Incidental Finding

Last fall as I was walking across campus, my foot became caught.  I looked and saw a landscaping spike skewering my foot between my fourth and fifth toe...going into my foot about 1.5 inches.  It was surreal and so sudden.  After x-rays determined it had very luckily (and nearly) missed any bone, the podiatrists removed it in the ER and flushed it out to remove any rust etc...yup it was covered in rust, and yes...I got a tetanus.  The attending asked to take photos...so you know it's a rare injury.  Should you want to check out the x-rays I'm happy to share but I didn't post for the squeamish out there amongst you. I had no weight on it for a week and used crutches for two weeks.  Not that long, but long enough to develop some numbness down my arm and into my hand.

After some months of PT the numbness was somewhat better, but remained.  I scheduled an appointment with a neurologist to see if something more significant was going on.  I had a cervical MRI and incidentally, two nodules were discovered on my thyroid.  Turns out a heck of a lot of women have nodules on their thyroid, so my primary care doc seemed to think it was no big deal, but as an ultrasound was recommended, I had one.  This showed one larger very likely cystic/benign nodule and one 1.2 cm solid nodule on the left.  It turns out it wasn't just solid...it had all the markings of malignancy.  So I went for a fine needle aspirate biopsy and we discovered what it seemed we already knew, it was cancer.

Thyroid cancer is very treatable, particularly papillary cancer which seems to be what I have.  We will know more after the final pathology comes back following surgery.  Surgery is the first intervention.  On the 21st of Feb I will have a total thyroidectomy which means they will remove the entire gland.  They will then do pathology on it and we will know more.  Ultrasound scans of the rest of my neck seem to indicate some lymph nodes that are also malignant, but again we won't know for certain until after surgery.  My surgeon, who I feel very comfortable with and confident about his skills, will also take the lymph nodes around the thyroid and any others that look suspicious that he can see.  They do some preliminary pathology during surgery which helps to guide his decision making.

In my age group (this is the only cancer where staging and prognosis are strongly related to age), even if the lymph nodes are malignant, it will still be stage 1.  Only if there are distant mets to the lung or bone for example, will it be stage 2...and that seems unlikely.  We will find that out after a scan a few weeks after surgery.  If it is in the lymphs I will need radioactive iodine treatment...radiation in a pill.  It's pretty "cool" in the academic sense in that they thyroid is the only thing that uses iodine, so the radiation is only taken up by any stray thyroid tissue...malignant or not.  And any metastases, no matter where they are, will always be thyroid cells!  

So it seems that the process will be this surgery, figuring out what the final pathology is, doing a whole body iodine scan, most likely doing radiation (dose to be determined) and then adjusting to life with thyroid hormone replacement.  As I hear it, I will be kept outside of the normal range (hyperthyroid) for the first several years to keep my TSH low...so we shall see how that feels.  There will also be a low iodine diet for a few weeks and the potential of thyroid withdrawal for the scan and radiation.  If you want more information on thyroid cancer, the following link has good information: http://www.thyca.org/

I will add updates here so that you can get information easily.  On the day of surgery my friend at the hospital will update the site when I come out etc. I will also hopefully actually start writing on here more again.  I have enjoyed that in the past.  Please feel free to comment or write.  I appreciate prayers, warm wishes, and positive thoughts.  The main concerns of the moment are a safe surgery, getting all of the cancer and any micro carcinomas lurking, being able to spare all of the parathyroid glands (one seems to have a malignant lymph very close to it and may not be completely spared), protecting the laryngeal nerve (again a lymph seems really close to the left one), and a "good" incision/scar that heals well.  I will keep you updated.