My mom, who's turning 50 this year, recently got diagnosed with papillary thyroid cancer. She's Asian and is the oldest of five siblings, with two sisters and two brothers. Both of her sisters have had surgery for thyroid cancer in the past, and the younger of the two has recently had a recurrence of the cancer and will require another surgery. Her younger brother has also had thyroid conditions, but without any signs of cancer. In short, she has strong genetic ties to have thyroid cancer.
My mom received the thyroid ultrasound and the fine needle aspiration biopsy (FNA) for investigation. With the results of both tests, the doctor told her that she had a mass the size of 0.6 cm (not very big; one of my aunt's masses was 4cm), and that it was "70% cancer." They told her that she needed to get surgery.
1. What does it mean by "70%"? Is there a 30% chance that it might not be cancer?
2. Post-surgery, she realizes that she will most likely have to take hormonal supplements. What are the side effects of these drugs?
3. The doctor told her that she will also need to take calcium supplements, since she won't have a thyroid to organize and distribute calcium intake. Is consuming calcium through natural means (ie. food, rather than drugs) futile? Will they not get deposited into the body the same way that calcium supplements would?
4. Her mass lies only on one side of her thyroid gland. A bit of research of my part revealed that it is possible to leave half the gland behind. If given the choice, which option is usually better? If half is left, are the chances of cancer recurrence higher?
She received the news in Korea, where the health care system is superb but the doctors are generally mean and unhelpful. Any help would be appreciated.
1. I'm not sure about this question. She should ask her doctor about it.
2. The side effects mostly come when the dosage is off, like when she has too much or too little. It sometimes takes time before they get the dosage right for the person and there is adjustment time of 2-3 months in between dose changes. So it can take time. Also, other things, like gaining or losing weight can change what dosage she will need. Some people do say that the supplemental pills don't works as well for them as their regular thyroid did, so they might be candidates for T3/T4 combination therapy, but I recommend that people try the T4 alone first, since many people are fine with that. If after she is on a "correct dosage" according to the blood tests and she doesn't feel right, then it may be time to explore other options. Some people also say that they gain weight, regardless of what dose they are on, but regular physical activity can help this a great deal.
3. It's not the thyroid that distributes the calcium intake (did the doctor really say that?!). The *parathyorid* glands do that and those shouldn't be removed if the surgeon knows what he is doing (unless those are cancerous). One or two may be removed because they may be imbedded in the thyroid gland or just because of how small they are, but there are four of them and it is very rare for all of them to be removed unless all of them are imbedded or the surgeon really doesn't know what he is doing.
She should take calcium supplements, however, because usually they want patients after thyroid cancer to be on a higher dose of thyroid hormone that is slightly hyperthyroid and this can cause calcium depletion and lead to osteoporosis.
If she gets a diet high in calcium, maybe she would be okay, but supplementing that would still be good if the doctor recommends it. However, if her parathyroid glands were removed during surgery, she will need supplemental, quick acting calcium several times a day to keep her blood calcium levels up, otherwise they could dip dangerously low. We don't just need calcium for our bones, but also for nerve function. It's vital.
4. I don't usually give a total recommendation, but given that your mom has such a strong family history of thyroid cancer and the fact that she is almost 50, I would think that removing just half wouldn't be a very good idea. Age generally isn't a positive factor in these things. It also depends on how large the nodule is (hers is small), but if she doesn't want to have to worry about it anymore. She also wouldn't be able to have RAI treatment unless she had a total thyroidectomy. They would be able to give her yearly or bi-yearly ultrasounds, but not the blood tests for thyroglobulins that track thyroid cell growth (that wouldn't be useful if there is still thyroid tissue).
I hope this helps. I wish your mom the best. Please re-post if you have more questions.
(Also, how can a healthcare system be superb if the doctors are mean and unhelpful? That's most of the quality of a healthcare system, if you ask me, how much the doctors care about and listen to their patients.)