HELP! I thought I was OK!

[KAnnD]

OK, folks...here goes:  After finding a cold nodule on my right thyroid, I had a biopsy and it came back negative for cancer cells.  I chose to have a lobectomy, anyway.  An oncology surgeon performed the right lobectomy and said that after surgery his preliminary report was that it "looked very benign" to him.  Now, it's one week from surgery and I got a call that my oncology surgeon wants to see me in his office first thing in the morning....and not for a follow-up (which is scheduled for two weeks away).  His nurse and assistant won't tell me anything.  My mind is running away with me.  Why is he needing to see me?  Did the frozen section that he took of the biopsy come back with cancerous cells, afterall?  HELP!!!!!! Has anyone had this problem or know what is going on?  

[KAnnD]

I go for my second surgery Wednesday to remove the left lobe.  I'm ready for all of this to be over.  I read somewhere that the 5 yr. survival rate for this is 100%.  I just want this nightmare to be over...and to move on.  I'm sick of it.  Thanks for all of your comments, knowledge, etc.  I can't tell you how much I appreciate it.  I've learned much!

[898]

Yes this is true; as more thyroid tissue destroyed by the antibodies the nodules containing colloid and "patches" of scars are forming

[KAnnD]

Well, nothing other than the initial large (3 cm) nodule was picked up on the ultrasound or the uptake scan.  This is what the oncology surgeon noticed and thought that it was scar tissue.  My mother has Hashimoto's and there was some talk that scar tissue builds up if you've got Hashimoto's thyroiditis (?).  

[898]

It suppose to be larger then 3 mm to be picked up; the microcarcinoma is actually the cluster of cells rather then well defined feature.

[KAnnD]

As always, thanks for your clinical research and insight!  This makes me feel better.  I think the TT will just give me some peace of mind.  I think that the cancerous nodule had to have been less than 7 mm or it would have been picked up on ultrasound or on the uptake scan? Anyway, thanks for responding.  There are times during the day when my fear gets the best of me.  It's nice to get some reassuring info!
- Kim

[898]

"A Mayo Clinic study of 900 thyroid micro-carcinomas from 1945-2004
The median size was 7 mm.

If the primary was completely resected by either lobectomy or total thyroidectomy, the patients with Papillary Thyroid Microcarcinoma have a 99% chance, they will not be threatened by the risks of distant cancer spread, or cancer specific mortality. Total thyroidectomy did not have any effect over lobectomy on outcomes over 40 years. Also the use of radioiodine ablation post operatively did not improve outcomes. There was no effect on tumor recurrence or cause specific mortality.

Results:
Patients need to be aware that radioiodine ablation has no place in the vast majority papillary micro-carcinoma treatment plans."

Reference: Ian Hay MD Mayo Clinic: A personal email answer to a ACT members question about small papillary cancers.

[KD9ER]

Have a second opinion if you don't feel right.  Sometimes listening to your gut is more important.  Did you ask your current oncology surgeon why he felt it would be overkill?

I don't think it's unreasonable to have the other lobe out at the very least to have it inspected too!  I'd say if he found something in there then the RAIU treatment isn't out of line either.  Just my opinion though.

[KAnnD]

Well, I talked to my oncology surgeon and he said that he removed a "speck" (his words), which was "far less than 1 cm" from the isthmus in addition to the right lobe (where the large nodule was located).  The large nodule in question came back benign.  The "speck" came back with micro papillary cancer cells.  He said he removed that region and he would just treat me with hormones.  I asked to have the rest of the thyroid removed and to take the radioactive iodine.  My surgeon thinks it may be "overkill", but I would feel better having it done.  What do you think?

[898]

The very small ojects less then 3 mm will not be seen on the RAIU scan and less then 1-2 mm on the ultrasound

[KAnnD]

Would any of this ever shown up on my thyroid uptake scan or my ultrasound thyroid scan?
- Kim

[KAnnD]

Thanks for the straight answer.  I know that it's something b/c there is no reason for me to come in before my two week appointment.  Bottom line:  Will I be OK?  Does this translate into a total thyroidectomy afterall and radioactive iodine?  At this point, I want it all to be over and done with.  Thanks! Kim

[898]

In theory they can find some suspicious cells in the dissected lobe.
These cells however may never reproduce themself in the quantity to be significant.
For the follicular neoplasm, for example if atypical cells are contained whitin the nodule, the nodule is benign [adenoma]; if cells are present outside of the nodule the neoplasm is considerd malignant[follicular carcinoma]