Not too long ago, we used iodine whole body scans to look for recurrent
thyroid cancer. Even prior to the surgery to remove the cancerous thyroid,
we knew there was also a strong likelihood of cancerous lymph nodes; however,
we didn’t have a way of predicting who had those lymph nodes until
the surgery was actually being performed. NOW…we have high-resolution
ultrasound, which physicians can use to carefully look at the central
and lateral parts of the neck. A qualified clinical thyroidologist and
ultrasonographer should map your neck BEFORE the original surgery so that
suspect suspect lymph nodes are identified and communicated to the surgeon.
INSIST on an ultrasound before the surgery. It will save you another surgery
in 1-5 years. The first surgery is the most important.
Case in point: A 25-year old teacher was found to have a nodule in her
neck by her OB/GYN doctor. On biopsy, this was found to be suspicious
for cancer. The nodule was only 1 cm in size. She came to see me mostly
to establish a patient relationship for future follow up. I performed
a pre-operative ultrasound and found lymph nodes in the opposite side
of her neck, an area that would likely not be explored during surgery.
I informed her surgeon. The surgery showed 6 of the 17 lymph nodes in
her neck were cancerous. She is now disease free!
The best time for a patient to see a clinical thyroidologist is when the
nodule is first found. Not after the biopsy and definitely not after the
crucial first surgery.