Home Chapter 1 ------------------ The Beginning Entry # 4 - My First Surgeon: First Disaster
Entry # 4 - My First Surgeon: First Disaster
My Story - The Beginning
Tuesday, 14 October 2008 17:00

My internal medicine doctor referred me to a general surgeon within the same hospital. This has to do with an insurance thing.  I did my research so I was anticipating that he would perform a fine needle aspiration (FNA) on my thyroid nodule.  Boy was I in for a big surprise....


Initially, the general surgeon did a physical exam and palpated my neck.  He then gave me a little thyroid pamphlet and discussed the function of the thyroid gland and hormones and gave me a brief description of thyroid cancer.  

Then the general surgeon informed me there is only one option for me and that would be to surgically remove my thyroid nodule.  I questioned this and asked if a biopsy should be done prior to surgery to verify if the thyroid nodule was cancerous.   This would avoid any unnecessary surgery and risks associated with surgery.  The surgeon flat out said “No because the nodule is vascular. A fine needle aspiration is too risky and can cause a neck hematoma.  The only option is to surgically remove the nodule and have it tested by pathology for cancer.”  A hematoma is when there is bleeding inside the body causing as cyst of blood.


He gave me two surgical options:


Option #1.  Hemi-Thyroidectomy. Remove the half of the thyroid that has the nodule and then have it tested by pathology.  A frozen section analysis of the thyroid nodule can be performed in the operating room to determine if the nodule is cancerous.  If cancerous they will remove the other have of the thyroid. If the nodule is not cancerous they will leave the other half of the thyroid.


Option #2.  Complete Thyoidectomy.  Remove the entire thyroid gland. This is what the surgeon recommended.


He actually wanted to schedule me for surgery the following week.  This was all too sudden and this entire experience with the general surgeon was overwhelming. I initially thought I was going to get a fine needle aspiration biopsy, so for the general surgeon to refuse this simple procedure and skip to a more invasive and risky surgical procedure without a biopsy or medical evidence of cancer really made no sense to me. 


Is a fine needle aspiration (FNA) not the “standard of care”?   From the research I have done I believe a FNA is the standard of care for a thyroid nodule.  I still do not understand why the surgeon would not do a simple procedure, FNA, which could possibly eliminate the need for a very invasive and risky neck surgery.


I found this interesting.  “The Thyroid Book” pamphlet the surgeon gave actually said that a fine needle aspiration is typically included in one’s evaluation for thyroid cancer.  Maybe he should have read his own pamphlet.


thyroid gland


I was not ready for this invasive surgery at this time.  I was overwhelmed and scared. I really wanted to do the least invasive procedure first.  I did not want to live without a thyroid if I didn't have to.  In the back of my mind I’m thinking second opinion.


Little did I know that this surgeon was a “general surgeon.” He was not an otolaryngologist (Ear, Nose, and Throat surgeon) also called ENT.  I have nothing against general surgeons but if I do have cancer I would prefer a surgeon that specializes in that particular area of the body, like an otolaryngologist.


During this appointment I did ask the general surgeon how many thyroid surgeries he had successfully completed and he went off on a tangent and never really told me.  He just showed me a picture of a large goiter he successfully removed from a young female in Africa while on a medical mission.  His work did look good on the young female but my confidence in him did not improve.  I also asked him about his complication rate in thyroid surgeries and again he went off on a tangent. 


I left this appointment with the general surgeon feeling very overwhelmed and frustrated.  It really made no sense to me why the surgeon would not do a fine needle aspiration biopsy.  Why did he want to jump to an invasive surgery if the nodule could possibly be benign?  The surgeon made me feel very uncomfortable and pressured me into getting a possibly unnecessary risky surgery.  I would prefer to keep my thyroid if possible! I'm a young active person.  We have these glands for a reason!


Well, after leaving the appointment and discussing this with family and friends I decided to request a second opinion by an endocrinologist.


There were many red flags that came up during this appointment with this general surgeon.  Please learn from my experience.  These were the red flags:


red flag  1.  The surgeon refused to do a fine needle aspiration which really is the current standard of care for a thyroid nodule workup.


red flag  2.  The surgeon pressured me into believing a surgical procedure is the only option.  There are always multiple options.  One option is just not to have surgery!


red flag  3.  The surgeon wanted to rush me into surgery in 5 days.  I guess he wasn’t a busy surgeon….I wonder why!?!


red flag  4.  The surgeon never told me how many thyroid surgeries he had completed and/or his complication rate.


red flag  5.  I am guessing the surgeon was about 65 years old.  I’m not saying that older surgeons are bad.  A matter a fact many older surgeons are very experienced great surgeons.   However, in my experience some doctors don't stay up-to-date with the latest standards of care and technology.  This is an unfortunate but sad truth.  This particular surgeon seemed to be using dated treatment decision making.    This surgeon was going to use an old school surgical technique and an old school methodology for treating.  In the 1980s most thyroid nodules were removed surgically, nowadays thyroid nodules are not all surgically removed.  Typically, they are removed only if they are cancerous, suspicious for cancer, or causing problems.  I would also recommend a specialty surgeon for specialty case, like myself.  Though, I guess we are all special in our own little ways.


Well, back to my story.  The surgeon agreed to send me to an endocrinologist for a second opinion.  However, this little drama session is not over yet. 





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