On the 11th Karen had both her ultrasound and a follow up with the oncologist. While I like talking with the techs to try and understand what it is they are seeing, and to get an impression of what they think, I'd appreciate it if they were more careful with what they say. This one was very vocal about the size of the nodule. It was roughly 2 inches across and she seemed surprised about the size. She asked scary sounding things like, have you ever had a PET scan to check for cancer? Do you ever have trouble swallowing? Afterwards, when we talked to the oncologist, he was as calm about it then as when it was first brought up. He said they're actually quite common, up to half the population has thyroid nodules. He also reiterated that these are almost always benign, and that her thyroid hormone levels were normal. However, after seeing the results of the ultrasound he wanted to make sure it wasn't something more. He suggested a thyroid biopsy, and a follow up visit with an endocrinologist - a doctor who deals with thyroids among other things - to review the results and decide if anything needed to be done. He also started Karen on a new medication, amitriptyline, to help with the burning pins and needles pain caused by her neuropathy, and signed off on her getting physical therapy to help deal with the numbness in day to day activities, such as walking.
Karen and I came away with very different impressions of the thyroid situation. To me it just seemed the doctor was being thorough. Karen, however, got the impression that he wanted the nodule out, and became worried about another surgery. She said it's not uncommon for pills to get stuck in her throat. I told her that even happens to me. She also mentioned that she chokes on food sometimes as well. I can only recall that happening a couple times in the past couple years, and it didn't seem frequent enough to be significant, but maybe it happened more than I realized. Afterwards, it seemed every pill she took got stuck in her throat. Could it be I just wasn't paying close enough attention before? Could it be some sort of self‑fulfilling prophecy where she is expecting to have trouble swallowing so she does something different and that causes trouble swallowing? In the past she's said pills can get stuck in her throat when her allergies were bad; maybe that's all it is? Perhaps a combination of things? It's hard to say.
She asked that I not tell anyone or update the blog until she knew one way or the other if it were cancer. She explained that she didn't want to worry anyone unnecessarily. The schedule we received even said "consult thyroid tumor" on the endocrinologist visit. Everyone had just been calling it a nodule. I'm not sure at what point a nodule becomes a tumor, but that small word change adds a sense of seriousness to everything going on. Karen had the biopsy on Wednesday and the follow up with the endocrinologist today. Talk about a long 24 hours.
The biopsy is done while you're awake and consists of fine needles being guided with ultrasound into the thyroid nodule to take samples. If you have the stomach for it, you can see how it's done here. The video says they use the needle 2 to 3 times, but Mayo Clinic's policy is to do it 5 times with 5 different needles. The video also says it takes 2 to 4 days for the results, but we got them in just 24 hours, when we saw the Endocrinologist. He said the pathology report showed the nodule to be benign, and once again, that this is actually quite common. He said he certainly wouldn't recommend surgery to remove the nodule unless it was interfering with day to day life, and even then he'd be hesitant at this point in her recovery. He didn't see it pressing on the windpipe but wondered if it was causing any problems swallowing. That would be the only reason to remove the nodule, and warned that you have the risk of hypothyroidism whenever you operate on the thyroid. He suggested talking with a thyroid surgeon to give us a better idea of what was involved and what to expect if the nodule has to be removed. Karen seems quite strongly against another operation, but is open to other opinions and points of view, and is willing to talk to the surgeon about the matter. The doctor suggested having regular ultrasounds to keep an eye on the thyroid since it is quite possibly bothering her. I didn't think about it at the time, but perhaps the CT scans she's already getting regularly would be sufficient.
