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Tuesday, May 21, 2013
Thyroid Nodules, Surgery, and Cancer Risk
In the recent physical examination by my endocrologist,the doctor detected slightly enlarged thyroid and asked me to do an ultra sound scanning. The scanning revealed at least 4 nodules on the right thyroid (the largest in the upper mole measures 9mm and one small nodule in the lower pole of the left thyroid (4mm). Further FNA of 9mm right thyroid nodule indicated suspicious for malignancy and for papillary thyroid carcinomia.
My question is: Do I need surgery to remove my right thyroid? If the right one is removed is it safe to remove the left thyroid too (to avoid another surgery in the future)? If surgery is not required, what follow ups are required to reduce the risks of cancer? I am 60 years and diabetic.
If you do not have severe complications from your diabetes or other major medical problems, I would normally recommend surgery to remove both thyroid lobes in your situation. Normally the right lobe is removed first, the cancer is confirmed to be present by frozen section, and if confirmed the left lobe removed during the same operation. You would need to take a pill once a day to replace thyroid hormone the rest of your life.
There are some doctors who would remove only the right lobe. The advantages to removing both in your case are: that there is a abnormality in the left seen on ultrasound, papillary cancer can spread to the other lobe, follow up and possible radioactive iodine treatments are easier with both lobes removed, you appear reliable to take your thyroid replacement medication, and it is generally very safe to do with one surgery for experienced thyroid surgeons. Details of the risks should be discussed with your surgeon.
Jeffrey J Sussman, MD
Associate Professor of Surgery, Chief, Division of Surgical Oncology
College of Medicine
University of Cincinnati