Tag Archives: completion thyroidectomy

Moving On

I can’t believe it’s taken me a week to sit down and update since my post-op follow up appointment!

I’ll start there…

First of all, the path report on the left side of my thyroid was cancer free.  Woo hoo, right?  So was the lymph node that he removed.  Dr. B offered me the option of a referral to the nuclear medicine doctor, but he and I both felt that I didn’t really need RAI ablation/treatment, so we are just going to skip it for now.  Double woo hoo!

The other side of my thyroid did have some weird stuff…for one, it had a LOT of nodules, which I knew, and “hurthle cell change,” which I was pretty sure they would find.  They also found some “giant” cells, which can be associated with Hashimoto’s (which I have–or had?), but also has an association with PTC and even Anaplastic cancer.

I was a little afraid ahead of time that if no cancer was found in this second surgery that I would regret having it done….but I don’t.  I just know with all the weird stuff that was in there that I would have required a lot of monitoring to stay on top of it, and I feel, myself, that some of that would have morphed into more cancer at some point.  No, I’m just glad it’s out, and that we know for sure there wasn’t any cancer there.  If it had stayed in there, I would have wondered forEVER.  I have this feeling like I am “clean” now.

Dr. B does want me to have a WBS (Whole Body Scan–they use a small “tracer” dose of RAI) to check for any possible metastasis, but I get the sense that it is just kind of a formality, just to make extra, extra sure. That will be at either 6 months or a year, I can’t remember which.  Beyond that, I will have my thyroglobulin  levels tracked.  (That’s a protein only made my thyroid cells.)  As long as they stay stable, it’s unlikely that cancer has returned.  And I will also have periodic neck ultrasounds to make sure there’s nothing abnormal springing up in the thyroid bed.  But that’s it.  Nothing more than a low-level annoyance, if things go as expected.

I am so, SO thankful that God has seen fit to give us a favorable answer.  I look around at others who are going through so much more right now–one college friend who just had a kidney transplant, another whose four-year-old daughter is in a battle with leukemia that could last for years, another whose younger brother has just learned he has stage IV, terminal stomach cancer.  I feel like I have gotten off pretty easy.

I am also SO grateful for all the kindness we have been shown.  I have gotten so many cards from people.  Our brothers and sisters in Christ are STILL bringing us food to help us out.  Jessica stayed with me overnight in the hospital AGAIN.  I could go on and on.  I LOVE being part of God’s family.  His children are the best siblings I could ask for.

I am also doing pretty well so far on my thyroid medication.  More about that next time!

Today is Mom’s birthday.  I bought some Mayfield Brown Cow Jr. ice cream pops at Publix to celebrate.  She used to always have them when her grandkids–my kids and Nathan’s–came to visit.  She called them “Cow Bars,” and that’s how my kids know them now.

I miss her SO much, but in many ways, the intense, sharp pain of her loss has faded.  She’s been gone just over three years now.  Happy Birthday, Mom!  I raise my Cow Bar in salute.

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At home, doing well.

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My incision, the morning after surgery. Second verse, same as the first, right? Once again, Dr. B appears to have done a great job.  I especially appreciate that he went looking for lymph nodes, even in the lateral areas of my neck. He found one on the left side, which he said he wouldn’t have thought anything about if I didn’t have cancer. I am thankful that he went to the trouble of looking carefully.

I have had no problems with my calcium levels, Praise God.  My pain at the very first was a little more than last time, but now is about the same. I am able to be up and moving about the same amount as before, which is not much yet.

Dr. B went ahead and started me on 100 mcg of Synthroid because he doesn’t think I will need RAI. (Sounds good to me!) He says he will check my TSH in 3 weeks to see if I am in the ballpark, or if I need to have my prescription adjusted. I was pleased to learn that he aims to keep his thyca patients with a TSH around 0.5.  That’s what I was hoping for.

My follow up is Thursday, when we’ll hear the final pathology report on what they removed in this surgery.

Aunt Sharon got here today in time to help Rusty get the family off to church.  She brought a car load of Krispy Kreme doughnuts, because that’s just how she rolls. :) I am so glad she’s here. Rusty has been doing a phenomenal job taking care of me and the kids, but its all a bit much, and I know it is overwhelming to him. This will ease his burden a good bit.

Follicular Variant Papillary Thyroid Carcinoma, Second Surgery Today

Just as I did when I had done research on Hurthle Cells way back when I was diagnosed with a Hurthle Cell Lesion and wanted to understand what that meant, I want to put down here some of what I have learned about the particular variety of cancer I was diagnosed with after my first surgery:  Follicular Variant Papillary Thyroid Carcinoma, FVPTC.

The very first things I read indicated that FVPTC pretty much behaves the same and is treated the same as “Classical” PTC (cPTC).  Since then I have read a good deal more, and have found that this is not always the case.  In both cPTC and FVPTC, it makes a difference if the tumor is encapsulated or diffuse (spread out with no clear margins in the tissue).  Just like you might think, diffuse tumors tend to spread more readily and are considered more “aggressive.”

There is also an “in between” type that is not encapsulated but is not diffuse–From what I have read, it tends to behave more like encapsulated tumors and is, as these authors love to say, more “indolent.” I haven’t found much about that, so cant say more.

Then there is a great deal of research published within the last two to three years that examines encapsulated FVPTC (EnFPTC) versus unencapsulated.   See this, this, and this.  The basic takeaways are two-fold.

One is that FVPTC tends to behave more like FTC (Follicular Thyroid Carcinoma) rather than PTC.  That means it is more likely to spread distantly through the blood than to reoccur locally in the neck (in lymph nodes, etc.)  It also means that a totally encapsulated FVPTC might even be considered benign.  In FTC, malignancy is determined by capsular or vascular invasion.

The other take-away is that encapsulated FVPTC is generally very non-aggressive.  It seldom spreads anywhere.  There is a good deal of debate about whether it warrants a total thyroidectomy if there is no vascular invasion.  Even with capsular invasion, some authors believe a total thyroidectomy is not worth doing.

Then there is an alternate point of view, that encapsulated FVPTC can have vascular invasion that is so microscopic as to be almost undetected, and that in such cases a tumor that looks to be harmless could end up with distant metastases years later.

So all of this was what I have waded through since my diagnosis, what I’ve struggled with as I decided whether to have the completion surgery or not. What it comes down to is that I do not believe completion surgery will change my prognosis, but it will lower my risk of recurrence and make it easier to be monitored going down the road. I put my trust in my God to continue with me down this path, wherever it leads me.

And in a few minutes, I’ll be headed over to the hospital for my surgery.  Last time I was anxious about having surgery–since I’d never really done that–and about what they would find.  This time I know what to expect and the procedure doesn’t worry me.  I don’t really expect them to find any more cancer, but know it is a possibility.  This time, I am more concerned about adjusting to life without a thyroid, life on a daily med.  Again I put my trust in the Father to take me forward one step at a time.

See you on the flip side.