probably, maybe

The results of my thyroid biopsy are in.  I probably don’t have thyroid cancer.  Maybe.

They were only able to get a sufficient specimen for pathology from the larger nodule, which does not have calcifications.  It was analyzed using Papanicolaou and H&E staining, says the report, and it was negative for the kinds of cancer you can see using that stain…i.e. morphological analysis.  They did not do a stain with immunoperoxidase, which apparently is how you check for calcitonin, which is how you check for medullary thyroid cancer….Which is the one I was most concerned about since systemic symptoms include those of hypercalcitonemia – diarrhea and “flushing” (as in overheating, turning red).  But it is a rarer thyroid cancer.  I suppose because of its rarity, it is not routinely checked for.

I think I handled this well though.  “We could do a lobectomy” the ENT surgeon said when he finally called me to discuss my results.  “Or we could wait and check back in on it in 6 months to see if it has grown or changed, maybe try another biopsy.  The likelihood that it is cancer is very low.”  He asks if I understand what he’s telling me and I say yes, that there is a kind of thyroid cancer that is routinely screen by the biopsy they did, and that the nodule they were able to get a good sample from was negative, which means it is not very likely that I have that kind of cancer.  I tell him that I knew there was more than one kind of thyroid cancer and that the one I was mostly concerned about was the one that causes elevated calcitonin levels, and I mention the diarrhea and overheating/flushing.  “Medullary thyroid cancer” he says.  “Yes, that one.  Would the tests they did on the biopsy sample have shown that if it was present?”  “No, not really, not unless it was a really good sample,” he tells me.  “Ok, then what I’d like to do is to see what my calcitonin level is and if it is not elevated, I’m ok with taking a conservative route and monitoring this,” I say.  “What was your calcitonin level?” he asks.  “No one’s checked it” I tell him.  And so we order a calcitonin level.

And we wait.

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3 Comments

  1. queenofoptimism

     /  October 11, 2011

    Tsk. Big sigh. What the hell?!?

    Enough already docs. Dyspatient is suffering. I have no expertise but vote for lobectomy. Not because I want you to have another surgery. More complications. More possible side effects. I just feel like no one can get the full picture ofvall of these nodules based on the complexity. And, because I want it to be – maybe, just maybe there’s an answer in that lobe (or it’s absence).

    In other words, I want you to get better….much better. <3.

    Reply
    • My primary told me they can restain slides. I’m planning to ask about that when I talk to ENT surgery guy to get the calcitonin results. Who knows, maybe the calcitonin will be elevated. Sure would fit the systemic symptoms to a T. In the meantime, I’ve got another round of burning mouth with sores on my palate. I thought it was a recurrence of thrush – which I seem to get at the drop of a hat. Called the primary and told them, they called in fluconazole, took it for 5 days and it seemed like it was getting better around day 3 but then got much worse. I saw my primary and he took a look at my mouth, then asked me where it hurt the most. Behind my tonsils and in that nasopharyngeal area. He took a look in my nose and said “Oh my god that is so red…”. I heard him tell the nurse “I”ve never seen mucosa that red.” He cultured it, and woah mama did that hurt. “It feels like someone scraped the first few layers of skin off” I told him He said it should because that is exactly what it looked like. “No more treating this stuff by phone…you’re too complicated” then gave me a referral to a mouth diagnosis center at a BATH. “They specialize in oral manifestations of systemic diseases” he told me. “But you don’t like _________ (BATH)” I said. He said “I don’t, they’re jerks, but these guys are good jerks.” Something to look forward to :\

      Reply
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