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  • A general surgeon or ENT to do surgery??

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    Old 11-04-2007, 12:37 PM   #1
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    A general surgeon or ENT to do surgery??

    I have been to 3 doctors regarding my 3.5 cm nodule. My FNA showed follicualr cells, but the dx is probably a nodular goiter. I really dont want to have this surgery, and I've been putting it off. Two docs say to watch and wait and the 3rd says to get it out ASAP. The doc that wants to remove it is an ENT. He has been in practice for 20 years and has done about 1500 thyroid surgeries. He uses a nerve monitor to locate the vocal cord nerve during surgery. He had had 3 patients in the last 20 years that have had hemoraging after surgery, and apporx. 2% of his patients have had some vocal cord paralysis. The ENT says theres no reason to see an Endo because he can prescribe meds if its needed. Now the second doc I'm considering is a general surgeon who specializes in breast surgery and thyroid surgery. My endo actually referred me to him because they were med school buddies. This surgeon says to watch and wait, but said that with follicular cells, there's no real way to know until its removed. Therefore, he would take it out if I choose. He has also been in practice for 20 years and has done about 1000 thyroid surgeries. According to his nurse, she has never known any of this patients to have vocal cord injuries from surgery. He does not use a nerve monitor during surgery though. So I'm trying to figure out which doc is a better choice for this surgery.

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    Old 11-04-2007, 01:29 PM   #2
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    Re: A general surgeon or ENT to do surgery??

    That's a very large nodule, and at this point, if it doesn't feel uncomfortable, it will eventually, and eventually it will have to go. In terms of your health, it's better to have surgeries when you're young and healthy, than later on when you might have other things going on.

    I would go with the surgeon you trust and feel most comfortable with. I actually didn't use my ent who diagnosed me, but instead found a thyroid specialist who was amazing, does many thyroids a week (but I'm in NY), and incidentally, he never mentioned anything about a nerve monitor.

    From your description, I liked the ENT that was up front and honest about his experiences with thyroid surgeries, but you should go with your gut, and who you felt you trusted the most. I question why a surgeon specializes in breast and thyroid, as they are very different body parts in so many ways, but I'm just a layman, and I'm sure whichever surgeon you choose, the procedure will go well

    Last edited by Reece; 11-04-2007 at 01:31 PM.

    Old 11-04-2007, 06:14 PM   #3
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    Re: A general surgeon or ENT to do surgery??

    Same story with me, I had a 2.5cm nodule on ultrasound, which the fna showed follicular cells, long story short I had my TT July of this year and I am so glad to get it over and done with. I am 40yrs old and feel great, my medication was adjusted correctly in 2 months time, my current tsh level is 1.38. And my path report came back as benign follicular adenoma. Which like you are aware with follicular lesions the only 100% way to know for sure if it is benign or malignant is to remove it.
    I consulted 2 different surgeons for my surgery, the first one only did thyroid surgeries but I have several nurse friends who told me some frightening stories about patients he had treated. My second surgery consult and the dr. that did my surgery was a head/neck surgeon/ent. He does approximately 25 TT per month on average so needless to say he was very well versed at doing the surgery. There was no vocal cord monitor that you mentioned and needless to say I had no post op complications whatsoever. And to mention lastly, my surgery ended up being 3hrs instead of 2 because after he went in my nodule was bigger than the ultrasound showed it was actually the size of a golf ball!

    Good Luck,

    Old 11-05-2007, 04:56 AM   #4
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    Re: A general surgeon or ENT to do surgery??

    My mother used a general surgeon that was recommended for her. I have an ENT that has performed two procedures on me and my son already.. so I trust him and would go with him. Go with your gut and the figures. 2% is actually a very good percentage given the surgery itself has a 3% chance of complications to begin with... so the ENT that you talk of is better than the curve.

    Good luck.

    If we learn by our mistakes, I am working on one hell of an education.

    Old 11-05-2007, 05:41 AM   #5
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    Re: A general surgeon or ENT to do surgery??


    They chances that you have benign multi nodular goiter are about nil with follicular cells. That is more indicative of Hashimotos disease and you should be test for that asap. That requires the antibody testing, including the TPO, anti-thyroglobulin antibodies.

    I agree, that thing needs to come out because it is impossible to diagnose a benign nodule with follicular cells unless it is out.

    The surgery is nothing to be afraid of. I know it hard to believe, because I was terrified myself. I had mine out 2 years ago due to the same situation, follicular cells in a nodule that was 2cm and that sucker was making me sick. Once my surgeon got in there the nodule had grown down under my collar bone and attatched itself to all my inner neck structures and wrapped around my vocal chord. The ultra sound showed none of this of course.

    I used a thoracic surgeon. Don't use the ENT that has had problems in the past, use a dr who has a clean track record. My surgeon was from Mayo clinic and had also practiced at Jewish hospital. He told me a dr who has blemishes with thyroid surgeries are a red flag so I would heed his advice. My surgeon had done thousands of thyroid and parathyroid surgeries without any problems and he was wonderful! I checked out many drs and surgeons for this. It really is worth your time to get to the best. I have a friend who had follicular cancer at the time I was having mine out and she used an ENT with some blemishes on his record and he did a botch job on her. Her vocal chord was damaged, he put drains in for 2 days, her scar was horrible not to mention he had mess around telling her to watch and wait and she had cancer all along.

    She is still dealing with the cancer and here I had mine out at the same time, because I had a dr who gave me the right advice and that is get it out right away and avoid the watch and wait, waiting for it to turn cancerous is what he implied.

    My scar is a dramatic 8 inches long, but my nodule and thyroid were a mess, but the scar is undetectable. My surgeon used no drains, he did internal stitches only and then used glue on the outside with steri strips. It left only a very thin, white line that way. Everyone was amazed how good it looked.

    It is a big deal so check out everything, use the best dr's, the best surgeons and get all your info upfront. Ask how they close your incision, that is a big issue, ask about the drains, my surgeon told me that drains are kind of a red flag that a surgeon does this surgery the old school way and it not up to date on the latest technology, he also said that about the vocal chord meter. He said that the vocal chord should be pinched off and moved, not left still and monitored by sound waves, that is when the damage occurs according to him.

    Believe me, the surgery is a lot less to worry about than sitting around, putting it off and then having thyroid cancer and all that comes with that, because that is unending scans and tests for several years. For me it was in , out and done...................

    best wishes and please keep us up to date. 2 years ago it was this board that got me through and a gal on here that really walked me step by step on how to avoid any problems.


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