Do I need a thyroidectomy?

[Stepheni]

I had a partial thyroidectomy 9/2/09 to remove a solitary 9mm follicular neoplasm. The pathology came back as follicular variant of papillary carcinoma. I have no other nodules.  The ENT who did the surgery wants to do a thyroidectomy and radiation.  I saw an endocrinologist who thinks that due to the small size of the nodule, the fact that it was solitary and that I'm 30 yrs. old a more conservative approach is warranted.  His plan is a PET scan followed by suppressive levothyroxine and close monitoring (frequent US and labs) His rationale is the risks of surgery and radiation are too great for a tiny non aggressive cancer that has already been removed.  What do I do?

[utahmomma]

Papillary carcinoma often spreads with microcancers which would be too small to visualize on an ultrasound or other imaging technology.  Since you already have a diagnosis of papillary carcinoma (and the slightly more aggressive follicular variant), there is a good chance that there are other small areas of papillary carcinoma within the remaining thyroid tissue.

The best way to check for ongoing or recurrent thyroid cancer (papillary or follicular) is through establishing a baseline thyroglobulin (TG) level and routinely monitoring it for any increase.  The TG level is the cancer marker but *cannot* be a reliable marker if there is remaining thyroid tissue.  Also, a PET scan will often not show recurrent or remaining thyroid tissue as well as the I-131 (we call it RAI for radioactive iodine) scan.  This scan is an oral dose of iodine which is radioactive and, since thyroid tissue is the only tissue that absorbs iodine, is highly specific in locating and identifying any remaining thyroid tissue or cancer.   Problem with this scan is that it also kills off healthy thyroid tissue and is best performed if as much healthy thyroid tissue as possible has been surgically removed.

Hopefully this helps.

Utahmomma
papillary carcinoma (5mm) '03, second surgery '04, recurrence and RAI '06
three sisters with papillary carcinoma (including one with three recurrences/RAI and distant metastases)
daughter and another sister with multiple precancerous nodules (all surgically removed)

[Stepheni]

The other side of my thyroid is completely free of nodules, I only had one nodule which was removed during the lobectomy, the pathology came back as cancer.  He wants to remove the rest of the thyroid and do radiation basically as a precaution I guess.  Of course I know it should be discussed w/ the pros and have gotten the opinions of 2 specialists, I just figured someone here may have had a similar experience and could lend some insight.  I have ttried posting on the expert forum and evidently there are only a certain amount of posts allowed there per day and they had met their quota.

[TamraW]

I don't understand. I thought the nodule was removed on Sept 2? So the ENT wants to go back and remove the other lobe? Is this a new nodule you're talking about that isn't cancerous?

You might need to reword this question.

Also, something like cancer surgery is tricky and should be discussed by the pros. Sorry to blow you off. I'm not trying to be difficult. Have you thought about posting this to Dr. Lupo on the expert forum?

Take care...
:) Tamra