Thyroid cancer - Stage I, Papillary

The standard treatment for papillary thyroid cancer is complete removal of the thyroid gland and the lymph nodes around the area of the thyroid gland, followed (in most cases) by radioactive iodine treatment.


Sincerely/ Robert A. Wascher, MD, FACS

www.doctorwascher.com

www.oncoguard.com

Hi, my relative, 36 years old, is diagnosed as papillary Thyroid cancer - Stage I (1.5 cm nodule)
two weeks ago. Her doctor suggested to do total thyroidectomy. I read the discussion in this forum
that many patients with total thyroidectomy had a lot side effects, such as weight gain, depression, inability to concentrate, fatigue, slurred speech, confusion, etc. I wonder if there is alternative approaches other than total thyroidectomy. Which one is better? Thanks,

Erwin

hi there , i have been diagnosed recently and i have the same thoughts with you. what have you done since?

I was recently diagnosed as well with PTC 0.8cm - small. Why is it the the canned response is "Yep lets just remove the entire Thyroid". Seems to me that it's just the easiest thing to do without thinking how I may feel about taking meds the rest of my life or finding alternatives. Im going for another opinion.

Hi-I was thinking the same thing! My papillary nodule is .7 cm... Very small, has no indication of having spread etc, but my surgeon and endo said that total is the way to go...I asked about doing a frozen section during surgery and then if that looks ok then stopping at half! He said that the pathology report during surgery is not 100 percent accurate....the real results come a few days or weeks later-so, I guess better safe than sorry? Wouldn't want to have to go back for surgery again...but let me know about your second opinion! Good luck

When having a hemithyroidectomy with frozen section it can sometimes be hard to tell the difference with benign and papillary cancer cells. So it can be difficult sometimes to make a call during a frozen section that it is definitely benign or papillary ca. In my case, the frozen section showed papillary cancer so the doctor did a full thyroidectomy which I was glad since the final report showed papillary cancer on both sides, my nodule was 1 cm solid, smoothe, with calcifications and increase vascularity on the right side. It takes a few days to get the final report. I am going today to set up appointments for treatment with thyrogen I131.

Hi-I was thinking the same thing! My papillary nodule is .7 cm... Very small, has no indication of having spread etc, but my surgeon and endo said that total is the way to go...I asked about doing a frozen section during surgery and then if that looks ok then stopping at half! He said that the pathology report during surgery is not 100 percent accurate....the real results come a few days or weeks later-so, I guess better safe than sorry? Wouldn't want to have to go back for surgery again...but let me know about your second opinion! Good luck

They usually only remove half and do the frozen section when they are unsure of what it is. In my case, for example, my FNAs had come out inconclusive, but the nodule was growing, so I had half of my thyroid out in one surgery. Unfortunately, they couldn't tell what it was with the frozen section, so they left it at that. A week later, I find out that, yes, it was cancer and I had to go back in again a month later. But I was mentally prepared for that.

Had they known from the get-go, it is generally accepted protocol to take out the entire thyroid in one surgery. I think that you're going to get that opinion with probably at least 9 out of 10 doctors you talk to, not only because it reduces risk of recurrence, but also because it makes it much easier to monitor after treatment. Also, you can't have radioactive iodine treatment (RAI) unless you have a total thyroidectomy. I think also that this has been the way that thyroid cancer has been treated for more than 50 years and it works. Especially with Papillary. So the answer just becomes to do what has always been done, regardless of the stage. It's also a relatively easy treatment compared to other cancers, so they don't see a reason not to do it.

Yes, a lot of people have issues with taking the pills for the rest of their life, but most doctors would want to keep you at a suppressive TSH level, at least for the first 5-10 years (although I don't know what the protocol is for only having a partial thyroidectomy), which would require you taking thyroid hormones anyway, albeit at a smaller dose and you wouldn't be dependent on them 100%.

I think it's something you need to decide for yourself, but don't make the decision based solely on not wanting to take the pills. Consider both sides, the risks included, and make an informed decision. Ask what protocols would be involved if you did only have a partial thyroidectomy, such as yearly ultrasounds to make sure there are no new nodules on the other side (although some doctors order them even with a total, at least for the first few years to make sure everything's okay).

I am all for you getting a second opinion. Nothing wrong with that, that's your right and I think more people should probably do that in many cases (especially with some of the stories I've heard on this board, you wouldn't believe!). But don't just dismiss their opinion. Challenge it. Ask them why that's the protocol and if it has to apply in your case. Write down a list of questions you have and make sure you understand the answers.

I hope this helps. I'm not trying to push you guys into anything, even though it really sounds like I'm an advocate for the traditional treatment. Just make sure you know everything to expect with both options and then decide.

Best of luck to both of you. Please re-post with what happens or if you have any more questions.

hi there , i have been diagnosed recently and i have the same thoughts with you. what have you done since?

I'm not sure what you mean by what I've done since (or were you talking to Twinsie?). Please clarify what your situation is exactly (what kind of cancer you have, how large the nodule is, what treatment you've had or are will have and when) and what you have questions about.

hi there , i have been diagnosed recently and i have the same thoughts with you. what have you done since?

Read more: Thyroid Cancer Forum - Thyroid cancer - Stage I, Papillary http://ehealthforum.com/health/thyroid-can cer-stage-i-papillary-t237310.html#ixzz1ne yhyPXq

I am 67 years. I had my left thyroid removed as the lab results shoed that it is cappilary cancer. It was 5 cm.
Now the Doctor suggests that I have the other right lobe removed too as the cancer my spread to the right load. Should I heed to his advice and remove the right lobe too. What are the good and bad effect s o the above operation.Thank you Dr.

Mahendrah: I was basically in your shoes. I was diagnosed with Hurthle Cell carcinoma when I was 24 (5 years ago) and had my thyroid removed. I was given the option to just remove the half that had the nodule, but decided to go ahead and have the second half out because otherwise I would not have been able to go through the Radioactive Iodine treatment.

Personally, I am glad I agreed to treat the cancer aggressively, since I have been cancer free for 5+ years. I did have some difficulty getting my thyroid replacement hormone dosage right, but if that happens for you, I highly recommend asking your doctor for combination T3/T4 therapy (although I DO NOT recommend Armor Thyroid because of it's dose inconsistency). I didn't feel like myself on just the T4, but with the two pill combination, I'm back to normal. However, don't bother with it right off the bat. Try just the T4 because that works fine for most people.

I know that most people's objection is not wanting to be dependent on the thyroid hormone pills, but often you'll need them after the operation anyway because half your thyroid can't make all you need. Also, many people have to take pills every day anyway. Why is this one so objectionable?

Bottom line: if I had the whole thing to do over again, the operation, the radioactive iodine, I would do it. It gave me the peace of mind to know that if the cancer had spread that it was taken care of. Also, the radioactive iodine is 1000 times easier than actual radiation. I've seen cancer patients going through regular radiation. It's absolutely nothing like that. It's a single pill and a weekend out of your life where you have to stay away from other people to keep from exposing them. Then a scan and you're done. No burns, no hair loss, nothing like that.

If you all have any more questions that you think I can answer, feel free to ask. Good luck to all of you. I hope everything works out, whatever you decide.

MyrahU - Thank you for your response. Its so nice of you
to enlighten me on your experiance and knowledge. It is a wonderful feeling to get your feedback. I am a bit worried as my Nodule was 5cm and I am 67 years old. Does this any way affect the treatment and can I be completely cured with the Iodine treatment. I am scheduled to have my operatikon on the right lobe done on 29.6.2011. Please let me know re the life expectancy after the treatment. thank you.

You'd have to talk to your doctor about that. Generally, the cure rate for Papillary thyroid cancer is extremely high.

The radioactive iodine treatment might be more of a judgement call, but there isn't really much downside to the treatment and there are very few side-effects, beyond the inconvenience of isolating yourself for a weekend and taking precautions not to expose other people. I got nauseated with it, but not too bad. And again, only lasts for a couple of days. Then, no worries. If your doctor is advising it, he or she might have a good reason (ask what the reasons are) and I think you should strongly consider it.

I would advise that you do some research on your own about Papillary Thyroid cancer, just make sure they are reputable medical sites, and then take your list of questions to your doctor. Again, all these decisions are up to you, but you'll probably have to be on hormone replacement after even a partial thyroidectomy anyway, even if it's just to keep your TSH low to suppress future cancer growth.

Sorry I wasn't able to get back to you sooner. I hope everything goes well. Keep us posted. Best of luck.

Dear MyrahU - Thank you so much. God Bless for all the good things you are doing for humanity.

does anyone one know the prognosis for those who have stage 1 papilary carcinoma with tall cell features with no lymph nodes involve.

I would discuss that with your doctor. Overall, stage 1 papillary carcinoma with no lymph node involvement would have a very good prognosis, but I'm not sure about the involvement of the tall cells.

I would also encourage you to do your own research so you are able to ask questions of your doctor, participate more fully in your own care, and make treatment decisions.

If you have more questions, please feel free to re-post.

Hi, Can anyone tell me what Hrthle cells are? I was told there was traces of them in my fine needle biopsy, but told me they werent going to say it was cancer until after my surgery and they can test it. Can anyone tell me if those cells are saying Its more likely I do or don't have cancer. I know I will find out when it's removed but the stress of worrying is awful right now.

Well...I can't say that I know 100%...even though they found them in my sample, too. I did end up having stage 1 Hurtle cell carcinoma, which some consider to be a type of follicular thyroid cancer (other experts say it should be it's own type). Hurthle cells can also be in benign nodules. From what I remember from researching them, they are also connected to Hashimoto's thyroiditis, which is an autoimmune disorder that causes hypothyroidism.

Unfortunately, like with my case and many others, you don't get a clear answer until after they take out the nodule and look at it under a microscope. It's nerve-wracking, but it's not uncommon. I would agree with your doctor that you are at high enough risk to take out the half with the nodule, but not to panic. You're on the right track.

Can I ask, how old are you and do you know how large the nodule is?

I'm 20 years old, and I do also have hoshimotos. I don't know the exact size but they did say it is quite large. I also have a family history of thyroid cancer my dad had it. And many family members have had several other cancers. Also the endo said that the cells in the nodual keep changing. But I guess I will have to wait and see they are hoping to have me booked for surgery before the end of January.

I think the Hashimotos might be the reason for the Hurthle cells. For me, I didn't have Hashimotos.

Since you are so young, that is very good if it does turn out to be something. It's likely to be in an early stage. I know it's also very scary. I was just a little older than you when I was going through all this (I was 24, about 6 years ago now) and it's really overwhelming.

At this point, try not to worry (I know, not easy), but there is nothing you can do right now. Go get your mind off things and have fun.

If you need some people to talk to, there are some of us here who have gone through or are going through the same thing you are. If you have questions, we're here, but don't be afraid to ask your doctor a ton of questions. That's your right and that's what they are there for. Write down your questions before you go to your appointment and make sure you understand everything. You're and adult and you should be a full participant in your own care.