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Forum Name: Endocrine Cancers

Question: Total Thyroidectomy - Overkill?


 KAnnD5 - Thu Aug 28, 2008 9:21 pm

I was initially diagnosed with a 3.1 X 1.9 X 2.2 cm "cold nodule" on my right thyroid lobe. I had a biopsy and the results came back benign. I chose to have the nodule removed. While in surgery to remove the large nodule in question, my doctor said that he noticed a "speck" (his words) which was less than 3 mm on the isthmus. Therefore, he decided to remove the isthmus along with the right lobe. The frozen section that came back from the surgery confirmed that the large nodule was benign, but the "speck" contained micropapillary carcinoma cells. My doctor assured me that I would just need to take hormone therapy from here on out and that the "speck" was cut out. I have decided to be "super aggressive" and have the rest of my thyroid removed AND receive radioactive iodine. My doctor says this is "overkill."
1. Is this "overkill"....even if it offers me peace of mind?
2. Am I considered "cancer free" when he removed the small cancer from the isthmus?
3. I'm scared. I have three small children (all under five yrs.). Does this impact my life expectancy? Do I have a reasonable expectation that I could live to see my granchildren?
Thanks,
Kim
 Dr. Safaa Mahmoud - Wed Oct 15, 2008 11:51 am

User avatar Hello,

Many studies showed that subtotal thyroidectomy is associated with double the recurrence rate and a lower survival rate than total thyroidectomy for papillary and follicular cancers. However, a large recent study has proved equal survival for those undergo lobectomy or total thyroidectomy whether they are categorized as low or high risk papillary cancer thyroid patients.

Prominent thyroid cancer specialists advocate subtotal thyroidectomy rather than total excision and consider it sufficient for the majority of patients who fulfill the low risk criteria.

Indeed the National Comprehensive cancer network NCCN recommend total lobectomy for patients with papillary microcarcinomas and consider this an adequate treatment for patients who have not been exposed to radiation, have a unifocal tumor smaller than 1 cm, without vascular invasion or small (< 1 cm) papillary carcinomas found incidentally on the final pathology sections
in the course of thyroid surgery for benign disease; no contralateral lesion, and no suspicious lymph node. Positive isthmus margins to the contrary is considered a risk factor and total thyroidectomy is recommended.

Postoperative radioactive iodine therapy is performed when the patient has a tumor with high risk features for recurrence after total thyroidectomy.

The most feared complications of thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve injury with much higher frequency after total thyroidectomy. Radioactive iodine therapy at conventional doses rarely cause serious long term effects on other parts of the body (salivary glands affection have been reported).

Total thyroidectomy and radioactive Iodine are associated with complications that are better avoided when their benefit under weigh their risks.

If the pathology report proved that the nodule has been removed with negative margin, not of high risk variants, unifocal, less than 1 cm and your physician has seen no other suspicious focal lesions in the other lobe, lobectomy and isthmectomy would be enough with close follow up.

I would advise you to follow up with your doctor and to discuss with him all the benefits and risks from being on FU or from more radical approaches to be more reassured and convinced with your final decision.

Hope you find this information useful.
Best regards.

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