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Do seven non-malignant nodules require a partial thyroidectomy?

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Posted on Wed, 20 Dec 2017
Question: Hi. I have been diagnosed at Stanford with hyperparathyroidism with large goiters growing up toward the
carotid vein and down the inside lining of my throat. I have seven nodules, all non-malignant, but one on theR is 5 cm and new, not cancerous. It is suggested that I have a partial thyroidectomy in
surgery removing the R side with nodules, goiters and leaving the parathyroid as it produces hormones still. What would you do with a patient? My thyroid has been rendered ineffective due to long lithium use. I need to maintainstability without lithium if I have a partial in surgery. Will be on synthroid. Please tell me. Kathleen

Would you have a patient have this partial thyroidectomy if she had similar
symptoms to mine? I am asking for an answer and reference material so that
I can make the right decision. We are concerned about my stability after surgery
due to bi-polar disorder and dysautonomia. I have also contracted light chain
disease (in a low proliferation that has gone down since I went off Lithium). I
have no cancer anywhere, and no amyloidosis (cancer) with the light chains.
I expect this disease get better in its symptoms, just as my kidneys have improved and I have a healthy urine function again. The thyroid is conundrum now, after we have attacked the other disorders. I have no nerve degeneration
except mild in the GI tract. Signals have gone. Not likely to regenerate.
Thanks for your help and interest. Kathleen
doctor
Answered by Dr. Mirjeta Guni (34 minutes later)
Brief Answer:
About thyroid and parathyroid treatment;

Detailed Answer:
Hello and thank you for asking!
I have gone carefully through your concern.
Before giving you a suggestion I would ask you for some more info. Would you please attach an ultrasound of the thyroid gland?
What is the cause of hyperparathyroidism? is there a single adenoma? Have you done sestamibi scan?
Will be a pleasure to help you further.
Kind regards,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Mirjeta Guni (16 hours later)
Dear Dr. Guni, from Kathleen S. XXXXXXX

There is no adenoma. The hyperthyroid was affected by long use of lithium which
kept me stable for years. We are mainly concerned about possible stability with
bi-polar after surgery and for my future. With a partial thyroidectomy: the nodules,the goiters and possibly the main thyroid, retaining the hyperthyroid which is intact and producing hormones, allow me to live without mood swings and other chances of stability.? I do not have an ultrasound scan as they are at Stanford. I could copy you a doctor's note, but am already quoting him. I have never had a Sestamibi scan, but have informed you well: seven benign nodules up to 4 cm recent one all benign, and enlarged benign goiters growing up toward carotid and down throat inside. Thyroid gland is generally useless, and non-toxic, but is inactive. Could remain making me feel imperfect. Thanks for help. I am very fit physically according to surgeon, but have more health issues as describled to you earlier. Kind regarfds. Kathleen
doctor
Answered by Dr. Mirjeta Guni (9 hours later)
Brief Answer:
About the thyroidectomy:

Detailed Answer:
Welcome back XXXXXXX
There are 3 reasons why we usually recommend thryoidectomy;
-When malignancy is suggested by ultrasound charachetristics and FNA
-When the gland produces more hormones (hyperthyroidism)
-When there are nodules over 3 cm or multiple nodules causing mechanical compression of the adjacent structures (cough, difficulty in swallowing).
SO, you belong to the third category.
If the all the nodules are located at one lobe of the thyroid gland, lobectomy is suggested and after it, thyroid gland may continue to function normally or may remain with a slight under production. In the last case, levothyroxine is suggested to try to maintain normal hormonal balance in blood and to avoid mood changes and other side effects and usually it substitutes very well the thyroid hormones, of course if the dose will be correct and monitored often as your physician will recommend.
So, do not get worried, in your case the surgical removal is necessary.
Wish you good health.
Best wishes.
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Vishesh Rohatgi
doctor
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Follow up: Dr. Mirjeta Guni (7 hours later)
Thank you so much, Dr. Guni. I will think about this and make the best decision,
in many ways considering all you have told me. Hope to have a consultation with
you again. All kind wishes, Kathleen S. XXXXXXX 10/30/17
doctor
Answered by Dr. Mirjeta Guni (50 minutes later)
Brief Answer:
Will be a pleasure!

Detailed Answer:
Wish a safe surgery and a good health ahead!
Best wishes,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Mirjeta Guni (12 hours later)
Oh yes, I read it right away and printed out copies to talk with my doctors at Stanford and in XXXXXXX XXXXXXX Everyone was glad to have Dr. Guni's point of
view and we send her our best regards. Hopefully all your doctors are this
good! Thank you all very much. Kathleen XXXXXXX
doctor
Answered by Dr. Mirjeta Guni (10 minutes later)
Brief Answer:
Thank you!

Detailed Answer:
Such a great pleasure to help you!
Please. P.S; please close and rate the answer!
Best wishes,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Vishesh Rohatgi
doctor
Answered by
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Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 2304 Questions

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Do seven non-malignant nodules require a partial thyroidectomy?

Brief Answer: About thyroid and parathyroid treatment; Detailed Answer: Hello and thank you for asking! I have gone carefully through your concern. Before giving you a suggestion I would ask you for some more info. Would you please attach an ultrasound of the thyroid gland? What is the cause of hyperparathyroidism? is there a single adenoma? Have you done sestamibi scan? Will be a pleasure to help you further. Kind regards, Dr.Mirjeta