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Medical Forum / Diseases and Disorders / Cancer / January 2008Thyroid surgery options
Hello all. I have two doctors offering me two different surgery options. Want to know what y'all think is a better option. I have an up-and-coming local doctor with about 100 endoscopic surgeries offer me a near-total endoscopic thyroidectomy next week. I also have a late February date with a top-notch doctor (many hours travel), who has done over 1000 surgeries, for an "open" conventional procedure. I know that endoscopic means smaller scar, lesser pain; but is it as safe? Tumor is about half an inch size, right lobe, papillary type, and so far, they havent seen it spread. My main concern is what thyroid surgery does to one's voice? I earn my living as a performer and give voice lessons also. There doesn't seem to be documentation about how much fine tuning in the voice can be affected by thryroid surgery and if endoscopic kind of surgery is better than the other one as regards voice quality. Anyone have any thoughts? Cheers! > Hello all. I have two doctors offering me two different surgery > options. Want to know what y'all think is a better option. [quoted text clipped - 18 lines] > > Cheers! Did either offer Radiation first? Seems more logical on a tumor that small? Betsy No, an endocrinologist, my ENT, physician and these two surgeons have all only been asking for complete thyroid removal.... >> Hello all. I have two doctors offering me two different surgery options. >> Want to know what y'all think is a better option. [quoted text clipped - 21 lines] > small? > Betsy >>> Hello all. I have two doctors offering me two different surgery options. >>> Want to know what y'all think is a better option. [quoted text clipped - 17 lines] >>> >>> Cheers! >> Did either offer Radiation first? Seems more logical on a tumor that >> small? > No, an endocrinologist, my ENT, physician and these two surgeons have all > only been asking for complete thyroid removal.... The usual treatment for thyroid cancer is surgery, usually followed by radioactive iodine ablation (except for single very small non-invasive tumors). If you (betsyb) mean external beam radiation, that's usually only if the thyca is iodine resistant -- and from what I hear it ain't no picnic. OP -- I had no trouble with my voice (not that it's any great shakes) that didn't get better within the first months after surgery & RAI (but I also had a plain-ole-(hard-to-shake)-winter-bug then too, which had a lot to do with my sounding hoarse & tired for a few months). I didn't have any side effects from RAI, either (e.g. salivary glands, tear ducts, tastebuds). Some people have less trouble than I did, some a lot more, or had problems for more or less time than I did. I'm not sure that any of it can be predicted for any particular person. You might want to visit www.thyca.org & link through to the support group list at http://groups.yahoo.com/group/Thyca/ for more info., including "questions to ask your surgeon". I don't recall anyone mentioning endoscopic TT, but someone did have it with a local anesthetic (which creeps me out). Lots of experience there, specific to thyca & surgery, among several thousand list-members. BTW, the scar isn't that bad -- hardly noticeable after a while ("while" varies, & so does how you feel about having it there *at all* -- me, I don't care). The main thing about your thyroid surgeon is how many *thyroid surgeries* s/he has done (total) & how many per month/year nowadays. "Endoscopic" experience can cover a lot of territory, not just thyroid. It's a *very delicate area* & you want someone who really knows what s/he's doing there. Ask about the surgeon's rate & experience with the known possible complications of thyroidectomy (e.g. voice, parathyroid). What are the plans if s/he sees something more "in there" -- how will s/he proceed then? And you may want to find out about post-op treatment scheduling, too, so it doesn't come as a surprise on issues like low iodine diet, isolation, not-driving-while-hypo, etc. Best wishes. bj > No, an endocrinologist, my ENT, physician and these two surgeons have > all only been asking for complete thyroid removal.... [quoted text clipped - 25 lines] >> small? >> Betsy When I had a small node pop up on my PetScan as glowing cancer it was about that size. Just above my left collarbone. My Oncologist asked my thoughts on this. Since I had just finished 2 rounds of Chemo and one long round of Radiation. I asked what she thought best? There was about one year in between occurances. We agreed that radiation might be the better choice. It worked. Have you ever seen an oncologist or just surgeons? I don't know what radiation might do to vocal chords. Betsy Not seen an oncologist ever- I plan to see one after surgery, RAI, endocrinologist for thyroxine etc, abt three months post-op. I really havent heard of pure radiation treatment for thyroid cancer in the journal literature or on the web. It just appeared from all this, that as soon as you get that diagnosis, you have a bed side date with a surgeon and his anasthetist goons :) I think bj has the right info on this... >> No, an endocrinologist, my ENT, physician and these two surgeons have all >> only been asking for complete thyroid removal.... [quoted text clipped - 35 lines] > radiation might do to vocal chords. > Betsy > Not seen an oncologist ever- I plan to see one after surgery, RAI, > endocrinologist for thyroxine etc, abt three months post-op. I really [quoted text clipped - 43 lines] >> radiation might do to vocal chords. >> Betsy You will probably be in the right area. Please let us all know how you make out. Mine was in the thyroid area so I guessed either might work. So much for guessing. Hang in there and holler any time. Betsy >>> When I had a small node pop up on my PetScan as glowing cancer it was >>> about that size. Just above my left collarbone. My Oncologist asked my [quoted text clipped - 12 lines] > > Betsy Thyroid cancer cells can actually end up anywhere, but if they're still "thyroid cancer" & either big enough to take out surgically or small enough & still taking up radioactive iodine, it's still treated just as if it were in the thyroid bed where they "belonged". And I think I've heard about non-thyroid-cancer occurring in the thyroid bed -- so it's not treated like thyca. It's not just geography, it's "type" & function. (hardly a technical answer....) bj > Not seen an oncologist ever- I plan to see one after surgery, RAI, > endocrinologist for thyroxine etc, abt three months post-op. I really > havent heard of pure radiation treatment for thyroid cancer in the journal > literature or on the web. It just appeared from all this, that as soon as > you get that diagnosis, you have a bed side date with a surgeon and his > anasthetist goons :) I think bj has the right info on this... Many if not most thyroid cancer patients never see an oncologist. I hope I never need to! (although some places custom is different from USA) Surgeon, endo, nuclear med; maybe an MRI or CT (I've had both) or PET, or even an actual looksee by the ENT with his little flashlite-on-a-tube (what fun! he had to go via my nose) if something hard-to-pin-down looks like it's showing up (which for me turned out to be "nothing there after all"). bj >> Hello all. I have two doctors offering me two different surgery options. >> Want to know what y'all think is a better option. [quoted text clipped - 21 lines] > small? > Betsy No, the correct treatment for thyroid cancer is surgery Personally, I'd go with the conventional open thyroidectomy every time. It doesn't seem to have spread for me... possibly some lymph nodes, but nothing showed on most recent ultrasound... longest diameter is 1.2CM. Do you think I couldn't get away with endoscopic? Is it worth waiting another 45 days for open surgery? >>> Hello all. I have two doctors offering me two different surgery options. >>> Want to know what y'all think is a better option. [quoted text clipped - 24 lines] > No, the correct treatment for thyroid cancer is surgery > Personally, I'd go with the conventional open thyroidectomy every time. > It doesn't seem to have spread for me... possibly some lymph nodes, but > nothing showed on most recent ultrasound... longest diameter is 1.2CM. Do > you think I couldn't get away with endoscopic? Is it worth waiting another > 45 days for open surgery? I know nothing about your endoscopic surgeon, but it's not a technique used here (BC). There are three important issues with surgery for thyroid cancer: 1) Remove all the cancer, 2) Remove all the thyroid 3) Don't damage the recurrent laryngeal nerves It seems to me that all are more likely to be successful with an open thyroidectomy. Endoscopic surgery may be fine for benign thyroid disease, but I don't know of any good evidence that it is fine for cancer. 45 days is irrelevant in the natural history of thyroid cancer. > My main concern is what thyroid surgery does to one's voice? I earn my > living as a performer and give voice lessons also. There doesn't seem [quoted text clipped - 3 lines] > > Anyone have any thoughts? I had open surgery about 23 years ago and I did not notice any change at all in my voice and the scar is virtually invisible. The scar runs horizontal, so it blends in with the other lines that will inevitably appear with age. Before you know it, you can barely find the scar. |
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