Monday, February 07, 2011
45 Y/O F had a isthmus nodule felt by her GI physician. An ultrasound done by a radiologist noted more nodules and one of them was biopsied. The results were suspicious, but she refused a lobectomy until an outside opinion that she had to pay for out of her own pocket.A second biopsy was even less helpful. After it they still wanted to operate. Finally, she heard about molecular classifiers that could tell if a suspicious biopsy was benign from my website. She was asymptomatic, had 2 firm nodules on my examination. My endocrine neck diagnostic ultrasound result was dramatic. She had 3 very suspicious nodules with microcalcifications, and the whole right side of her neck lateral to the biggest suspicious nodule was full of 5-10 mm abnormal lymph nodes with all the criteria for thyroid cancer spread to local regional lymph nodes. There was no mention of the nodes in the radiology report. Ultrasound techs are not taught endocrine neck changes, such as lymph nodes or parathyroid glands, and only report the thyroid. Many biopsies done by radiology departments are done by PAs, not by radiologists. The biopsy was inferior and only suggested suspicious, because they failed to do smears and only did thin prep. This is a poor substitute for smears, and caused the endocrinologist to recommend lobectomy instead of total thyroidectomy. She did not have a pre-op ultrasound lymph node evaluation before planning to send her for surgery. The second opinion changed everything. She needed a lymph node biopsy and needle washout test for cancer marker thyroglobulin. She will surely be positive for metastatic thyroid cancer in many nodes in her right neck. She now has a pre-op Thyroglobulin test which was not planned before the surgery. She will now have a total thyroidectomy, and central compartment node dissection, but will have a complete level 2-5 node dissection. This is called a Modified radical neck dissection MRND. She was on her way to have a second right neck surgery in one year, which they would have told her it was a recurrence, but it was there all the time BEFORE the first surgery, if she did not get her own second opinion. Please, do not go in for thyroid surgery without an outside second opinion. She would have had many surgeries, and multiple doses of radioiodine as a result of an initial evaluation and therapy plan which was flawed.