Goiter.

[himmel]

On 7/5/2024 at 7:57 PM, Sheryl said:

 

Addendum: I have verified that the doctor listed at Buriram Ram, Preeyapat Chattieng, is one of the endocrinologists at Buriram hospital. It would therefore be strategic to consult her, as she may be able to help facilitate later treatment at Buriram Hospital (regional government hospital) and referral from Lamplaimat.

 

We had an appointment with the Doctor today, the blood test came back as normal, but not good news on the ultrasound. Ti- rads 5. although the Doctor said 20to 30%Cancer, I google it, and it said 85%, will be seeing the Consultant Surgeon on Wednesday 

[Mike Lister]

2 minutes ago, himmel said:

We had an appointment with the Doctor today, the blood test came back as normal, but not good news on the ultrasound. Ti- rads 5. although the Doctor said 20to 30%Cancer, I google it, and it said 85%, will be seeing the Consultant Surgeon on Wednesday 

I think I mentioned before that my ultrasound was inconclusive so I had several biopsies, all of which were also inconclusive. I do not believe that an ultrasound alone can detect the existence of cancer in the thyroid although I'm happy to be corrected on this point, it was certainly never mentioned to me at the university hospital, hence the biopsies that followed. I believe the ultrasound can probably assess probabilities, and that's all. 

 

I ended up initially with a 28% probability of cancer, which subsequently turned out to be unfounded. Do not try and google medical answers on this, it's unhealthy and unreliable.

 

And until the cancerous cells have been seen under a microscope, following a biopsy, your wife does not have cancer.

 

 

 

 

[himmel]

8 minutes ago, Mike Lister said:

I think I mentioned before that my ultrasound was inconclusive so I had several biopsies, all of which were also inconclusive. I do not believe that an ultrasound alone can detect the existence of cancer in the thyroid although I'm happy to be corrected on this point, it was certainly never mentioned to me at the university hospital, hence the biopsies that followed. I believe the ultrasound can probably assess probabilities, and that's all. 

 

I ended up initially with a 28% probability of cancer, which subsequently turned out to be unfounded. Do not try and google medical answers on this, it's unhealthy and unreliable.

 

And until the cancerous cells have been seen under a microscope, following a biopsy, your wife does not have cancer.

 

 

 

 

I thank you for your reassuring post.

[Mike Lister]

Just now, himmel said:

I thank you for your reassuring post.

I'm pretty sure that Sheryl will confirm that the results of a biopsy is the only sound basis on which to discuss action with a surgeon. 

[Sheryl]

59 minutes ago, himmel said:

We had an appointment with the Doctor today, the blood test came back as normal, but not good news on the ultrasound. Ti- rads 5. although the Doctor said 20to 30%Cancer, I google it, and it said 85%, will be seeing the Consultant Surgeon on Wednesday 

 

At which hospital?

 

And which new blood tests came back normal?  We knew already her thyroid hormones were normal (actually a bad sign when there is a mass). Did they do blood test for liver function?  Is she still jaundiced?

 

With  Ti-Rads 5 the decision tree is whether to biopsy first or remove thyroid and biopsy after. If the mass is large they would likely advise the latter since even if benign it is going to need removal eventually (even benign thyroid lesions keep growing).

 

She needs to follow through quickly. But you can  reassure her that 

 

(1) She can live a fully normal life with her thyroid removed, just have to take daily thyroid hormone replacement (pill)

 

(2) Prognosis for most thyroid cancers is good (there are differnt types)

https://my.clevelandclinic.org/health/diseases/12210-thyroid-cancer#outlook-prognosis

 

 

 

 

 

 

 

[Sheryl]

4 hours ago, Mike Lister said:

I'm pretty sure that Sheryl will confirm that the results of a biopsy is the only sound basis on which to discuss action with a surgeon. 

Biopsy is only way to know if cancer is present, and what type.

 

UItrasound gives only odds/probilities.

 

However as I mentioned above, even benign thyroid masses need surgical removal if large enough, so a surgeon might recommend proceeding with thyroid removal first and biopsy after.  Depends on the specifics of each patient's case 

 

Be guided by/follow what surgeon recommends.

[himmel]

1 hour ago, Sheryl said:

 

At which hospital?

 

And which new blood tests came back normal?  We knew already her thyroid hormones were normal (actually a bad sign when there is a mass). Did they do blood test for liver function?  Is she still jaundiced?

 

With  Ti-Rads 5 the decision tree is whether to biopsy first or remove thyroid and biopsy after. If the mass is large they would likely advise the latter since even if benign it is going to need removal eventually (even benign thyroid lesions keep growing).

 

She needs to follow through quickly. But you can  reassure her that 

 

(1) She can live a fully normal life with her thyroid removed, just have to take daily thyroid hormone replacement (pill)

 

(2) Prognosis for most thyroid cancers is good (there are differnt types)

https://my.clevelandclinic.org/health/diseases/12210-thyroid-cancer#outlook-prognosis

 

Buriram Private Hostpital with the Doctor you recommended. 

 

 

 

 

 

 

[himmel]

15 minutes ago, himmel said:

 

Sorry here is some more information,

IMPRESSION; 1. Enlargement right thyroid gland.

2. Right thyroid mass(4.0x. 1.7.9cm) with internal hypoechoic and punctate

calcification in inferolateral aspect. about 1.6x0.8cm:TI-RADS 5.

3.Two TI-RADS3 nodule in right upper pole (1.8cm) and left upper pole(0.5)cm

OVERALL TI-RADS 5: Highly suspicious, FNA is suggested if size :1.0cm.

[Mike Lister]

3 minutes ago, himmel said:

Sorry here is some more information,

IMPRESSION; 1. Enlargement right thyroid gland.

2. Right thyroid mass(4.0x. 1.7.9cm) with internal hypoechoic and punctate

calcification in inferolateral aspect. about 1.6x0.8cm:TI-RADS 5.

3.Two TI-RADS3 nodule in right upper pole (1.8cm) and left upper pole(0.5)cm

OVERALL TI-RADS 5: Highly suspicious, FNA is suggested if size :1.0cm.

It may be helpful to know that the total thyroidectomy is a painless and easy affair, from a patient perspective. Even after waking up after surgery, there was no pain, no discomfort and swallowing was normal. The most arduous part was the constant blood tests every few hours, even through the night - my hospital stay was five days. The following six months or so can be interesting whilst trying to get the hormone replacement levels to the desired levels. The FT4 remains in the blood for six weeks, that means, blood test, adjustment to the Euthyrox replacement hormones and then more blood tests six weeks later....eventually you get there. Eventually everything settles down and normality returns.

[himmel]

Mike, I can not thank you enough for all the information you have shared with us, gives us a great insight into what procedures we can expected in the coming days/weeks, may I have the audacity to ask if you was in Government 

or Private Hospital, if Private what was the cost for everything in those five days,   

[Sheryl]

38 minutes ago, himmel said:

Mike, I can not thank you enough for all the information you have shared with us, gives us a great insight into what procedures we can expected in the coming days/weeks, may I have the audacity to ask if you was in Government 

or Private Hospital, if Private what was the cost for everything in those five days,   

While consultation costs at private hospitals are not much, actual impatient admission and surgery is another matter and inclusive of all tests, the surgery, and follow up you would likely be at 100,000 baht or more. You can get a more exact quote fro mthe hospital after seeing the surgeon. Unless the amount is affordable for you,  I would suggest that you try to get the surgery done at Buriram (government) hospital.  It can be fully covered under the "30 baht" scheme if your wife gets a referral letter from Lamplaimat. A doctor's note from Buriram Hospital asking them to supply this will almost certainly work. Dr. Preeyapat  should be able to help, and the head & neck surgeon, if he also works there (probably will) also could do this.   This advice assumes she can be scheduled for surgery in a timely manner at the government hospital. If she cannot, then that would be a  reason to spend the extra money to have it done privately, if you can afford to,

 

In fact, the doctor she saw at Lamplaimat should IMO have given her a referral at the first visit but I think you were dealing with a brand new medical graduate who was unsure of him/herself and may have just recently been posted there after graduation. They are told to avoid "unnecessary" referrals but deciding when a referral is necessary/unnecessary is up to their medical judgement....which in this doctor's case was weak. Hence the stalling, come back after a few weeks for more blood tests etc etc.

 

 

[himmel]

Sheryl, could we now go back to Lampliamat Hospital with the paper work we now have and ask 

for a referral with not having to wait 3.5 hours to see a Doctor, it would be nice if we could show 

Dr Preeyapat and the Surgeon some of the reply's here, but I think that would be inappropriate.     

[Mike Lister]

42 minutes ago, himmel said:

Mike, I can not thank you enough for all the information you have shared with us, gives us a great insight into what procedures we can expected in the coming days/weeks, may I have the audacity to ask if you was in Government 

or Private Hospital, if Private what was the cost for everything in those five days,   

The total cost for me (as a foreigner) was 170,000 baht but this was at Sriphat Hospital, the semi private wing of the much larger university hospital, it is very much of a five star facility. comparable to some of the the best in the West. The surgeon fee was 50k baht which was included in the price.....as far as I can tell the cost for a Thai at the same hospital would be about 120,000. The cost for the same operation at a Bangkok Hospital Chiang Mai was quoted at between 200k and 300k. All those things said, the surgeon would have been the same one, regardless of where I had the OP and the OR would have been the same one, even if I'd used the District Hospital.

 

The things I'd do differently, if I knew then what I know now:

 

The hormone replacement tablets dosage is relative to body weight.  I needed to lose 15 lbs of body weight, which I didn't do until after the OP, mostly because my blood glucose and liver panel numbers went out of range. This meant my dosage was too  high, as my weight was falling and that was tricky to manage. With hindsight, I should have had a stable weight going into the op but didn't.

 

My endocrinologist was focussed solely on hormone levels and wasn't monitoring blood glucose and liver panel. It was me who asked for those tests privately because I started to feel unwell and because my body weight started to increase after the OP. My weight went from 84 kgs to 87 kgs and after dieting, down to 80 kgs which is now my stable weight. I found it helpful to weigh myself daily and track my weight changes and respond to them in real time.

 

On the plus side:

 

Even with a 28% chance of cancerous cells being present, I still would have gone for total removal, even though the partial removal was an option, a 28% risk was too high for me.

 

And my long standing, higher than normal blood pressure problem resolved as soon as my thyroid was removed, I am now at text book level, even when tested in a hospital.

[Sheryl]

1 hour ago, himmel said:

Sheryl, could we now go back to Lampliamat Hospital with the paper work we now have and ask 

for a referral with not having to wait 3.5 hours to see a Doctor, it would be nice if we could show 

Dr Preeyapat and the Surgeon some of the reply's here, but I think that would be inappropriate.     

 

You can go back to Lamplaimat Hospital with all the records you now have including the recommendation to see a head & neck surgeon, and ask for a referral letter to Buriram Hospital but you will have to wait to see a doctor to do this.  I would give that about 60 - 70% chance of working.

 

If you can get a letter from Buriram (government) Hospital asking them to provide referral letter, that is a surer approach;  I have not known that to fail. You may need to first go to Buriram Hospital and be seen by a surgeon there to get this.

 

No, don't show the doctors this thread.

 

 

[Sheryl]

1 hour ago, Mike Lister said:

The total cost for me (as a foreigner) was 170,000 baht but this was at Sriphat Hospital, the semi private wing of the much larger university hospital, it is very much of a five star facility. comparable to some of the the best in the West.

I would add to this, that this was in Chiang Mai and at a hospital with two tier pricing for foreigners.

 

I would expect Buriram to be cheaper, hence my estimate of 100,000 give or take. Still significant money, so @himmel try to get her referred to Buriram Hospital by Lamplaimat. They issue such referral letters daily. Just have to get a doctor to request one.

[himmel]

We had an appointment with the Surgeon today, the decision was to remove the right thyroid gland,

then after a biopsy on that, decide what course to take, the operation we take place on Saturday.

[Sheryl]

37 minutes ago, himmel said:

We had an appointment with the Surgeon today, the decision was to remove the right thyroid gland,

then after a biopsy on that, decide what course to take, the operation we take place on Saturday.

 

All the best.

 

I take it you opted to do it privately at Buriram Ram? Can I ask the estimated cost including biopsy?

[himmel]

10 minutes ago, Sheryl said:

 

All the best.

 

I take it you opted to do it privately at Buriram Ram? Can I ask the estimated cost including biopsy?

Thanks Sheryl, your correct, the cost 70,000 Baht all in.

[Sheryl]

24 minutes ago, himmel said:

Thanks Sheryl, your correct, the cost 70,000 Baht all in.

While she could have gotten it done under the 30 baht scheme it would have taken some time to arrange, with lots of back and forth to Lamplaimat snd red tape hassles. Which would have added to her (already considerable)  stress. 

[Mike Lister]

I'm pleased to hear that you've been able to move things forward speedily. All the very best to your wife for Saturday.

[himmel]

14 hours ago, Mike Lister said:

I'm pleased to hear that you've been able to move things forward speedily. All the very best to your wife for Saturday.

Thanks, Mike.

[himmel]

Update.  All went well for the operation, she was given a full medical before the OP, then we had the agonizing wait 

for 10 days for the biopsy report, well that was yesterday and the result was negative, and there were no problems found on the medical report, we are over the moon.

We would like you for your support, and encouragement, Thanks Sheryl, Mike, and others that contributed.

[Sheryl]

12 hours ago, himmel said:

Update.  All went well for the operation, she was given a full medical before the OP, then we had the agonizing wait 

for 10 days for the biopsy report, well that was yesterday and the result was negative, and there were no problems found on the medical report, we are over the moon.

 

Thank you so much for the update. I am very happy to hear you got a benign result.

 

The surgeon chose well in opting to remove only the 1 lobe of the thyroid rather than the whole thing.  Usually the remaining lobe is able to take over avoiding the need for lifelong thyroid replacement - or if any replacement  is needed it will be at a lower dose and without the major hormonal ups & downs  that in initially occur after complete removal.

 

It was a bit if a gamble in that, had it been malignant, depending on the exact biopsy results (how well encapsulated etc), might have then needed a second operation to take out the rest. But worked out very well in your case. Likely the doctor felt confident from the ultrasound that even if malignant, it was of an encapsulated/ noninvasive type. She opted to be conservative in approach (many doctors here would not) and it paid off. 

 

Incidentally, had you opted to go through the government system, while you would have saved some 70K, odds are that right now she'd still be on a waiting list for surgery -- if not still awaiting parts of the diagnostic work-up -  with al the mental stress that goes with it.