Doctors Lounge - Endocrinology Answers
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Forum Name: Endocrinology Topics
Question: Cyst in left lobe of Thyroid
|climax - Thu May 07, 2009 1:15 pm||
I am 32 years male. I have cyst in left lobe of thyroid. I have gone through the isotope scan and it shows cold nodule. The nodule was diagnosed in 2007. My latest reports says:
1. US : left lobe size = 5.5x3.3x4 cm ( isthmus and right lobe appear normal )
2. Blood : TSH = 1.19
FT4 = 1.20
FT3 = 3.43
FNAC shows benign nodule.
I am going to surgery after two days. I have taken opinion from three endocrinologist. Two endo says that i should have full thyrodictomy, while one says that i should go for half thyrodictomy and after the histopathology result the second surgery might be possible if malignant cell detected in analysis.
After two days i have a half thyrodictomy surgery. My surgeon is confident to save all four parathyroid, vocal cord and recurrent nerve.
I am too much confused about the second surgery that the FNAC result might be wrong. I want to ask some of the questions here that :
1. After half thyrodictmy will I need to take thyroxine for the rest of my life.
2. How much is the possibility that FNAC result are wrong.
3. If I go through the second surgery for removing the entire gland, will the surgeon remove lymph nodes across thyroid ? then what will happen if there is some infection around neck in future because no lymph node will be there to fight infection.
4. What is re-occurrence rate of malignant thyroid?
5. How can i be safe from metastasis to lung and bones ?
6. If histopathalogy found papillary then after surgery and radio active iodine what will be normal span of life. Does papillary shorten the average life span ?
I hope you will give all the answer as I am in very tension.
|Dr.M.Aroon kamath - Mon Nov 16, 2009 4:50 am||
It would have been immensely helpful if details of the biopsy report had been provided.
Generally, the histopathologist would mention which benign nodule they are referring to- for example, a follicular neoplasm, a colloid nodule,colloid cyst etc.
Surgical management of thyroid disorders varies between hospitals and sometimes within an institution.Some advocate total thyroidectomy for most conditions.Others may, in certain cases first perform a hemi-thyroidectomy and proceed to a total thyroidectomy when a frozen section report becomes available.
Now,about trying to answer your questions one by one....
1) After half a lobe of thyroid is removed (and if proves to be benign),one can't accurately predict how much the remaining lobe is capable of producing the hormones. Periodic post-operative thyroid function tests will help to determine if thyroxin supplements would be needed or not.If it turns out to be malignant, the surgeon, in all probability would remove the rest of the thyroid, in which case,life-long thyroxin for TSH supression will be needed.
2) Depends on the experience of the pathologist.
3) Unnamed alternative lymphatic channels are thought to develop.
4)Depends on histological type of the tumor, successful local & regional lymph nodal clearance and other factors.
5) This will depend upon the type of tumor, whether histopathology showed any vascular invasion,grade of the tumor etc.
6) Cancer-specific mortality in relation to papillary thyroid carcinoma is multi-factorial and still being studied.
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