Re: I Have A Substernal Goiter

[Guest guest]

>

> I have a multinodular substernal goiter. One of the nodules is

about

> 6cm (creating a bulge), the other 3cm. I have two nodules, one on

each

> lobe.

>

> I've had a CT scan, chest X-ray, nuclear thyroid uptake scan, and

> ultrasound guided biopsy, as well as various blood tests for TSH,

T4,

> T3, antithyroid antibody, and calcitonin.

>

> I am lucky not to have any cancer, My biopsy revealed a " colloid

> nodule " , and my next appointment will be to discuss surgery

options

> with my endocrinologist.

>

> Both my nodules are cold on scan, so shrinking them may not be

possible

> since they won't absorb iodine.

>

> Fred

>

Unfortunately I think you are one of those people for who surgery

would be the best option. I would not let them use iodine to shrink

the nodules as RAI usually increases the size of the goiter right

after treatment and considering the positon of the goiter it could

put you at high risk for further complications.

You do not say whether or not you are hyper or hypo or eurothyroid?

You have four options...

1. Doing nothing..given the position of your thyroid it would really

depend on how comfortable you are with this and usually goiters do

not shrink when you do nothing..

2. Suppressive doses of T4 hormone.. Supressive doses have been

thought to shrink small goiters, I am assuming with the size of

nodules and the position that it is not small so this option maybe a

futile at best.

3. RAI..this is called Radio Active Iodine.. the same procedure they

did to do the nuclear scan on your thyroid during testing. Except

they use a different isoscope and higher dosage with the idea of the

thyroid taking up iodine carrying the radiation which in turn burns

your thyroid from the inside out destroying it.. this will destroy

your thyroid and leave you hypo but your thyroid size may actually

increase right after initial treatment..not to mention with cold

nodules the radiation may not enter the nodules so you would be left

with a non functioning multinodule thyroid and will have exposed

your body with the complications of Radiation which side effects may

take 20 years to show.

4. Surgery.. Although I am not one to jump up and down and say

surgery is best. I really think it is your best option.

Now surgery has a few things that can happen..most really depends on

location of the nodules, amount of thyroid that is in your chest

cavity etc. these need to be discussed with the ENDO /surgeon who

will be doing the surgery. Ideally a partial thyroidectomy would

leave you with some thyroid function.. you would most likely still

become hypo and need replacement medication but the more of your

thyroid function you are left with the easier it is to stablize you

on replacement medication.. Do realize that your thyroid is in an

unusual position and how much is possible to leave may depend on the

surgeon's ability but also the condition of your thyroid.

Rarely nodules have also been shown to be cancerous on biopsy after

removal even with the FNA showing benign so you want to make sure

the surgeon if leaving part of the thyroid in place can have the

option to biopsy the nodules and switch to a complete thyroidectomy .

Homework for you..

How will your ENDO treat you after surgery? Who will do follow up

life time monitoring of thyroid levels? Will the doctor test

TSH,FT4, FT3, or just TSH for replacement treatment. Is the doctor

willing to go beyond just Synthroid if Synthroid is not working for

you? Does the doctor just go by labs or take symptoms into

consideration? Will you be given a prescription for replacement

medication before you leave the hospital?( some docs actually wait a

week and then do blood work first).

Your treatment will leave you hypo, how hypo really depends on how

much of your thyroid is removed, so between now and your appointment

do some research on hypo..hypo is easier to treat if you know the

symptoms and have a doctor willing to work with you.. the hardest

part of treating hypo is for someone who is kept or remains long

term hypo..the longer you are left hypo the longer it takes the body

to recover..

Kats3boys