Thyroid Cancer

[sleepyjohn]

Hi Sheryl and all I thought this deserved a new topic as I would like to get advice ASAP now.

I previously posted and Sheryl kindly as ever responded:

John:

while we're on thyroids interested in your opinion.

I have a very enlarged thyroid, visible, and 6.3 x 5.4 x 4.8cm. Big enough to get a bit of a throttling feeling though that's receded probably as the nerves adjust. It's apparently tucking down just into my ribcage.

I have had three ultrasounds over 6 months which show it as fairly much homogenous so probably benign though it is still gradually growing.

Two sets of needle aspirations, the first suspicious, the second could not be read.

Unfortunately my stimulating hormone level is pretty normal, so no easy medicinal fixes or reasons for the tumour.

The attitude of the endocrinologist seems to be to monitor every 12 weeks with surgery as necessary.

Is this a good plan?

He talks about a 5% chance of a very malignant cancer, but as I see it that's across the board including those with a swelling due to hypo or hyper (easily most) which are generally much safer and more treatable, which doesn't apply to me. Thereby interested in how elevated my (bad) chances are and if he's taking this into account as it seems to me one should. I shall certainly talk about it to him at an appointment next week for a new biopsy result but interested in further good opinion.

thanx John

Sheryl:

John,

1. Before I get into your question -- are you on, or have you been on, any chronic medications? Because some drugs can cause this e.g. amiodarone, lithium etc

2. With one needle aspiration "suspicious" and the other unreadable it is really hard to say anything about your odds of this being malignant.

3. Malignant tumors of the thyroid are among the most curable cancers if treated early. You should therefore be aggressive about excluding the possibility of malignancy, and might want to consider getting a second open if there is still any doubt once you have the results of the new biopsy.

Good luck

Today I got a call from my endocrinologist about the latest needle aspiration.

The main diagnosis was

Suspicious for papillary carcinoma.

which is followed by a lot more detail about condensed colloids and the nuclei and so on.

As I said in my first post this is the third biopsy over a few months. The first suspicious and the second unreadable.

I also have three ultrasounds. The hormone test came out normal which is unfortunate because as I previously said complicates the matter as the growth is of unknown cause.

Anyway he now wants a thyroidectomy, and because he said papillary cancer is spreadable to the lymph system he wants a total throidectomy. He has arranged for me to see the ENT man tomorrow. Naturally I would like a second opinion on an irreversible matter like this, and fairly fast.

There are two possibilities (presuming there are no endocrinologists or pathologists reading this)

1. Can anyone authoritatively recommend an endo in CM or even BKK?

2. Whilst I'm not particularly biased against Thai doctors, I am in fact friends with some who I might ask the same question, I have found it hit and miss such as this tumour being overlooked by a senior doctor in CM doing a regular physical. So what i would prefer is to send all my results abroad for opinion. Is this in any way possible?....I would obviously be happy.....well, willing anyway.....to pay.

thanks to all and BTW Sheryl I'm not on any meds

sweet dreams, John

Edited February 17, 2010 by sleepyjohn

[zaza]

sleepyjohn,I feel for you on this exact confusion caused by uncertain medical diagnose.

Almost since two years ago, my health has been declining dramatically.

No right, or sufficient diagnose was given to me even with the appearance of contradicted, or even abnormal findings of free T3,T4,TSH levels that were on my lab tests. Although I had several full-medical check ups in various hospitals, and on very close periods of time(less than 3 months). Only July, last year, I was informed by a docotor in Bangkok Hospital who was reading my medical check up report, that my bone density is so low, so when I asked for a further explanation, he just went to my hormone/gland part of the medical report and noticed that there is " little" health problem as he stated, back then my lab tests were:

TSH = 0.28 (0.27- 4.20) ulU/ml

FT4= 0.66 (0.93-1.71) ng/dl

He was so reluctant, and hesitated to address that serious findings. After a long discussion with him he finally referred me to endocrinologist in the diabetes/metabolism center there. After waiting for almost an hour, I met a very young and inexperienced doctor, who was even more confused and "lost" in reading those findings. He just expected that either there is a lab "error" in testing my hormones, or I was taking a "herbal" medication that could effect those findings. When I asked other friends, they told me that maybe that " I should not worry and trust the doctors".

After waiting for two weeks, I took another lab test, in a beauty-oriented hospital, that time, I just wanted to make sure if the Bangkok hospital lab-tests are correct or not concerning that issue. To my surprise, the lab tests came like this:

TSH = 4.92 ulU/ml (0.35-5.5)

FT4 = 0.9 (0.8-1.5)

T-3 = 80 (60- 181)

The endocrinologist in that hospital confirmed to me , that these findings are very "normal", as long as it is in the expected ranges. She related my weight-gaining problem to "over-eating" although, I explained to her that I am on the same diet/ food consumption habits.( which never could gain me extra 25kg/year= almost half my original weight 18 months ago), that does not respond to dieting or exercising!

I thought I might be getting older, lazier,slower or weaker, or whatever! so, I started to accept all the abnormal health-related issues that was/still suffering from, such as fatigue, gaining weight, depressed etc..

Then, I had to travel back to my home-country, there, all my family,relatives and friends were shocked to see me after only 14 months since I was there , looking very huge ( I gained 25 kg) by November. There, my friend who is a MD doctor, just asked me few questions, and diagnosed me with Hypothyroidism ! without me even telling him what my lab-tests were. When he examined my neck, he found out I have an enlarged, and very recognizable goiter. That none of the endocrinologists here in Bangkok, tried to examine . Afterward, I had done ultra-sonogram of Thyroid gland, that confirmed the existing of a goiter, but no malignant tissue.

When I came back here in Bangkok, I made a new lab tests in late January, the findings was:

TSH = 15.28 ulU/ml (0.35-5.5)

FT4 = 0.9 (0.8-1.5)ng%

FT3 = 2.0 (1.8-4.6)pg/ml

Then, the doctor said I have "hypothyroidism" and prescribed for me 100mcg Euthyrox, once daily ,after breakfast, for 50 days.

Now ;Sheryl, please; kindly advise me if I should continue, or stop using this medication? should I quest more medical examination/investigations?

do you think I should consult another doctor?

I will highly appreciate your help.

Best regards.

[Sheryl]

John:

I most definitely recommend Dr. Rosanee (details in prior thread) at Bumrungrad, as far as I know pretty well the leading expert on thyroid disorders in Thailand.

As for sending abroad for an other opinion, also possible, there are several online services which for as small fee will do this. I have used these in the past, unfortunately am not sure which one, might have been "Ask the doctor" . Anyhow it was US based, let you specify the specialty area and provided opinions from 3 different doctors within a pretty short time. The 2 times I did this, the quality of the responses was good, the specialists obviously really were specialists and had obviously taken the time to carefully read and consider the query. If you do this, try to first get the latest (and if possible, the earlier) biopsy reports so that you can attach scanned copies.

Zaza,

I recommend that you also see Dr. Rosanee. Your last lab results clearly indicate hypothyroidism, what is puzzling is the huge difference between this and the tests you had done previously, at least one of which was apparently at a hospital with good quality lab facilities. Hence I am hesitant to give advice beyond consulting a good specialist.

Euthyrox is levothyroxine which is the normal drug of choice for primary hypothyroidism. Issues related to this vs thyroid extract have been covered in another recent thread.

[sleepyjohn]

Thanx as always Sheryl. For the sake of a few days and a train trip I guess it's worthwhile.

I was impressed with the ENT surgeon at Ram Chiangmai and liked him. My girlfriend works there and has grilled the OR nurses who say he does very neat work which is a good thing when you get a frankenstein slice I guess! He also recommended total thyroidectomy. He said I could have a partial and hope for the best but warned that he had a patient who took that route who had an "unfortunate outcome" (gulp :-/). Also said if he found anything outside the thyroid he was going to have to cut it so could lose my voice (double gulp :-/). He demurred to take a vertical slice out too to improve the lizard skin on my neck as he said if I had to have radiotherapy scar tissue wasn't good . Raised a smile though.

keep up the good work

John

[Sheryl]

Good luck John and keep us posted, I'm sure many TV members join me in expressing our support for you.

Take heart in fact that thyroid cancers are usually completely curable if excised.

[eek]

Guys, i went to Dr Rosanee, and I have nothing but praise for her. She recommended me Dr. Ampica in Chiang Mai, as i live in Chiang Mai, and i have found her to be excellent also. However, personally I would go see Dr.Rosanee, then use Dr.Ampica as a regular maintenance doctor.

Dr Ampica works out of Sri Pat Clinic in Suan Dok Hospital. 13th floor.

[sleepyjohn]

Guys, i went to Dr Rosanee, and I have nothing but praise for her. She recommended me Dr. Ampica in Chiang Mai, as i live in Chiang Mai, and i have found her to be excellent also. However, personally I would go see Dr.Rosanee, then use Dr.Ampica as a regular maintenance doctor.

Dr Ampica works out of Sri Pat Clinic in Suan Dok Hospital. 13th floor.

Thanks again Sheryl and thanks for that Eek may be useful.

I made a provisional appt with Dr Rosanee but earliest is Friday next. As I have a panic disorder i can't fly to BKK but can manage the train now.

I think a reasonable plan is to see my endocrinologist which I can do this Sunday to try to get his interpretation of the detail in the FNA diagnosis and play it from there. If I don't see much downside from the hormones and so on the likelihood is I'll go along with the recommendation for a TT without too much procrastination. If I'm unclear I'll get further advice.

goodnight and thanks

John

Edited February 19, 2010 by sleepyjohn

[sleepyjohn]

Hi Sheryl an update

I went to see Dr Ampika, an elderly lady, who was mentioned as recommended by Dr Rosanee. Though I didn't hear exactly what I wanted to it was a very worthwhile trip. I am a proponent of people talking in probablistic terms, percentages, rather than in vagaries such as "big chance" "small chance", and this is exactly what Dr Ampika did. Instead of the "suspicious" result on the FNA diagnosis and because the slides showed enlarged nuclei she told me I had an 80 to 90% chance of cancer. She then went on to tell me the percentage cure rates in the event of types of spread.

As usual I am left with a decision, and this post is a method of thinking about it and maybe getting a little feedback.

It is clear now I need a total thyroidectomy.

I immediately moved on to the surgeon, having told her I'd had a referral to Dr Chalermpong at the Ram already. She immediately, in an unmitigated manner, recommended a Dr Pichid at Maharat. I have provisionally made an appointment though it's not for three days.

My decision is now about which way to go.

I know Chalermpong has been referred "at least 100" cases by Dr Kaset......and for what it's worth I liked him and my girlfriend who works there says the OR nurses speak highly of him. OTOH I'm told Dr Pichid at Maharat is very highly experienced.

The other factor is although I'm willing to undergo waiting and so on, the conditions at my consultation at Maharat, even though it was via Sripat, were not great. The doctor did very well by me and oozed competence but I must say it felt rushed with the nurse standing in the open doorway as if to hold the next patients back. She had about 28 patients booked in over four hours. There was so much noise that with a bit of a hearing problem it was actually difficult to have a conversation. I'm mulling over how relevant to my future treatment this environment would be, as i'm quite likely to need radioactive ablation and so on. The Ram is certainly much more relaxed and hey maybe Kaset was being nice, is perfectly competent, and trying not to worry me unnecessarily.

gotta run

cheers John

[zaza]

Thanks a lot; Sheryl, for the kind advice, I will make an appointment this week with Dr. Rosanne, as also EEk recommended the same doctor.

Thanks again for your highly appreciated contribution in this forum.

[Sheryl]

Hi Sheryl an update

I went to see Dr Ampika, an elderly lady, who was mentioned as recommended by Dr Rosanee. Though I didn't hear exactly what I wanted to it was a very worthwhile trip. I am a proponent of people talking in probablistic terms, percentages, rather than in vagaries such as "big chance" "small chance", and this is exactly what Dr Ampika did. Instead of the "suspicious" result on the FNA diagnosis and because the slides showed enlarged nuclei she told me I had an 80 to 90% chance of cancer. She then went on to tell me the percentage cure rates in the event of types of spread.

As usual I am left with a decision, and this post is a method of thinking about it and maybe getting a little feedback.

It is clear now I need a total thyroidectomy.

I immediately moved on to the surgeon, having told her I'd had a referral to Dr Chalermpong at the Ram already. She immediately, in an unmitigated manner, recommended a Dr Pichid at Maharat. I have provisionally made an appointment though it's not for three days.

My decision is now about which way to go.

I know Chalermpong has been referred "at least 100" cases by Dr Kaset......and for what it's worth I liked him and my girlfriend who works there says the OR nurses speak highly of him. OTOH I'm told Dr Pichid at Maharat is very highly experienced.

The other factor is although I'm willing to undergo waiting and so on, the conditions at my consultation at Maharat, even though it was via Sripat, were not great. The doctor did very well by me and oozed competence but I must say it felt rushed with the nurse standing in the open doorway as if to hold the next patients back. She had about 28 patients booked in over four hours. There was so much noise that with a bit of a hearing problem it was actually difficult to have a conversation. I'm mulling over how relevant to my future treatment this environment would be, as i'm quite likely to need radioactive ablation and so on. The Ram is certainly much more relaxed and hey maybe Kaset was being nice, is perfectly competent, and trying not to worry me unnecessarily.

gotta run

cheers John

Dear John,

clearly in terms of comfort and ease of communication Ram would be a better environment. However I would be inclined to give a lot of weight to Dr. Ampika's advice. First of all, she was recommended by Dr Rosanee; secondly, from the way you describe her, she is a straight talker of the type who inspires confidence; and thirdly she gave you a very specific recommendation which did not include the surgeon you had in mind.

Have you ruled out the possibility that Dr Pichid has privileges at the Ram? Many government doctors do. If so you could then have the best of both worlds.

If you can provide the full name of both surgeons I can search about a bit to see what I can find.

All the best

Sheryl

[sleepyjohn]

Dear John,

clearly in terms of comfort and ease of communication Ram would be a better environment. However I would be inclined to give a lot of weight to Dr. Ampika's advice. First of all, she was recommended by Dr Rosanee; secondly, from the way you describe her, she is a straight talker of the type who inspires confidence; and thirdly she gave you a very specific recommendation which did not include the surgeon you had in mind.

That's true Sheryl...

Have you ruled out the possibility that Dr Pichid has privileges at the Ram? Many government doctors do. If so you could then have the best of both worlds.

I have enquired of my girlfriend who works there and she doesn't know of him ever working at the Ram.

It's only a few minutes away to Maharat to come for an op but maybe the need for bedside follow ups is a negative factor. I'd certainly be more comfortable at the Ram and i know some of the docs and nurses there. I even have trouble being on the 13th floor of Maharat with my panic problem though it may be good exposure therapy .

Not sure of the politics of placing the resident doc as second best.

If you can provide the full name of both surgeons I can search about a bit to see what I can find.

Don't have the full name right now Sheryl but it's Chalermpong at Ram and Pichid (pronounced "pitch it" from the Thai spelling I think it's พิซิด ) at Maharat.

thanks once again for your interest and kind offer Sheryl

cheers John

ps: Ram is expensive on meds. I usually get a prescription and buy at Thapei Gate from our own Nalin. Whilst thyroxine is cheap I will likely need radioactive Iodine 131. Anyone know the ballpark price here?

Edited February 23, 2010 by sleepyjohn

[Sheryl]

John

The fact that your gf doesn't recall him working at Ram does not mean he doesn't have privileges there.

I suggest you contact him and ask if he is able to do the procedure at Ram.

Sorry I have no idea on the radioactive Iodine cost

[sleepyjohn]

Hi there

7 days (used for 2nd opinion and checking other highly recommended surgeon) after the biopsy result came back which was (because some genius forgot to make a date for the doc to check the result....only got it because I queried!) 14 days later than it was issued....because of waiting lists and other reasons I am surgeonless and back at square one.

Onward and upward....

I shall start further investigations tomorrow but if anyone can give me a referral to a good thyroidectomy-experienced surgeon I would be very grateful.

cheers John

ps Sheryl PMed you