Tag Archives: thyroid nodule

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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The incision

image

This is from the morning after surgery.  Looks pretty good, huh?  Nice work, Dr. B.

Macrophages

Ok, so I couldn’t leave well enough alone.  I HAD to keep on researching.

Let me back up.  Here is the word-for-word write up of FNA of the the larger nodule on the isthmus of my thyroid:

Hurthle cell lesion–see comment

COMMENT:

The specimen consists of numerous Hurthle cells and fragments of Hurthle cell epithelium, with a population of macrophages.  The differential diagnosis includes Hurthle cell change in a background of thyroiditis or a hyperplastic colloid nodule versus a Hurthle cell neoplasm.  Clinical correlation recommended and follow up as indicated.

So that actually didn’t sound too bad, especially the idea that it could be “Hurthle cell change in a background of thyroiditis.”

But I couldn’t leave well enough alone.  I wanted to know what, if any, meaning the macrophages had.  I had some vague memory that macrophages were immune cells, maybe a type of white blood cell?  I knew that certain cell types like lymphocytes tended to point towards a benign nodule.  So I went looking, using “macrophage” as a term in combination with “Hurthle cell lesion,” “Hurthle cell adenoma,” “Hurthle cell FNA,” etc. ad nauseum.

I found one case study in which two different patients had similar FNA samples that included Hurthle Cells and macrophages.  One ended up being a Hurthle Cell Adenoma (benign) and the other a Hurthle Cell Carcinoma (malignant).  So I know that macrophages could be present in either.

Then, for whatever reason, I searched for “macrophage thyroid cancer.”  From that I learned that macrophages are generally present in tumors (benign or malignant) and that a certain type of macrophage, known as a Tumor-Associated-Macrophages can sometimes make up up to 50% of a tumor, and that their actions tends to help the tumor grow and spread.

I found this article.  The title alone almost sent me into a panic attack.

I had a little freak out moment, feeling SURE that the “population of macrophages” meant my nodule is FOR SURE cancer. I have reeled it in a bit, and I’m now back to the recognition that “tumor-associated” doesn’t have to mean “cancer-associated,” and that, once again, I cannot find out if my nodule is cancer or not by doing research.  Still, I am not comforted.

I’ve also learned that “hemosiderin-laden” macrophages are usually associated with benign tumors; they “digest” red blood cells when a colloid nodule (always or almost always benign, from what I understand) undergoes “hemorrhagic decay”.  My FNA report didn’t say whether the macrophages were “hemosiderin-laden” or not.  So I really have no idea where I stand.

Before I made my macrophage discovery, I sent Dr. B an email to ask how long surgery should take (45 minutes to an hour)  and where pathology would be done (right here in our local hospital).  I have now looked up the pathologists on staff and am considering sending them gift baskets the day before my surgery, to make sure they do top-notch work for me.

Also, my sweet, sweet Aunt Sharon has said that if I need her, she can come for a few days.  We are going to play it by ear to see how things go.  And UK is in Uganda, preaching.  Love it.

Ok, I REALLY, REALLY need to forget all about this until maybe a few days before June 7th!  Although, I think it would be good to work on some things that would be helpful to accomplish before surgery. I am going to put my “folder” (containing my lab reports, surgery instructions, etc.)  somewhere out-of-the-way.

Should I Google “Hashimoto’s macrophage,” just to make myself feel better?  You see how sick I am?

ETA:  I did Google some more.  I am back to the realization–full realization, not just what I’m telling myself to think–that macrophages don’t mean I have cancer, and very well could point to a Hurthle Cell Lesion associated with Hashimoto’s.    Must.  Stop.  Googling.

Giving Thanks

I heard from M a little while ago.  Her melanoma surgery this morning was a complete success!  She said it was a “very superficial cancer.  No treatments or lymph node biopsies.”  Praise the Lord!

I am ready for my appointment tomorrow.  Questions printed and emailed.  (Dr. B’s quick response was, “Lots and lots of good questions,” maybe with the emphasis on “lots and lots?”)  Childcare lined up.

And here, for your amusement, are pictures of my neck!

Now you see it (swallowing):

Lump visible when swallowing 5-5-13

Now you don’t! (not swallowing):

Lump invisible 5-5-13

Waiting for a Biopsy

I couldn’t quit wondering what the ultrasound report said. I knew that certain characteristics were more indicative of malignancy. I called Dr. G’s office back and asked if they could print out a copy of my blood work results and the ultrasound report. I went by and picked it up.

While I was there, I asked if it was ever possible to talk to Dr. G without making an appointment. I explained that waiting so long for my results had caused me a lot of anxiety—that I felt like I didn’t matter—and that I just wanted to talk to him about it. I was trying really hard not to embarrass myself by crying. As always, the women at the desk were extremely kind, and said they would leave a note for him to call me when he had a chance.

The lab work truly did look “normal.” Most of my levels were close to the middle of the normal range. My FT4 was at the low end of normal, but my TSH–which is what they use to determine if you are hyper- or hypo-thyroid–was right on target. The ultrasound report was very short. What I learned was that I had a lot of nodules, including three larger ones—one in the left lobe, one in the right lobe, and one on the isthmus in the center. That, I figured out, must be the one I had discovered. It sounded like the one in the right lobe was the most concerning—it had “areas of calcification.” The radiologist who had written the report recommended a biopsy.

“Areas of calcification” didn’t help me out much. I had read that microcalcifications strongly suggested papillary cancer, but “coarse” calcifications didn’t necessarily, and a calcified “halo,” or “eggshell,” as it was called, actually pointed to the lump’s being benign. The report didn’t even mention the size of the more worrisome lump, though it offered measurements on two others. I would just have to wait on more details.

The woman who had given me the call had said that I would probably hear from Dr. B’s office on Thursday. I didn’t.

I did get to meet with my ladies’ Bible study group though, and I shared with them about my thyroid nodules and upcoming biopsy. As always, it was a huge comfort to know those women would be added to the number of people who were praying for me. Y also told me that I was the third person in a short period of time who had been concerned about suspicious thyroid nodules. That was comforting too.

Thursday also brought a call from Dr. G. To be honest, I was a little embarrassed when I actually had him on the phone. I told him simply about the anxiety I had experienced while I had waited for my call-back on the ultrasound. He was very kind. He also told me about being gone for a long weekend right after the report got to his office, and about some of the nightmare issues they had been having at the new office. He had come back from his vacation to an office that smelled like a latrine because the sewer line was backed up—it was filled with concrete. And he’d been battling other problems related to the new building. It sounded like a nightmare of a week.

“I don’t want to make excuses, because I hate it when someone makes excuses to me,” he said. But it helped me a lot to know that there had been extenuating circumstances. I really felt for him, and I told him so. I also told him that I really didn’t want to be a complainer or a “problem patient.” I hope I’m not on the “bad” list for him and his staff now.

Friday brought no call from Dr. B’s office. Is there a pattern here? I thought. I decided to resign myself to the fact that this was going to be a long, drawn-out process.

Over the weekend I found a blog by a thyroid cancer patient. I have always been someone who can face things better if I know what to expect. I fully realized that my odds of having thyroid cancer were small, but I needed to keep reassuring myself that if I did, the path forward was doable.

In this blog, the writer, a young man in his twenties, outlined his entire cancer journey from discovery of a lump during an MRI for something else through his post-cancer recovery years later. One thing I found interesting was that the doctor who handled his surgery was an ENT. That made me feel better about going to Dr. B. It seems like even though the steps taken on this journey are pretty standardized, they can be carried out by doctors in several different specialties.

On Sunday we gathered with our brothers and sisters in Christ to worship. B, a long time friend, lead a prayer in which he asked for God to help those who were undergoing diagnostic tests, and for the results they received to be accurate. He doesn’t know it, but he’s praying for me, I thought.

On Monday, I decided to call Dr. G’s office just to make sure that I was supposed to be waiting for Dr. B’s office to call me, and that I was not supposed to call them. The receptionist told me that the referral had been sent, and that I should hear something soon. I did. Later that morning, someone from Dr. B’s office called and apologized for it taking so long for them to call me. She was training someone new and had gotten backed up. I had the feeling that Dr. G’s office had checked in with her to prompt the call.

I told her that I was being sent to Dr. B because I needed a biopsy of some thyroid nodules. She said that I would have to do a consultation appointment first. I wasn’t thrilled with the delay, but decided not to worry about what I couldn’t change. She told me where I could fill out my patient info online, and I told her I had already printed off the new patient information packet from their website and filled it out.

“Well, Dr. B is in surgery today, but he has an opening tomorrow at 3:30.”

So he’s a surgeon, I thought. I wondered if he did thyroidectomies. I took the appointment and called Rusty to let him know about my plans. He again arranged to take a few hours off work so that Eleanor could nap undisturbed. I was thankful he had time off available and that he was willing to use it to help me out that way.

I noticed that I had already received two emails from Dr. B’s office—one to remind me of my appointment and one with a link to a their patient information site. There I could enter all my patient info directly into their system. It was basically all the same information I had already filled out on paper, but I went ahead and did it. Anything that would get me in faster.

I got a shipment of some new oils that afternoon. I used some of them to mix up the popular “Peaceful Child” calming blend for my kids. Is there a “Peaceful Mommy” blend? I wondered.

Tuesday morning I went to visit with my good friend J–the one who had ordered me to find a good doctor. It had been a long time since we’d had a chance to sit and talk together. We talked of many things, but conversation did eventually come around to my thyroid nodules. I confided to her that the thing I was most afraid of, if one of my nodules was cancerous, was radioactive iodine therapy. I felt like in order to keep my children safe while I was radioactive, I really would need to be in a separate house. In her usual way, she said she would come and take care of me if I went alone somewhere like the house in Florida.

“Isn’t Rusty going to go with you?” she asked, when I told her about my consultation that afternoon. “I could come over so that Eleanor could still have her nap.”

“I kind of feel like that would make it too big a deal,” I said. “Things may get to that point, where I’ll want him with me for appointments, but I don’t think we’re there yet. But I’ll tell him you offered.”

Tuesday I also got Rustic Youth Camp applications for my boys. We’ve been to RYC the past two years—it’ss something that we all look forward to. I immediately called Sarah, my sister-in-law to see if she had gotten her applications yet, or if she had heard whether she was accepted to work the camp or not. I had found out the week before that I was in as a teacher for Elliot’s class. Last year we had tried to get Sarah in to work camp so that she could bring my nieces and nephews with her. My idea of camp Nirvana was for all of us to be there—Rusty and me, my brother, Nathan, and SIL, Sarah, with all of our children. Barring the presence of our husbands, having Sarah and her kiddos join me and mine there was a close second.  I was hoping this thyroid thing wouldn’t interfere with camp.

Sarah still didn’t know if she was accepted. I went ahead and filled my kids’ applications out and got them ready to return.

At about 2:45 Rusty came in from work. I told him about J’s offer to keep the kids if he wanted to come.

“I just assumed you would tell me if you wanted me there,” he said.

“I assumed you would ask if you wanted to come,” I replied, smiling. “I just don’t want to make it into a big deal yet.” I took off to my appointment, calling J on the way to let her know I was going alone, and that I was fine.

“Well, call me when you’re done,” she said.

Here’s how it all started…

(Note:  The first few entries in this blog are timestamped for April 19th.  Some of that material was probably written on April 19th, but not all of it.  I edited the time stamp so that all entries would appear in chronological order.)

On March 26, 2013, as I was in my bathroom getting ready for my day, I took a sip of coffee. Out of the corner of my eye, I saw my reflection as I swallowed. There was a lump on my neck. Was that my voice box? I swallowed again, paying closer attention. The lump was below my voice box, and was slightly off-center. That doesn’t look right, I thought. Is that where my thyroid is?

Looking at myself straight on in the mirror, the lump was completely undetectable. I swallowed. There it was. I tried to feel the lump. It was hard to find with my fingers unless I tipped my head back or swallowed. When I did get my fingers on it, it felt smooth and firm.

I decided to be on the safe side and call my doctor. Dr. G, my primary, had an appointment open that afternoon, so I booked it. I called my husband at work to tell him what was going on, and he arranged to take the afternoon off to stay with the kids so that Eleanor, our two-and-a-half-year-old, could get her nap undisturbed.

A few minutes later, my friend MA came over with her children. It was spring break for Auburn schools, a good chance for our families to get together and play. (My family homeschools, so our schedule is flexible for playtime!) I was feeling slightly rattled, and while the kids played, I mentioned my discovery. We didn’t talk about it much, but it was good to confide in a friend.  Later, another friend, L, brought her kids over to play.  I was glad for the distraction.

That afternoon, I got to see Dr. G’s shiny new office. The practice has been growing fast, and they had just moved into a large and lovely new facility. There were still painters with ladders touching up spots in the waiting room.

Dr. G has a double specialty in pediatrics and internal medicine, so he is the primary doctor for my entire family, except for my husband. I really like this arrangement because, even though we are a pretty healthy family, we see Dr. G often enough that we have a friendly rapport.

When Dr. G came in, we chatted for a minute about his new office. He said that there were several kinks they were still trying to work out.

He asked me a few questions about symptoms of hyper- or hypo-thyroidism; I had none. He had me tip my head back so that he could look at the lump and see what it felt like. He watched my neck as I swallowed, and held a light up to the lump. I didn’t know it at the time, but thyroid lumps are extremely common, especially in women. This assessment is probably one that he does often.

After his examination, he told me that there was a wide range of things that the lump could be, including cancer. But he reassured me that even if it was thyroid cancer, it was one of the best kinds to have, and nothing to be overly worried about. He ordered blood work to test my thyroid levels and had his nurse schedule a thyroid ultrasound for me.

Back at home, I sent out a text to some of my close friends and family. Found a lump in my neck, on/near my thyroid, ultrasound scheduled Friday. Probably nothing, but would appreciate prayers.

I called my Dad. I had recently been up to visit him in Arlington when he was in the hospital recovering from a surgery to clean out an abscess on his spine. I felt he deserved to hear voice-to-voice. He’s not an overtly emotional person, but I could hear the worry in his voice. I promised to keep him updated.

That night my Uncle Ken (UK) called to condole with me. He’s my mother’s brother, and my “father in the faith.” He and my Aunt Sharon had always been dear to me, but have become even more important in my life since the death of my mother in 2010 of metastatic breast cancer. He had read my text to Aunt Sharon and my cousin Karen, who was there visiting. Karen had commented that she couldn’t believe I had one more thing to worry about, and told UK about Dad’s recent medical drama.

I should probably add here that we have already had several difficult family situations to deal with since the start of the year. Rusty’s paternal grandmother had passed away after multiple bouts of pneumonia over the winter. Then his brother Danny had been hospitalized for what they thought was quickly progressing MS, but turned out to be neurological problems caused by as severe B-12 deficiency. Then came my Dad’s scary illness. We were hoping life would cut us some slack for a little while.

I had, just a week or two before, discovered the fascinating world of essential oils. I called a friend, K, who was more experienced with them to see if she had any ideas for oils that might be helpful. We discussed possibilities, and I settled on what I would start with. She promised to bring me by some myrrh—which is supposed to support normal thyroid function—the next day. When she did come, she brought benedictions with her, in the form of a little booklet about God’s healing. I felt very loved—as I always have whenever anything difficult comes up in our lives. Rusty and I have truly amazing friends and family, and we are very thankful for them.

I want to make something very clear at this point.  I have complete faith that my Lord can heal me–or anyone else–completely.  I believe that He hears prayers.  I also have experienced enough to know that God doesn’t always lead us down the easy path, and that He can use difficulties to refine us for his purposes.  I try very hard to follow the command, “Be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known to God,” and to embrace the promise that goes with it, “And the peace of God, which surpasses all comprehension, will guard your hearts and your minds in Christ Jesus.” However, as in everything, I often fall short and must constantly work on putting my trust in Him.