Thyroid Cancer

This post will be a significant divergence from my typical anecdotes about my travel experiences, but I felt like it was time to open up and tell the story of my diagnosis of thyroid cancer and the journey to recovery. But before I begin, I just want to give a spoiler and say that I’m healthy and doing well, so there is no cause for concern!

The saga begins in 2017 when I had decided that it was time to finally start adulting and find a primary care physician to inevitably tell me that I was healthy and invincible. During my physical I was poked and prodded and had my personal space violated, and everything initially seemed normal. But when the physician was palpating my neck and throat, her expression slightly changed and I could sense that something was abnormal. She discussed that she felt a lump on my thyroid and recommended that I get a routine ultrasound prior to my next visit. I wasn’t overly concerned, but obliged her wishes and scheduled my ultrasound for a few weeks later.

Drawing of the location and appearance of the thyroid gland

I’d not been on the receiving end of medical care much during my life, so I was actually interested in undergoing the ultrasound procedure to experience it firsthand and understand what patients endure. The process was entirely painless as I laid on the table while a gelled-up wand was pressed into my neck and throat from every angle in order to visualize the thyroid gland and any possible lymph nodes in the area. After the procedure, I went back to work for the remainder of the day and waited for my results to be analyzed and posted on the patient portal within the next couple days.

The official ultrasound results were disconcerting because they distinctly recommended a biopsy and further nuclear imaging to be performed, shattering my illusion of invincibility. My next step was to personally review the American Thyroid Association (ATA) guidelines to decipher the ultrasound results, and every descriptive detail of my thyroid nodule checked the box for “cancer”: hypoechoic, internal vascularity, microcalcifications, and larger than 4 centimeters in size, with a borderline prominent left lymph node. With the more research I did, the more I realized that I was facing a threatening situation to my health, so I promptly scheduled a follow-up with my physician to determine the next step.

Within several days, I was laying back on an examination table and preparing for my thyroid nodule to get biopsied. I was initially injected with several stinging shots of lidocaine to numb the area, and then the interventional radiologist performed two fine needle aspirations to obtain different core samples of the nodule. After the procedure, a Band-aid was placed on the injection site, and I returned to finish up the rest of my shift. Despite having multiple needles inserted into my thyroid, I only experienced a very mild, dull pain at the site, which was a pleasant surprise. The samples were sent to pathology to be analyzed, and the final results came back as a “benign follicular nodule” indicating the absence of cancer. To say I was relieved was an understatement, but I still had this nagging feeling that the histological results weren’t entirely accurate because of the damning description of the ultrasound findings in conjunction with the ATA guidelines.

Several days later I was scheduled for my nuclear medicine thyroid imaging scan, in which I swallowed some radioactive Iodine-123 capsules in the morning and returned in the afternoon for images to be done. The thyroid takes up any circulating iodine in your body, and the capsule’s iodine was radiolabeled allowing the scanner to detect how much iodine was being taken up by the thyroid. The following day I returned yet again for additional scans to compare with the first set. Both scans showed normal uptake of my thyroid, with a corresponding lack of uptake within the nodule, which is typical.

Representation of part of the thyroid uptake scan

Throughout this process I had selected an endocrinologist and set myself up as a new patient. With all of this welcome news, we made the joint decision to do a follow-up ultrasound in 6 months and then reevaluate the situation at that time. The second thyroid ultrasound showed no change in the size of the nodule, but there was increased vascularity compared to the previous study. While this was a negligible change, the nagging feeling about my biopsy results led me to request that my endocrinologist refer me to an oncology surgeon for a more professional evaluation.

After meeting with the surgeon, he strongly felt that the left half of my thyroid should be surgically excised, leaving me with half of a thyroid that should still produce an adequate amount of hormone. While I preferred to remove the whole thyroid based upon the ultrasound results, I accepted his decision because the biopsy had been negative, and it would be better to conserve a partial thyroid and maintain normal functioning if possible. The elective surgery was scheduled, and I apprehensively waited for the date to eventually arrive.

In April 2018, I arrived at the surgical center feeling nervous, but ready to proceed. After being disinfected and pre-medicated, I was wheeled into the operating room and drifted off to a drug-induced sleep. What seemed like seconds later, I was groggily waking up in the post-operative area as the anesthesia wore off before being transferred to a hospital room for an uneventful overnight stay. Because there are four small parathyroid glands embedded directly behind the thyroid gland, they can sometimes get damaged during the surgery, so I was admitted in order to keep a close eye on my calcium levels which would indicate parathyroid damage, of which there was fortunately none. A couple days after discharge, the surgeon personally called me to let me know that the pathology results of the nodule were back. Despite the prior negative biopsy, he discussed that the pathology clearly showed papillary thyroid cancer, and I needed to urgently go back for a second surgery. And that’s when my world came crashing down as the big C-word finally materialized into a reality for me. Cancer… yes, it was the "best" kind of thyroid cancer to get if you had to choose because it has the best outcomes, but it was still cancer nonetheless.

All prepped up for my first hemithyroidectomy surgery

Recovering after the left lobe of my thyroid was removed

Being discharged from the surgical oncology unit

Exactly a week after my initial surgery, I was back at the surgical center having the remainder of my thyroid completely removed, followed by another overnight hospital stay for observation. It was a complete sense of déjà vu as I was taken care of by the same nursing staff on the same floor while recovering from the same surgery, just as my initial incision had begun to heal. With my throat sealed up with glue for a second time, I was discharged and allowed to recuperate at home for a week. I began experiencing an inordinate amount of swelling at the surgical site, and was told to immediately make a follow-up appointment to evaluate the wound. They determined that I was developing a post-operative seroma, which was aspirated and drained, and temporarily helped alleviate the swelling. As the days passed, the bruising and swelling continued to dissipate, and eventually even the surgical glue came off, which allowed me to look somewhat normal again.

Recuperating at home with my caring nurse

Here we go again -- surgery #2

The bruising and developing seroma post-operatively

Having the seroma drained under ultrasound-guided aspiration

With my thyroid completely removed, I now had no ability to create thyroid hormone, which is in charge of the body’s metabolism. This causes you to feel sluggish and gain weight among other symptoms, so the body requires a daily replenishment of synthesized thyroid hormone as a replacement. However, before you begin a thyroid hormone replacement regimen after surgery, it is necessary to force your body into a hypothyroid state, causing you to exhibit these symptoms and experience incessant tiredness that cannot be cured by sleep. Once the thyroid hormone is sufficiently suppressed, the next step is to visit a radiation oncologist for further radiologic testing, to make sure that all of the thyroid has been removed. And this is where it begins to get interesting.

In the radiation oncologist’s office, the physician retrieves a highly secured radiation-filled capsule enclosed in a portable Fort Knox contraption to prevent accidental exposure. I swallow the capsule of radioactive Iodine-131 with the purpose of destroying any residual thyroid tissue that remained post-operatively. This time around, the radioactivity of the iodine is significant enough to pose a danger to others in my vicinity. A Geiger counter is waved over me to ensure that there is indeed an adequate amount of radioactivity emanating from my body, and then I am promptly ushered out the back door and told to self-quarantine for 3-4 full days. This involves being isolated in a guest bedroom in the house, completely avoiding all contact with humans or animals, and refraining from getting within 6 feet of any living thing, even if separated by a wall since the radiation will easily pass through. All of my bodily fluids were considered to be contaminated, so I had to use disposable dishes/plasticware to eat, wash all of my clothes separately, and ensure that no one came into contact with my bedsheets or towels. I felt like an ostracized leper who was shunned from society, but I at least had the company of my books and music to occupy my time. All in all, I actually enjoyed my relaxing isolation time, and it allowed me to mentally process my circumstances and begin to feel at peace with everything that was occurring. Once my quarantine was completed, I was free to join society again, disappointed that I hadn't gained any special superpowers from my radiation exposure. I was even given a document stating that I’d received radiation for oncologic purposes, should I set off any radiation detectors at the airport, in an effort to prove that I wasn’t a dangerous terrorist.

The Geiger counter which confirmed that I truly was radioactive

The next step in my recovery process was the whole body scan, where I was placed inside a gamma scan device similar to a CT machine, and my entire body was slowly scanned to detect where I was emitting radiation. This can detect for residual thyroid tissue, as well as the metastatic spread of any cancerous thyroid tissue throughout the body. My results showed uptake in the thyroid bed indicating remnant thyroid tissue, but absolutely no evidence of any lymph node involvement or metastatic disease. Some residual thyroid tissue is expected post-operatively, and is nothing to be concerned about. This was the best news for which I could have hoped!

Undergoing the whole body gamma scan

The final step in this process was the initiation of thyroid replacement hormone, which merely involves taking a single levothyroxine (Synthroid) pill once daily in the morning as soon as I wake up. I have my thyroid labs checked on a semi-regular basis, and have been regulated back to a normal level with no ill side effects. I have essentially been completely cured of my thyroid cancer, and despite having an unsightly scar on the front of my throat for everyone to see, I live my life as if nothing happened, which is the best result that one could imagine. I am truly blessed to have a good core group of friends, and excellent physicians to have gotten me through this ordeal, and I look forward to continuing to live the rest of my life cancer-free!

Raise awareness and get your neck checked!