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Dr. Kuppersmith, ENT, Specializing in Thyroidectomies, A New Type Of Surgery For Thyroid Patients

Post Published: 01 April 2010
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Category: Dr. Ron Kuppersmith ENT Specializing In Thyroidectomies for thyroid patients, Guest Bloggers
This post currently has 28 responses. Leave a comment

Dear Thyroid,

It is dreadful enough that you make me feel bad when you are not reliably making the right amount of hormone, BUT when my doctor tells me that you have a growth that may potentially be cancerous and she wants me to consult with a SURGEON; you are trying to push me over the edge.

New Options for Thyroid Surgery: MIVAT and Robot-assisted Thyroid Surgery

The most common reason patients are referred for a surgical consultation is either to remove a known thyroid cancer or to remove a mass that is suspicious for cancer. Less commonly, patients have surgery for an enlarged thyroid that causes compression on the airway and/or esophagus causing breathing difficultly and/or swallowing problems. Occasionally, thyroid surgery is also performed for Grave’s disease that does not respond well to medications or as an alternative to radioactive iodine.

The reason why this might be important to you is that thyroid nodules are very common. Studies have shown that thyroid nodules have been detected in 19-67% of randomly selected individuals by ultrasound. While nodules are common, fortunately cancer is,  uncommon. It is estimated that 5-15% of nodules are cancerous. Several recent studies suggest that thyroid cancer rates are on the rise. Fortunately, most thyroid cancers are amenable to treatment and have a good prognosis. (There are some rare cases that prove to be the exception.)

Some risk factors for thyroid nodules include being female, advancing age, history of pregnancy, and radiation exposure. Risk factors for thyroid cancer include family history of thyroid cancer (medullary thyroid carcinoma), radiation exposure, Hashimoto’s thyroiditis (lymphoma), and the presence of a thyroid mass in a child or in male patients.

For many years, thyroid surgery had been performed through a horizontal incision in the lower collar. The length of this incision can vary from 4-8 cm in length. Most people are familiar with this incision and with time most fade away and are not noticeable. (Of course, there are exceptions.)

The typical risks of thyroid surgery include injury to the superior or recurrent laryngeal nerve which can result in temporary or permanent hoarseness or airway obstruction and injury to the parathyroid glands, which can result in temporary or permanent low calcium levels. In patients, who undergo total thyroidectomy, lifelong thyroid supplementation will be necessary. In patients, who have a thyroid lobectomy (removal of half of the thyroid) and do not require thyroid medication before surgery, approximately 20% will eventually need thyroid medications.

Recent advances have provided surgeons and patients with new possibilities for improving thyroid surgery outcomes in terms of reducing the risks and improving the cosmetic results of thyroid surgery.

One advance, Minimally-Invasive Video Assisted Thyroidectomy (MIVAT), was developed in Italy. MIVAT allows a surgeon to remove the thyroid through a smaller incision (1.5-4 cm) in the location of a typical thyroid incision. This is accomplished through the use of an endoscope, which provides a two-dimensional image, allowing the surgeon to safely identify the nerves and parathyroid while removing the thyroid.

Another advance is the application of robotic instrumentation to thyroid surgery. The most commonly used technique was developed in Seoul, Korea where they have performed more than 1500 cases and have shown the procedure to be safe and feasible. By approaching the thyroid through an incision under the arm, this procedure can be described as a “remote access” rather than “minimally invasive…

From the patient’s perspective, Robot-assisted Thyroid Surgery allows the thyroid to be removed through an incision in the armpit,  eliminating the incision in the neck. For some patients, this is an important consideration.   The use of the daVinci Surgical System provides the surgeon with a three-dimensional high-definition view of the surgical field, magnifying important structures including the nerves and parathyroids. It also allows the surgeon to control three instruments, instead of two, with improved precision and manual dexterity.

Not all patients that need surgery are candidates for MIVAT or Robot-assisted Thyroid Surgery. The size of the thyroid, presence of thyroiditis, and other anatomic factors may determine whether a patient is a candidate for one of these procedures. Additionally, as these techniques are relatively new, they may not be available in all cities around the US.

As in the case of any surgery, it is important to do your research and understand the different options that you might have, including the risks and benefits. You should choose a surgeon who has significant experience with the procedure you need and you should feel comfortable asking the surgeon about your concerns.

Ronald B. Kuppersmith, MD, FACS
The Texas Institute for Thyroid and Parathyroid Surgery
College Station, Texas
Website, Twitter and Facebook

Questions for us from Dr. Kuppersmith:

What are your biggest concerns about having surgery? If you haven’t had surgery, are you concerned about having a neck scar? If you have had surgery already, how was your surgical experience? How was your recovery? What did you like about your surgeon? How could your surgeon have been more helpful? What suggestions do you have for other patients who may have surgery? What do you think about your scar? How long did it take to get your thyroid hormone levels correct after surgery to where you were feeling good?

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28 Responses to “Dr. Kuppersmith, ENT, Specializing in Thyroidectomies, A New Type Of Surgery For Thyroid Patients”

  1. Dear Thyroid says:

    Dr. Kuppersmith;

    Thank you for guest posting on Dear Thyroid today and for providing information about a new kind of surgical procedure that you’re providing for patients.

    My biggest concerns regarding surgery, would be anesthesia and recovery time.

    Looking forward to everyone’s input.

    Thanks again! Great post.

    DT

  2. DT,

    Thanks for inviting me to post. I am also looking forward to hearing what people have to say. With most thyroid surgeries, patients recovery fairly quickly. With both the MIVAT and robot-assisted approaches, patients seem to have more soreness than pain. When patients have larger thyroids or require more extensive surgery, recovery can be more difficult. As far as anesthesia, it is important to share your concerns with the anesthesia provider prior to surgery to make sure that they are addressed.

  3. quin browne says:

    What are your biggest concerns about having surgery? my biggest worry was the extent of the cancer. i wanted it done asap.

    If you have had surgery already, how was your surgical experience? i had great technical help, but, no emotional support from the medical staff.

    How was your recovery? again, i had no contact with a doctor, no advise on what would happen nor to stay on a no to low iodine diet. no advice on the length of time before i could have rai, no one to check to see how i was doing, etc.

    What did you like about your surgeon? i trusted him (he’d done surgery on my dad) and he made me laugh with his comments to me after i woke up and he gave me the news

    How could your surgeon have been more helpful? support. could have told me they took my parathyroid (an oops) and that i had bottomed out on calcium.

    What suggestions do you have for other patients who may have surgery? understand this is for a reason and do it… find a doctor who makes you feel comfortable, and have them explain the parathyroid to you.

    What do you think about your scar? i tell people it is from the time i didn’t pay off benny the fish and he came after me. (it is an amazing scar–full across the neck, and you can barely see it)

    How long did it take to get your thyroid hormone levels correct after surgery to where you were feeling good? yeah, still waiting for that one 3.5 years later

    • Donna says:

      Dr. Kuppersmith,

      Thank you from the bottom of my heart for sticking your neck out and helping us. You rock!

      If you have had surgery already, how was your surgical experience? How was your recovery?

      I had two surgeries in October of 2006 for follicular thyroid cancer. Your comment about having normal TSH and still having cancer sings to me because that was my case. Thus, I’m a check you neck freak to anyone who will listen. My only problem with both surgeries was low blood pressure waking up from surgery. I got throught the process just fine. Recovery was relatively easy for me. I really can’t complain. My surgeon was awesome, very informative and kind. He took the time to explain the risks and I consider him an honest person. I have been thinking I should send him a note explaining how I appreciate him. My scar is barely visible and I too am proud of it. I remember taking my 5 year old to his pediatrician while I was still healing and he was a little freaked out and so worried about me but I was so oblivious to it.

      How could your surgeon have been more helpful?

      After my RAI treatment and full body scan I started synthroid but did not continue with the cytomel so I lost 4 additional days being hypo. There was nothing in the instructions about continuing the cytomel. It was only after I called him that his nurse clarified that I should have so that is something I always tell others. I felt like I was dying a slow death. I did not have an endo yet because I had no thyroid problems until the cancer was detected.

      How long did it take to get your thyroid hormone levels correct after surgery to where you were feeling good?

      Once I started the cytomel with the synthroid it probably took less than a few weeks to feel good. Each year at my annual follow up my dose has been increased except this past year. Unfortunately, I have been swinging hypo to hyper for the last few years and did not realize it, thought it was a weakened immune system, peri-menopause, etc. I know now that my levels should have been looked at more than on an annual basis. Currently I am hyper (0.04 which increased from 0.02 in six weeks) but am slowly but surely on the road to a better place. I have become educated and an advocate for myself in this process.

      What suggestions do you have for other patients who may have surgery?

      First, if they are having RAI and taking cytomel prior to going hypo to please clarify if it needs to be continued once you start your throid replacment med. Second, I agree with Dorienne 110% to reach out to others. I was alone through the process which was my choice and a big mistake. And finally, to get their levels checked every three months and understand the symptoms of being hypo and hyper so they don’t waste precious time suffering. Education and advocacy are key if you want to be a reasonable facsimile of who you were.

      Thank you so much!

      Donna

    • Donna says:

      Dr. Kuppersmith,

      Thank you from the bottom of my heart for sticking your neck out and helping us. You rock!

      If you have had surgery already, how was your surgical experience? How was your recovery?

      I had two surgeries in October of 2006 for follicular thyroid cancer. Your comment about having normal TSH and still having cancer sings to me because that was my case. Thus, I’m a check you neck freak to anyone who will listen. My only problem with both surgeries was low blood pressure waking up from surgery. I got throught the process just fine. Recovery was relatively easy for me. I really can’t complain. My surgeon was awesome, very informative and kind. He took the time to explain the risks and I consider him an honest person. I have been thinking I should send him a note explaining how I appreciate him. My scar is barely visible and I too am proud of it. I remember taking my 5 year old to his pediatrician while I was still healing and he was a little freaked out and so worried about me but I was so oblivious to it.

      How could your surgeon have been more helpful?

      After my RAI treatment and full body scan I started synthroid but did not continue with the cytomel so I lost 4 additional days being hypo. There was nothing in the instructions about continuing the cytomel. It was only after I called him that his nurse clarified that I should have so that is something I always tell others. I felt like I was dying a slow death. I did not have an endo yet because I had no thyroid problems until the cancer was detected.

      How long did it take to get your thyroid hormone levels correct after surgery to where you were feeling good?

      Once I started the cytomel with the synthroid it probably took less than a few weeks to feel good. Each year at my annual follow up my dose has been increased except this past year. Unfortunately, I have been swinging hypo to hyper for the last few years and did not realize it, thought it was a weakened immune system, peri-menopause, etc. I know now that my levels should have been looked at more than on an annual basis. Currently I am hyper (0.04 which increased from 0.02 in six weeks) but am slowly but surely on the road to a better place. I have become educated and an advocate for myself in this process.

      What suggestions do you have for other patients who may have surgery?

      First, if they are having RAI and taking cytomel prior to going hypo to please clarify if it needs to be continued once you start your throid replacment med. Second, I agree with Dorienne 110% to reach out to others. I was alone through the process which was my choice and a big mistake. And finally, to get their levels checked every three months and understand the symptoms of being hypo and hyper so they don’t waste precious time suffering. Education and advocacy are key if you want to be a reasonable facsimile of who you were.

      Thank you so much!

      Donna

      Reply

      • Donna says:

        Sorry Quin, I mistakenly replied under your post then copied and did it again. Sleep is a marvelous thing if only you can get some, lol.

        Can DT remove the duplicate reply please?

  4. Lori says:

    Thank you for this post, Dr. Kuppersmith.

    I have Hashimoto’s hypothyroidism and have not had thyroid surgery, but I notice you mention “Hashimoto’s thyroiditis (lymphoma)” as risk factors for thyroid cancer. I originally had thyroiditis with goiter and enlarged lymph nodes, which caused difficulty swallowing, and now I am being treated with NDT.

    Can you explain how this leaves me at risk for thyroid cancer? Also, how does lymphoma fit into this equation?

    Thank you,
    Lori

  5. Dear Lori,

    This is a great question. While lymphoma arising in the thyroid gland is quite rare, patients with Hashimoto’s thyroiditis have a higher incidence of lymphoma arising within the thyroid.

    For this reason, we get concerned about thyroid masses that occur in patient’s that have Hashimoto’s. If a needle biopsy is not specially processed looking for lymphoma, or this is not suspected, the diagnosis could potentially be missed. Sometimes, it requires surgery to obtain this diagnosis.

  6. Kristin says:

    What is your opinion of the level of thyroglobulin that a MD should be concerned about? My sister and I have both been treated for thyroid cancer in 2 different states. I have been followed by doctors in 4 different states. There doesn’t seem to be a definate number or lack of number that is all incompassing.

  7. What are your biggest concerns about having surgery? I was worried about cancer. The FNA showed only follicular neoplasm and I had read that the risk of cancer can be increased with large tumors (mine was 4.2 cm.)I worried even longer because it took over 2 weeks to get the pathology results after surgery!!!! But, it was benigh, so gratefuk!

    If you have had surgery already, how was your surgical experience? The surgical experience was good as it could be. I love my surgeon, though I would have liked to have gotten more explanations about what my recovery would REALLY look like.

    How was your recovery? Still working on it. Had a total thyroidectomy (lost one parathyroid too)about six weeks ago. Although I can breath now when laying flat, I had expected to feel a lot better than I do by now. Still have no energy and trouble sleeping.

    What did you like about your surgeon? He is friendly and gives blunt answers to my questions. I just didn’t know what to ask. He is very funny and straight forward about how many thyroidectomy he does per year (100+) compared to other surgeons. Knowing his experience put me at ease.

    How could your surgeon have been more helpful? I wish there would have been a clear plan on regulating my levoxyl before my surgery. My endo asked me to see her three weeks after surgery, then it took another week to get blood test results and another week (at least) for the new meds to begin having SOME effect on me. I wish I had known that I could have called my surgeon for a quicker post-surgical monitoring of my TSH and Free T’s.

    What suggestions do you have for other patients who may have surgery? Don’t expect to feel better immediately, it WILL take a lot of time. Take comfort knowing that the surgery was necessary and unavoidable and DO YOUR HOMEWORK ahead of time. Know what questions you have when you meet your surgeon.

    What do you think about your scar? It’s still healing, so I don’t know yet. I hope that it remains visible all my life because then people can see it, they should know there might be a physical reason for my behavior and appearance. If it were gone they would probably think I was crazy and unattractive without cause!!!

    How long did it take to get your thyroid hormone levels correct after surgery to where you were feeling good? Still working. I just started my 1st new dosage and I am beginning to see a glimmer of the old me. Just a glimmer though.

  8. Dear Kristin,

    With most lab tests, the actual numbers are typically relative to reference values that may vary by lab, so a specific number is not always useful.

    Typically in patients that have a thyroidectomy and radioactive iodine ablation, thyroglobulin should be undetectable. Shortly after treatment it still may be present and there are some other confounding issues which may affect the measurement of thyroglobulin. Certainly rising levels of thyroglobulin are concerning.

    I hope that helps.

  9. HD inOregon says:

    Hello Doctor,

    I had an uptake on my thyroid full body scans twice now at the base of my neck. My endo (and a second opinion too) think that a bit of saliva was trapped in scar tissue from my thyroid and throat cancer surgery. – Have you seen this in your praxis? I am not worried, since the uptake is very small and it is not growing in any way. It is the only uptake on the scan. Also thyroglobulin is near zero.

    Thanks,
    HD in Oregon

  10. Dear Quin,

    Sounds like you have had a tough recovery. Hopefully, your calcium problems were temporary? Seems like a long period of time to get the thyroid levels straightened out…I know that can be very frustrating…hang in there!

  11. Dear Pattie,

    Great news that it was benign!It sounds like you had a pretty good experience with surgery and your surgeon. Losing one parathyroid typically will not cause any short or long term problems, so I wouldn’t be very concerned about that.

    Any surgery is a pretty big stress on anyone’s system, and it can take a while to get feeling back to normal, and gaining your full strength back. Getting the thyroid hormone levels and medications worked out can compound the issue.

    While most patients can go back to work a week or two after surgery, that doesn’t mean you necessarily will feel back to full strength that sometimes can take 6-12 weeks or even longer….

    Good luck with your recovery!

  12. Dori says:

    What are your biggest concerns about having surgery? I was diagnosed with papillary thyroid carcinoma in June of 2006. I was 17 at the time, so it was pretty frightening. I never had surgery before, so I was very nervous. My huge concerns were nerve damage and dying. I was young, so of course I was petrified of death during surgery.

    If you have had surgery already, how was your surgical experience? My first surgery in June ’06 was a success, if by success you mean that I came out alive and no damage was done to my nerves. Cancer was still wiggling around in my neck, so my surgeon did not catch everything. I don’t blame him for that, though. This spread further through my neck than he had to get the first time. So, I had a second surgery in November ’07. I had multiple lymphectomies in the left side of my neck. 29 lymph nodes in total were removed. Even today, the feeling from the upper left side of my chest, neck, jaw line and ear is gone. I get tingles, but nothing more. At first it was horrible, but now I’m pretty much used to it.

    How was your recovery? I don’t think I’ll ever really recover, considering the feeling is gone. But overall, I’m doing well now. My medicine is working okay, and I’m still moving on with my life. My battle isn’t over, but it has slowed down a little.

    What did you like about your surgeon? He’s wonderful! He is very honest and blunt with me, but he is such a gentle man. It’s funny; when I walked in and he had told me he would do surgery, he said to me, “I really don’t want to do surgery on you, but naturally, you want the cancer out of you.” I said, “Yes, of course!” Haha. He has a soft spot for me and my family, and I love him for that.

    How could your surgeon have been more helpful? He is wonderful, so I have no complaints here. 🙂

    What suggestions do you have for other patients who may have surgery? Talk to as many people as possible about it. The whole situation is a lot easier to deal with if you have people to listen to you and support you. It may not be easy at first, but the idea and concept of it all does sink in. Get involved with groups like Dear Thyroid, I’m Too Young For This!, Planet Cancer, and other groups who deal with thyroid diseases and/or cancer. It helps to know you’re not alone. I felt so alone during this whole ordeal. I didn’t connect with anyone until after my surgeries and treatments. Start making the connections as soon as you are diagnosed.

    What do you think about your scar? I forget it’s there sometimes, actually. At first I was horrified at how it looked once I removed the bandages. But, once I went out for the first time with the scar, I was proud of it. People gave me odd looks, but I looked right back and smiled. I was proud of getting through it. I didn’t care what people thought or said about me. Now, I treasure them and am proud to show them off!

    How long did it take to get your thyroid hormone levels correct after surgery to where you were feeling good? Ugh. It took two months because right after surgery I had to go through my radioactive iodine treatment. So not fun. I felt horrible and was completely miserable.

    By the way, Dr. Kuppersmith, this was a wonderful blog! Thank you so much for contributing and bringing a new surgery option to light.

    I do want to ask you one question though. You said this in your blog: Risk factors for thyroid cancer include family history of thyroid cancer (medullary thyroid carcinoma)… As I mentioned before, I have papillary thyroid cancer, and we have now found out that we have a family history of it. Recently, my mother, sister, aunt, and cousin have all been diagnosed so far. I wanted to ask you if you meant that only medullary is usually familial, or you were just giving an example?

    Thank you again for posting! This was really great!

    –Dori from Maryland

  13. Dear HD inOregon,

    I am not familiar with your situation, but it is encouraging that both your doctor and a second opinion do not seem concerned. In complicated cases (which it sounds like yours may be) frequently other opinions and physicians from multiple specialties consulting together can be very helpful.

  14. Dear Dori,

    I am so glad you are doing well. Your post reminded me of young patients I have taken care of, and even gave me the chills…

    You have great insights and maturity. You raise so many great points that are helpful for other patients. Especially, the idea of talking to as many people as possible about your problem. One of the great things about the Internet, and especially sites like Dear Thyroid, is that their are now opportunities for people to easily (and even anonymously) speak with other people that have had similar experiences in the past. This is so helpful and helps put things in perspective that you are not alone.

    As far as the scar is concerned, I have spoken to many patients and other people that also equally proud. I say good for you!

    I mentioned medullary thyroid carcinoma as example, mainly because a genetic test now exists for the familial version of this disease. When it is detected, prophylactic thyroidectomy is recommended even in young children.

    Family history may also be a contributing factor for other types of thyroid cancer as well. There could be a genetic component in some cases or even similar environmental exposures contributing to these cases.

  15. HD inOregon says:

    Dr. Kuppersmith

    Thank you so much for taking the time to talk to all of us, and to even answer our questions individually. Your responses were very helpful and educational indeed. – We know that doctors are very busy and that your time is therefore extremely valuable. Again, thank you so much for participating here!!

    HD in Oregon

  16. Dear HD inOregon,

    Thank you! I am really enjoying this opportunity! Thanks Dear Thyroid!

    It is so interesting to hear patients’ perspectives of their experiences, have a dialogue about how to be better physicians, and hopefully share useful information with each other.

  17. Lisa says:

    I wish these new procedures were available for me 3yrs. ago. Thank you so much for your information. I just wanted to let other’s know that I had undiagnosed Hashimoto’s for several years by many doctors, they all told me my thyroid blood levels were fine. But Jan. of 2007 my thyroid became enlarged and a ENT noticed it when I had to see him for an abscess in one of my tonsils. They then asked me if I wanted to get it checked…of course I did! They then did an ultrasound, found out size, and it was solid, etc. Then proceeded to do a FNA, inconclusive results…the ENT then asked me if I wanted it removed and biopsied or they would wait and see if it got bigger and treat me with a low dose of medication. The ENT, the doc that did the ultrasound & doc for FNA all told me it was a very low percentage for it to be cancer. Well I didn’t care what the percentage was, I wanted to know!! Had the surgery, it came back cancer…the ENT was shocked because he told me to that all my blood levels were good, but never listed to me about all my symptoms I had for many years. The second surgery was alot harder on me, to have the rest of it removed and had to have RAI and the cancer had started to spread to the other side. Where would I be now or the years to come if I hadn’t chose to get it checked? No cancer is good cancer, please press the issue with your doctors and get it checked!
    When they found out it was cancer I needed the RAI done, so my care was transfered to an Endo doc, I then found out I had Hashimoto’s the ENT never told me and it was in the paper work that was transfered to the Endo doc. from the ENT. This is crazy, people with thyroid disease need better care.

  18. Dear Lisa,

    Thank you for sharing your experience. Sounds a bit frustrating, but as many people in this group know, it is essential that you are the biggest advocate for your own care, as you demonstrated.

    You also bring out another important point: The ***function*** of the thyroid (thyroid hormone levels) is independent of whether you have a ***mass or cancer***. You can be hyperthyroid, hypothyroid or have normal thyroid hormone levels, and still have thyroid cancer. There are some “tumor markers” that can be measured in the blood, but they are mainly for medullary thyroid carcinoma (which is rare) or useful for scanning for recurrence after treatment (thyroglobulin). Patients frequently are falsely reassured by having “normal thyroid levels.” While this is good, it does not give any insight into the whether a mass is cancerous or not.

    Additionally, fine needle biopsies are most useful if they demonstrate cancer. If they do not demonstrate cancer, it does not guarantee, that cancer isn’t present. The results are dependent on the skills of the person performing the biopsy and the pathologist who looks at the cells that are collected. With a skilled pathologist, the value of an FNA in predicting whether a lesion is cancerous or benign is much improved.

  19. Lori says:

    Lisa, I’m glad you listened to your instincts. You said your thyroid was enlarged but did it have nodules or a mass? I ask because I have Hashimoto’s, which went undiagnosed for many years as well. My thyroid was enlarged but came down in size with treatment and ultrasound showed no nodules; the last report several months ago read “normal appearing”.

    It is irritated once again because my levels are off and my med was just increased, but I still suffer from irritated/sore throats and chronic enlarged right tonsil, which sometimes shoots pain to my right ear. Most of the time now it’s only mildly noticeable unless my levels are off. I did not know the tonsil could have anything to do with this. I used to get enlarged lymph nodes with this but those have not come back.

    Several months ago the ENT gave me a script for a PPI (omeprazole) but I declined because I know that’s not the problem. Testing even proved that. Otherwise he did say my tonsil was chronically infected and to just use saltwater rinses. He never once related the throat and tonsil irritation to the thyroid. Hmmm, I guess my question is, do I wait for my next appt with my new thyroid doc in six weeks.

    Thanks everyone for sharing your stories and Dr. Kuppersmith for taking time to write this blog and answer our questions.

  20. Lori,
    Thanks for having me. I have really enjoyed reading each of your experiences. I have to admit that I have not seen tonsil irritation related to the thyroid. Certainly chronic infection and reflux are more common causes of chronic tonsillitis and sore throat. I hope you find a solution soon…

  21. kelley says:

    I think this is a great solution, however, is it only available in texas, as there is a slight possibility that I might need surgery. Is it available in Massachusetts?

  22. Renee' says:

    Dr Kuppersmith, my FNA says that both my largest nodule and right lymph node show the possiblity for thyroid follicular neoplasm. My lymph nodes are inflamed on occassion. I was hoping to have the da vinci operation. Is this possible for me?

    I have an apt to see you at 9:30 Monday morning. I am coming from Houston. Your office has my reports and scans.

    I’m scared to death and don’t want a scar on my neck.

  23. Michelle says:

    Dr Kuppersmith, thank you for your time and contribution to this community.
    In January of this year I had a total thyroidectomy and removal of 28 lymph nodes. My 3cm Papillary tumor was fully encapsulated and well within the surgical margins and the lymph nodes all came back clean. I’m feeling great now and at .137 Synthroid, and no RAI treatment foreseen.
    I am happy to give you comments on my experience.

    1) Surgical Concerns: I had never had major surgery and was afraid of not waking up, waking up with a tracheotomy, and how much of the bill I would be responsible for after insurance. My FNA was not conclusive, but showed calcifications which I was told was very indicative of papillary cancer. On the morning of surgery I still was thinking “what if it turns out NOT to be cancer and I’ve just had this surgery”. I was also a little bummed about having to take thyroid supplement forever. Prior to this, I had no major medical issues.

    2) Surgical Experience: It was great. I could not have asked for a better, less frightening experience. I remember being wheels into the surgical room and seeing lots of instruments and that’s was it. In my mind I had pictured a much more stressful scary thing. Not simply drifting off to sleep. I woke up briefly in the elevator on the way to recovery and tried to sit up. I heard the elevator ding and thought I was at work and remember talking to the nurse. When I awoke later in recovery I was surpassed at how little my throat hurt and how badly my neck and shoulders hurt. The nurse gave me more pain meds and a heat compress and I instantly felt relief.

    3) Recovery: My recovery was smooth. I honestly had more issues with neck and shoulder/headache pain than my throat for a couple days. I was only in the hospital one night. I had no nerve or parathyroid damage. I was back to work after two and a half weeks.

    4) Surgeon: I LOVED my surgeon. So informative and gentle and reassuring in a factual and human sense. I felt very lucky to have such a warm and compassionate surgeon. And I felt extremely lucky to have a surgeon with such a respected reputation amongst my team of doctors and generally everyone I came into contact with at the hospital.

    5) Suggestions for other patients: If possible for you, seek out a therapist to help you with all the emotions and thoughts that arise. Medical conditions are very stressful. Cancer is a life changing event, not just for the patient but also for your loved ones. It is a challenge to process your own feelings on the matter and even harder if you feel like you have to help everyone else too. Seek out information about your diagnosis so you can be prepared with questions for your surgeon/Endo. And remember to put yourself first when processing this. Do what feels right as far as sharing or not sharing your diagnosis with those around you.

    6) Scar: Mine is so much cleaner and smaller than I imagined it would be. I put sunscreen on it every day. But after 8 months, somedays I get self-conscious with the redness that lingers. But I would rather be here with a scar and cancer free.

    7) Thyroid Hormone: feeling good now. Was tired at the 6 month point on .112 and feeling great since jumping to .137.

    Again, thank you 🙂

  24. Michelle says:

    Ps, I was 38 at diagnosis/surgey, no family history of thyroid cancer, although my maternal grandmother had some kind of iodine pills to take in the 60’s. We dont know the details. My mother has had two unrelated cancers (neck fibrosarcoma 15 years ago and endomytrial cancer 5 years ago and cancer free now) and her brother died of lung cancer 15 years ago.

  25. Priya Joshi says:

    Hi Dr Kuppersmith,
    I have had a thyroid goiter diagnosed last year in March 2011 and have deferred surgery in order to get to the right practitioner. My endocrinologist has indicated that I have Hashimotos but energy and function wise I am doing ok so far. I am beginning to see swallowing problems though. I am very keen on a minimally invasive approach for the right thyroid lobectomy. Ive had a positive past experience with a robotic hysterectomy performed in 2010. My thyroid nodule is about 6.5 cms in the longest dimension, which makes me wonder if it is too big for the robot assisted surgery approach ?
    Pl advice.

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