Change of Plans

OK, first, a bit of a glossary. (I’m not a fan of glossaries in basic writing, but those who are uninitiated into the world of thyroid cancer may need a few definitions for what’s to follow.)

  • Thyroglobulin: the protein marker given off in the blood by thyroid cells. Ideally, in a post-treatment thyca patients, Tg should be 0. This happens for many people, though it’s never happened for me. Mine went way, way down after the last surgery and round of radioactive iodine, but then had bounced back up to less-than-comfortable levels with the blood tests I had in March, indicating the return and growth of thyroid cancer cells.
  • Radioactive iodine (RAI): Also known as I-123 or I-131, a highly radioactive, well-calibrated dose of iodine that is like a deadly magnet to thyroid cells. It finds them and kills them. Sometimes I call it radiation, too, even though it’s not the external beam radiation that you may think of when you think of radiation to treat cancer.
  • Low-iodine diet (LID): What you have to do to prep for RAI. Your body needs to be starved of iodine so it will soak up all the RAI goodness/badness. More on this a bit later, though you may have recall that I’ve earlier called it “the hateful diet.” Anyone who loves cheese, chocolate, bread or sushi will understand why.

Now that that’s out of the way, here’s why I needed to set the stage with those:

As I mentioned last night, during my pre-op appointment with the surgeon, she suggested flip-flopping our original plan, and going with another course of RAI before surgery. You see, I’m a bit of a confusing case. Ten years ago–or even five–the docs would have known that I have a higher-than-advisable level of thyroglobulin, but they probably wouldn’t have been able to see the .9 cm nodule in my neck. Imaging just wasn’t as good as it is now. So the docs would have treated a case like mine with another dose of RAI and sent me on my way.

But now we’ve got these fancy machines, and pathologists who can stick a long needle deep into your neck to diagnose the tiny pebble as cancer, and surgeons who are good at what they do and so want to go after whatever they can.

But.

My team of doctors is, as I’ve explained before, one of the best in the world. No turf wars here–the endocrinologists, surgeons, nurses, nuclear med docs and more all get together weekly to talk through all of the current thyca cases and decide what to do. And mine falls into a gray area. They could go after the nodule, for sure. I have no doubt in my surgeon’s abilities, and neither does she.

But.

They could also just give me another RAI treatment, and see if that kills the cancer. Dr. Boyle’s quote last week: “The more surgery I do, the more conservative I get.” She doesn’t see how the benefits of this one outweigh the risks–yet. The nodule is on one of my vocal chords, and right next to my carotid artery. It’s likely embedded in the scar tissue from my last surgery. If it were bigger–2 cm, or 3–she’d take it out without hesitation. But for this size, she’s ambivalent.

Her explanation made a lot of sense. She listened to our concerns (um, hello? I have cancer and would like it GONE, thank you very much) and answered every one of our questions. She told us she’d do the surgery if I absolutely had to have it. But when a surgeon–whom you trust–puts it like that, I don’t know about you, but I’m inclined to think about our other options.

And RAI is a good one, and the way our team has decided to go. It’s not a fun option, but one that as Dr. Boyle explained, I’d probably end up needing regardless of surgery. And surgery’s always there as an option, if this course of RAI doesn’t zap the nodule and it continues to grow.

So now I wait for Shari, my favorite physician’s assistant from the nuclear medicine department who I’d hoped never to see again (and YES, radioactive iodine is administered by the nuclear medicine department), to call with when they can pencil me in for more shots and scans and isolation. I’ll keep you posted. But for now, I’m going to eat some cheese–while I can.

(More on the LID, and all its virtues and suckitude, tomorrow.)

(PS. I’ve been away from work and analysis so long that I’ve forgotten the difference between benefits and risks, hence the need for an edit…)

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