does a minimum of 100 thyroid/parathyroid surgeries per year, some of these call themselves endocrine surgeons.

I had a partial thyroidetomy (lobectomy) mysrelf, followed... sixteen (!) years later by a completion thyroidectomy, where indeed they found more cancer. The second operation was a lot more tricky because of the adhesions, scar tissue etc. but I was fortunate to have an experienced reoperative surgeon and I don't have any voice or parathyroid damage. A few years ago I needed surgery to remove a parathyroid adenoma (a benign tumor), and once again it was tricky, but I had a super reoperative surgeon who was able to remove it without damaging the other parathyroids.

Good luck and hope this helps

Posts: 1
Joined: Dec 2007

Hi every body
I just wanted to say : choose your surgeon carefully : I've total thyroidectomy on November 21th 2007 , & since that I'm taking calcium supplement & voice problems .
So be careful
Pipillary with lymph nodes invasion

Posts: 4
Joined: Aug 2007

My opinion is do it all. I had surgery 17 years ago where they took out half. Then 5 years ago due to new nodule growth. Once is really enough.


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