Second Thyrogen injection: Step 4 to RAI

Had my Thyrogen injection at 9:30 a.m. today.  This is my last of two injections.  So far, so good.  Continuously praising God for all of this as i await for another victory.

First Thyrogen injection: Step 3 to Radioactive Iodine treatment

I came early to the ENT clinic today for my Thyrogen injection.  Guess what? The original presciption of the Thyrogen is missng and Pharmacy refused to release the Thyrogen kit without the original prescription.  After waiting and praying,  the beautiful nurse from ENT called me to collect my Thyrogen kit. So i came running and took the kit from the Pharmacy and went back to the clinic for my injection.

The Thyrogen is in powdered form  kept in a vial.  This has to be mixed with saline to be ready for injection.  A little warming for the solution and the target has been set - the buttocks!  Waaaah.

Yes, Thyrogen is meant to be injected in the gluteus muscle (buttocks).   Thanks to my caring nurse it did not hurt much. I had to stay for 10 more minutes in the procedure room before they had to let me go.  After that, i went back to work normally.

Tomorrow, i will visit the clinic early to get my second Thyrogen injection.  I will come earlier because after the injectioni will be admitted for the RAI.

Completion thyroidectomy

Just got home after my completion thyroidectomy on 4 October 2015.  This time the left side was removed.  I continue to praise God for the second operation was uneventful and of course successful except for the sudden calcium level drop that lead to upper and lower extremity numbness and muscle twitching. The sudden drop in calcium level was corrected with 600 mg two tablets of calcium carbonate.  All went well and I am now home recuperating.

Thank you for all your prayers.

  

What is papillary thyroid carcinoma?

My histopatholoy read:  Well-differentiated pattern lesion with papillary cytology.  Part B shows papillary carcinoma.....

When the "bomb" was thrown to me three days ago, i read and re-read the test results, the laboratory tests, medical reports and operative report.  It says carcinoma...papillary thyroid carcinoma.  What in the world is papillary thyroid carcinoma?

 the final pathology report

According to Thyroid Cancer Survivor's Association, 

• Papillary and follicular thyroid cancers are referred to as differentiated thyroid cancer, which means that the cancer cells look and act in some respects like normal thyroid cells.
• Papillary and follicular thyroid cancers account for more than 90% of all thyroid cancers. They tend to grow very slowly.
• Their variants include columnar, diffuse sclerosing, follicular variant of papillary, Hürthle cell, and tall cell. Two other variants (insular andsolid/trabecular) are considered to be intermediate between differentiated thyroid cancer and poorly differentiated thyroid cancer. The variants tend to grow and spread more than typical papillary cancer.
• If detected early, most papillary and follicular thyroid cancers can be treated successfully. Their treatment and management are similar and are based on staging and individual risk levels.
• Papillary thyroid cancer is the most common type of thyroid cancer. It accounts for about 80% of all thyroid cancers. Papillary thyroid cancer generally grows very slowly, but can often spread to lymph nodes in the neck. It also can spread elsewhere in the body.
• The most common variant of papillary is the follicular variant (not to be confused with follicular thyroid cancer). It also usually grows very slowly. Other variants of papillary thyroid cancer (columnar, diffuse sclerosing, and tall cell) are not as common and tend to grow and spread more quickly.
• Follicular thyroid cancer accounts for about 10-15% of all thyroid cancers. Treatment will be discussed later in this booklet. Hürthle cell thyroid cancer is a variant of follicular.
• Follicular thyroid cancers usually do not spread to the lymph nodes, but in some cases can spread to other parts of the body, such as the lungs or bones.
• Treatment for follicular thyroid cancer is similar to treatment for papillary. Hürthle cell cancer (also known as oncocytic or oxyphilic) is less likely than other differentiated thyroid cancer to absorb radioactive iodine, which is often used for the treatment of differentiated thyroid cancer.
• A protein called thyroglobulin (abbreviated Tg) is used as a marker for whether all of the differentiated thyroid cancer has been successfully removed. Determining the Tg level in your blood by periodic testing will help your doctors determine how well you are doing with your treatment. Some patients produce anti-thyroglobulin antibodies (TgAb), which are not harmful but which mask the reliability of the Tg value.

Cancer of any type is still cancer - scary and dreadful.  A lot of doctors say, even my doctor, that thyroid carcinoma is the simpliest and the easiest to treat.  Well, it is still cancer, right?

How to survive hemithyroidectomy - Week One

Today marks the first week of my right hemithyroidectomy.  I have been confined to my room the whole week.  I tried to walk a little further away from the entrance door or our building to the nearest grocery store in the same building but i was lightheaded and felt dizzy, so I went back to my flat immediately fearing that i might fall.  I have now less choking with clear fluids but still have some few incidences of choking.  It is hard when i cough or sneeze.  I still have hoarse voice.  But with all of these, I am optimistic that i am on my way to healing.

my patient ID during the surgery and confinement

How to survive the first week of post hemithyroidectomy:

1.  Relax.  All wounds heal in time.

2.  Take the time to totally rest.  Do not force yourself to do certain activities that can cause dizziness.  This is the first week.  Activity is as tolerated only.

3.  Take pain medications as necessary.  I took only take pain medication at night so i can have a good night sleep.

4.  Spray lavender mist, so you can have a good night's sleep.

5.  Sleep as long as you can to get back your lost energy.

6.  Change position slowly.  One time when i was kneeling while praying, i suddenly stood up but my knees and legs won't let me as if i am paralyzed.  Good thing somebody was at my back to support.  So, i knelt back and slowly stood up while holding on to something.

7.  Eat really nutritious foods for healing especially avocado.  Avocado gives extra energy. 

8.  Adult coloring book.  Colors helped me relax and felt the pain less.

9. Drink lots of water to help heal the hoarseness of voice.

10.  Pray.  As you stay confined, do not stop praying but keep on talking and listening to God.

Onwards to healing!  Tomorrow is my first follow-up checkup.  Claiming for negative biopsy result.

I've got thyroid nodule

I never thought that i will be undergoing surgery of the neck, not in my whole lifetime, surgery of the thyroid.  I thought my thyroid was healthy.  I never felt any difficulty  in swallowing or breathing.  I did not  have any lump felt in my neck.  I never had any symptoms of mood changes that come with thyroid disease.  But, one fateful afternoon, a workshop for the new neck ultrasound machine in the hospital i worked for was done.  In that workshop, volunteers were called to try the new machine.  I volunteered hesitantly but with my friend's encouragement, i went and got checked by the machine.

The pictures above showed how they did the test.  On the last picture,  the monitor showed that they found a right thyroid nodule.  Immediately, i went straight to another endocrinologist even though the neck surgeon told me that I can have it checked or just let it be as most of us have nodules in the neck.  I decided to get checked by an endocrinologist.

The endocrinologist did some palpation.  The nodule was too small to be palpated.  He ordered some blood tests.  The blood tests were normal - TSH, FT4 and FT3, all these tests for the thyroid were all normal.

The next visit, he did an FNA.

FNA - Fine Needle Aspiration biopsy.

According to Wikipedia.  Fine-needle aspiration biopsy (FNAB, FNA or NAB), or fine-needle aspiration cytology (FNAC), is a diagnostic procedure used to investigate superficial (just under the skin) lumps or masses. In this technique, a thin, hollow needle is inserted into the mass forsampling of cells that, after being stained, will be examined under a microscope. There could be cytology exam of aspirate (cell specimen evaluation, FNAC) or histological (biopsy - tissue specimen evaluation, FNAB).^[1] Fine-needle aspiration biopsies are very safe, minor surgical procedures. Often, a major surgical (excisional or open) biopsy can be avoided by performing a needle aspiration biopsy instead. In 1981, the first fine-needle aspiration biopsy in the United States was done at Maimonides Medical Center, eliminating the need for surgery and hospitalization. Today, this procedure is widely used in the diagnosis of cancer and inflammatory conditions.^[2]

The endocrinologist did an FNA.  Just like a dart thrown on my neck and tried to get tissue samples from the nodule.  He did succeed but the cytology revealed not enough tissue to make a diagnosis.

The doctor ordered ultrasound of the neck that revealed the  nodule measuring 1.2 x 1.2 x 1.2 cm, round, hypoechoic without internal vascularity.

The endocrinologist told me that these types are suspicious for malignancy, so he wanted to get another FNA but this time ultrasound guided.

So, the doctor ordered again an ultrasound-guided FNA, again!

The ultrasound-guided biopsy was done in the Imaging Department by a radiologist with the ultrasonographers (there were 2) and cytologist to get the specimen.  It took three times of pricking and probing to get a sufficient specimen.

The results came and it was really suspicious for malignancy.  Thus, the nodule needed to be excised.

I was referred to the ENT surgeon.