Tuesday, November 08, 2005

planet of the thyroid

I saw the endocrinologist on Monday for the second time, and she was able to answer a number of questions I had about my thyroid cancer and the treatment I'll be receiving.

First, the cancer is papillary cancer, not follicular. This makes it the single most common and most treatable form of thyroid cancer that exists. Chief Justice William Rehnquist died from a completely different, much rarer, and far more aggressive, form of thyroid cancer. So if you were hoping to inherit my Spider-man comic books, my twenty- and twelve-sided dice, or my cassette tapes of white Christian rap, I'm afraid you're out of luck. Papillary thyroid cancer is also extremely slow-growing, which means there is no hurry to have surgery. I should have it sooner rather than later, but it doesn't have to be done before I go to bed tonight.

Because the recovery time for a thyroidectomy is about three weeks, we're planning to have the surgery done shortly after Thanksgiving. The endocrinologist gave me the names and phone numbers of two surgeons based at a hospital here in the city. Once I get the insurance madness lined up, I'll schedule the appointment, probably in the next few days. The surgeon will remove my thyroid and will check my parathyroid glands for any indications that the cancer has spread. That is considered unlikely.

About four to six weeks after the operation, I'll be given radio-tagged iodine. Any thyroid cells that are left in my body -- including thyroid cancer cells that were spread elsewhere -- will light up under a scan. If any do -- and they almost always do in the first scan after an operation -- they'll give me a dose of slightly more radioactive iodine. The thyroid cells will suck up this iodine and blow themselves to kingdom come. (Thyroid cells absorb iodine, an ability passed on to cancerous thyroid cells, and an ability that makes thyroids uniquely treatable for cancer.) After about a day or two, I'll pass this iodine out of my system and out into the sewers, and everyone will be happy.

There is no evidence that the radioactive iodine poses a health threat to my other, healthy body tissues. Nor will there be enough radiation to give me superpowers. Forty years of data indicates the exact opposite.

About six months after the operation, I'll be taken off thyroid hormone for three weeks. As the levels of thyroid hormone in my body plummet, my pituitary gland is going to go nuts, urging my thyroid to get its act in gear and produce more hormone. (I'm afraid I'll display record levels of sloth during this time.) After this three week period ends, I'll have a blood test done to see what traces there are of thyroid hormone in my blood. If there's any evidence that any part of my body is producing thyroid hormone, we'll repeat the iodine treatment since all my thyroid cells should be gone by that point. I'll also go back onto thyroid hormone pills.

After that, if I remember correctly, there's one more six-month checkup, then it's annual checkups, if even that. There is no evidence at all that having thyroid cancer raises my risk of cancer elsewhere in my body, so I should be as healthy as anyone else, at least where cancer risk is concerned.

Lastly, the doctor prescribed me thyroid hormones to start taking now. This will have the effect of telling my pituitary glad to stop producing thyroid stimulation hormone, which in turn will get my thyroid to stop producing its hormone and should have the effect of slowing any growth of my thyroid nodule even further.

Weird factoid: From what the doctor told me -- and doctor is so much easier to type than "endocrinologist" -- autopsies have revealed that about 50 percent of all dead people have some sort of thyroid cancer, and yet that's not what they died from. Pretty wild, huh?

No comments: