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Have multi-nodular goiter. Suggested for thyroidectomy and removal of the nodes. Any thoughts?

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General & Family Physician
Practicing since : 1980
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I have multi-nodular goiter, I have had biopsy, it came back negative for cancer but it did show hot and cold spots on the nodule through a Nuclear Scan. On the last ultrasound, one had reduced the other had increased in size. My Family Doctor suggest I have a Thyroidectomy and also removal of the nodes. My Otolaryngologist suggests I just have the Thyroid removed and not the nodules. I am afraid that if I have the Thyroid removed and they find anything, I'll have to go back for a second operation and I cannot afford this. Do you suggest removing both or just the Thyroid? What are the implications of removing the Nodes, anything?
Posted Wed, 6 Mar 2013 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. Rahul Tawde 3 hours later
Hi,
Thanks for writing in. Only the thyroid has to be removed. It means thyroid and nodules it harbours will be removed. Nodes means lymphnodes which are outside the thyroid. They have to be removed only if they are enlarged or in a patient with known thyroid cancer. Yours is not that case. So only thyroidectomy is needed. I dont think repeat surgery will be required for any reason after total thyroidectomy.
Hope this helps
Shivaprasad
Above answer was peer-reviewed by
 
Follow-up: Have multi-nodular goiter. Suggested for thyroidectomy and removal of the nodes. Any thoughts? 1 hour later
One thing Dr. XXXXXXX The fact is this, the ENT Doctor said that the only way to rule out Cancer in the Lymph Nodes is by dissecting the nodules? What I am trying to stop is going through later having to have the Lymph Nodes taken out? Perhaps you could make me understand why one Doctor is telling to remove both while the other Doctor is just going suggesting taking out the Nodules/Thyroid = Thyroidectomy ... The only way I can understand this, the Doctor is wanting to take the Lymph Nodes just in case, would you think this wise? What are the chances that when the pull out this stuff out my neck it turns up positive for Cancer even though the Needle Aspiration indicates benign?
 
 
Answered by Dr. Rahul Tawde 2 hours later
If surgery is done for MNG without any evidence of malignancy in pre-op evaluation then the standard practice everywhere is to remove the thyroid gland only. Nobody dissects the lymphnodes. Chances are less that malignancy will be found if FNAC is negative. I can only advice based on the standard practice and guidelines. Guidelines dont advice removal of lymphnodes if they are not enlarged and preop evaluation is negative for malignancy. It must be ENT surgeon' s personal preference to remove lymph nodes. I cant opine on that. So in my opinion only thyroid gland needs to removed.
Hope this helps
Shivaprasad
Above answer was peer-reviewed by
 
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