Q:What is the recovery time following thyroid surgery?

A:There is very little down time after either a partial or total thyroidecomy. One patient of mine years ago was a surgeon, and he went to the Houston Country Club the day after his operation to play 18 holes of golf. I told him that this was a bad idea and against my medical advice, but doctors don’t make good patients for the most part. Nothing bad happened, but this is not recommended. Most patients will take a day or two off from work just to rest a little. Obviously, this is OK for office personnel, computer folks, and so on. If you are a professional bull rider, I wouldn’t want you to return to that line of work for about 4-6 weeks at least. Common sense is the guide here.

Q:I’ve had friends tell me they had their thyroid out and afterwards they got fat. Will I get fat after my thyroid operation?

A:If you take the correct dose of thyroid hormone after your operation, you will not get fat. On the other hand, if you eat poorly, do not exercise, and suffer from what I call the “Hostess Twinkie Syndrome”, you may well gain weight. That, however, is not because of your operation, but rather because of your chosen life style. The beauty of thyroid hormone medicine is that it completely replaces what your body would make if you had a thyroid gland. I really don’t think of a thyroid hormone pill as medicine, but rather a perfect replacement for a substance your body normally makes.

Q:What if I decide not to undergo surgery and have my thyroid nodule or tumor removed? What will happen?

A:Fact is, I don’t know. If your nodule is benign today (and there is no way to know with certainty unless it is completely removed) and if it remains benign throughout your lifetime, then nothing bad should happen to you unless it should grow to such size that it causes what we call “compression symptoms”, that is, difficulty in swallowing or trouble breathing, especially when lying down. It could also grow large enough to become aesthetically displeasing. I think it is reasonable to assume that most people would not want a cantaloupe sized mass hanging off the front of their neck. Next, is the question as to whether or not these tumors can undergo what is called ”malignant transformation”, that is, convert to a cancer from a previously benign tumor. I know with certainty that this can happen with some salivary gland tumors because I have first hand experience with that. Whether it can happen with thyroid tumors is less certain, but we do know that in some very wild growing thyroid cancers, e.g. anaplastic thyroid cancer, we will often see areas of the less aggressive and more common types of thyroid cancer, such as papillary or follicular thyroid cancer. Some thyroid experts hypothesize that these very lethal anaplastic cancers may, indeed, arise in those more common forms of thyroid cancer that were allowed to go untreated for long lengths of time. I’m not certain about this, but it would seem prudent to remove suspicious thyroid tumors when indicated, especially in young patients who would have lots of time ahead of them for a tumor to undergo malignant transformation.

Q:My young child has a thyroid nodule. Should I be worried or is this just one of those childhood things he may grow out of?

A:You shouldn’t be overly worried, but it would be wrong not to have this tumor properly and completely evaluated. Back in my early training years in the 70’s we were taught that “a solitary thyroid nodule in a child is papillary cancer until proven otherwise”. This may be a bit exaggerated, but there is some wisdom in this approach. I am always suspicious of thyroid tumors in kids, and we do not rest until we can be certain it is not a cancer. My youngest thyroid cancer patient was a 6 year old girl who required a total thyroidectomy and bilateral modified radical neck dissections for an advanced cancer. So, be diligent, do your homework, and take your child to and experienced thyroid physician if he or she has a thyroid tumor.

Q:I had some radiation exposure in childhood and have a mass in my thyroid. Am I in any great danger? Does radiation exposure in youth have any effect on the thyroid?

A:Although we are getting further and further away from the times when radiation was used to treat acne, tonsillitis, and so on, we still occasionally see patients that were exposed to radiation in childhood. Depending on who you read, some authors say that this increases the possibility of thyroid cancer as much as ten times the risk in the normal population.

Back in the early 70’s I’d guess that between 3-5% of our thyroid cancer patients had a history of radiation exposure in childhood. Because it is now 30 years later this is less and less true, and in fact it is uncommon now, even in a practice such as ours where the only thing we do is thyroid surgery. Curiously, I had a 60 year old patient about a year ago who was in Chernobyl some 30 years ago when everything blew up over there and low dose radiation poisoning was everywhere. She had a firm thyroid nodule and given that history, I would have bet dollars to donuts that her thyroid nodule would prove to be cancer. I took it out, and it wasn’t. But if I had another new patient with the same history and physical findings as that lady, I would once again make the same wager, and the likelihood is quite high that I would win some donuts ! In the proper hands, the risk of thyroid surgery is quite low, and in these patients, the risk of a significant cancer is quite high. I believe the prudent approach is to remove these tumors.