January 21, 2014

The Battle with Graves' Disease III: The Thyroid Strikes Back!

I am sure many of my dear readers know about my 8 years battle with Graves' Disease and I have posted a couple of posts on this issue and my visits to the hospital.

In case you have forgotten, here are the links:

Part I:  Five Stitches, Two Weeks Running Ban: The Prologue to my Running Hobby.A Life changing Experience 

Part II: The Adventure of being poked and probbed at Changi General Hospital

My medical took a new turn on 20th Jan 2014 as I was pushed into the surgical room for a total thyroidectomy. Many asked me why did I choose to undergo such a major surgery and have I considered other alternatives. I will have to elaborate what happened since the radioactive iodine treatment...

Changing into the surgical gown
 After my near death experience with Thyrotoxicosis as a result of an overactive thyroid gland due to the radioactive iodine treatment (RAI), I was put under observation for 2 years to monitor the aftereffect of the RAI. There has been cases whereby the thyroid cells take up to one year to die off as a result of the radiation, and the docs were hoping that there was the case. As the end of the day, there is only a marginal improvement in my condition. Prior to the RAI, I am taking the maximum dosage of 30mg of carbimazole and yet, the hormone levels, indicated by T4 and TSH remained out of the healthy range. After the RAI, the blood count level came down successfully to the normal zone, with a dosage of 25mg of carbimazole on weekdays and 30mg on weekends. It means that only a small portion of my thyroid gland was destroyed by the RAI and any tweaking of this formula downwards, will lead to a spike in the thyroid levels again. In order to check the condition of my thyroid gland post RAI, the doc ordered an ultra-scan on the thyroid gland sometime on the 4Q of 2013. 

As usual, more complications arised.

The ultra scan revealed a nodule, which has the potential to grow cancerous if left unchecked. For now, the doc diagnosed that it should be benign, but to be sure, a biopsy should be performed. However, the RAI which I have underwent previously had scrambled the cellular structure, that the biopsy may not have any conclusive results, which might lead to a surgery which they need to cut me open to take a look at the lump. I was given these options:

1) Continue with the current condition and pray that no other complications kick in.

2) Do a RAI again. However, due to my resistance to RAI the last time round, the Doc is not confident that the procedure will kill off all the thyroid gland. If the RAI fails again, the celluar structure will be even more messed up and they may really need a surgery to take a look at the lump.

3) Perform a partial thyroidectomy. Given how powerful and unpredictable my thyroid gland is, the reminding thyroid cells may still produce enough hormones to put me back at a hyperthyroid condition again. A second surgery or RAI to remove the thyroid will have much higher risk.

4) Perform a full thyroidectomy. Takes away all the thyroid problem once and for all, but accompanying that, a new set of problem and lifelong medication.

It was a very difficult choice to make! I was tempted to maintain my current condition as I feel pretty good and healthy after all these years but the stupid lump is complicating matters. So, as a consultant myself, I asked the all important question that all clients should ask:

"If you were in my shoes, which option will you choose?"

Doc hesitated for a while and replied, "I will go for the full thyroidectomy."

 I considered for a while.. Heck! This stupid gland has been bothering me for the longest time, disrupting much of my life. Let's go with what the good Doc says!

"In any case, just book an appointment with the Surgeon and let him explain to you the surgical complications. You can cancel the procedure anytime within these few months."

Sounds like a good deal! I booked an appointment with the surgeon and began researching on life after a total thyroidectomy.


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