Question:
Would you delay surgery for a thyroid cyst???

My WLS is in five days. Five. I've worked on this for 13 months. Last week I saw my PCP for the final medication changes, and she noticed a lump on my thyroid. The ultrasound diagnosis is "multiple cysts of unknown origin," but all of my blood levels & other thyroid tests came back absolutely normal--and they've been normal for the last two years.(So none of this is the root of my weight problem. I eat like a horse on steroids.) The earliest time they can get me in to do a nuclear medicine scan is 2/26--two weeks after my scheduled surgery. I've looked it up, and it seems like 95% of all thyroid cysts are benign. But my doctor is recommending postponing the WLS until after the scan, "just in case." (BTW-she has a history of always erring on the "safe" side--I've been through so many extra tests and procedures that come back normal that I've actually lost count.) If I postpone the surgery, I go back to the bottom of the wait list--meaning at least another 6 month to one year wait--plus, my paperwork will expire, so I'll have to start the whole damn process over again. What should I do??? I absolutely don't want to postpone surgery for a "what if"--not when I've come this far. What would you do????? The doctor refuses to call me back by phone, so I have to wait until a Friday afternoon appointment--which will be too late to call and cancel the surgery. Help!    — Stephanie M. (posted on February 3, 2004)

February 3, 2004
I personally probably would go ahead with the surgery. Is your Dr. Giving you a medical reason not to have WLS first like there could be complications because of the cysts? Maybe you can get them to clarify why they want you to postpone you can have a better insight of why they want you to wait.
   — jenafwife

February 3, 2004
I agree ask your doc why they want you to delay your surgery, if there are no risks I would go for it. How long before they do your tests on it? Maybe they could rush it?
   — Saxbyd

February 3, 2004
If you wonder what it might be like to be diagnosed with thyroid cancer right after you have WLS, just read my profile. I can't tell you what to do, but you can see what it would be like if, worst case scenario, you went forward with WLS first and then oops . . . found out, two months later, that you had thyroid cancer. It hasn't been so bad, actually.<P> Quite frankly, I'm glad I had no idea I had thyroid cancer at the time that I had my WLS; I'm not sure, to this day, if I'd have had the WLS at all if I'd been diagnosed first with the thyroid cancer. But I know one thing: If I hadn't lost a lot of weight quickly, with WLS, I wouldn't have found the lump in my neck (actually, a lymph node to which the thyroid cancer had metastasized) that finally led to the diagnosis. Without WLS, I'd probably still have an undiagnosed case of advanced thyroid cancer.<P>All that aside, you are correct that it's highly unlikely that *you* have thyroid cancer. (Having said that, I've got two friends who've had it, and it's supposed to be relatively rare.) But, please be sure that, whatever you decide regarding timing of testing, you have a fine needle aspiration done of those "multiple cysts of unknown origin." Surprisingly, thyroid cancer quite often doesn't show up in bloodwork; my thyroid bloodwork was normal despite the fact I had a fairly advanced cancer. And the nuclear medicine people ... well, they are not going to be able to tell you whether or not you have thyroid cancer just by staring at your cysts on their little hot-or-cold-nodule screen (they sure as hell missed mine initially by doing that, some years ago, but that's another story). Only a doc with experience doing fine needle aspirations can help you determine if your cysts are a problem. If I'd understood that, years ago, the first time I found a lump in my neck (and was told, wrongly, by nuclear medicine people, that it was not cancerous, as IF they had any way of knowing that, but I didn't know that they didn't know, etc.), it wouldn't have metastized as it did. I believed my docs when they were satisified with a nuclear medicine scan and bloodwork, all of which were normal, and utterly unrevealing in my case. (I content myself with the knowledge that, in the unlikely event this takes me down, I can at least haunt those knuckleheads wearing a size-4 bedsheet, thanks to WLS.)<P>Sorry to dump this on you five days before your WLS, but I don't think reading my profile will make you think you *need* to cancel your WLS surgery over the mere possibility that you might have thyroid cancer. Whether you *should*, is a decision for you and your doc to make together. Thyroid cancer, if caught early, has a 95 percent cure rate. If caught a bit late, like mine, at least it's a real slow-growing sucker, in most cases.<P> Whatever you decide, PLEASE be sure to get that needle biopsy at some point in the not-too-distant future. Do NOT let the nuclear medicine people advise you that they can tell whether you have cancer based on a scan, without a needle biopsy. T'ain't so, and I'm not the only thyroid cancer patient who went undiagnosed for a time because somebody stopped there, and *didn't* do the simple needle biopsy in the first place. (Climbing off my soap box now.)
   — Suzy C.

February 3, 2004
You have to make the decision yourself, but keep in mind that if you do need to have the cysts biopsied, it might be easier to do after you have lost weight. I had a 4cm by 2cm complex nodule on the left side of my thyroid. I had five passes done (biopsies) that were "normal tissue" (a cytologist was in the room and made sure the samples were tissue and not fluid.) I went back to the head and neck surgeon who said we could leave it alone and do nothing, watch it, or remove it. His question was, "If it's normal tissue, why is it growing there?" I wound up having a hemithyroidectomy (removed the left side) and all the frozen sections came back negative for cancer. (The only true way to find out if there are cancer cells present). Had he found cancer cells, he would have removed my entire thyroid gland. The reason I am telling you my story is that the whole process started 7/2/00 and I had my thyroid surgery 8/20/00! I was in the hospital less than 24 hours, off work for 2 weeks (and could have gone back sooner). Having been through the thyroid thing, if I was in your shoes, I would go ahead with the WLS. Thyroid cancer (and you are correct - it is likely NOT cancer) is very slow growing, anyhow.
   — koogy

February 4, 2004
Stephanie, I have the same problem to a greater degree - I would make sure the cyst were not cancerous - (as I did) then have the surgery (and your're right most cyst are not benign. My appetite also increase because of these cyst, but I had abnormal labs - whereas you have "normal" labs - I also had other hormone & Thyroid dysfunctions. My surgern did the WLS, but wants me to wait at least 6-1 year before any other surgeries - unless absolutely necessary. As he did not want any complications to overlap with the WLS. My doctor has a 100% success rate with WLS and also does not like to take any risk.
   — Anna M.

February 4, 2004
I've had a cyst on my thyroid since 1994. I had an ultrasound done at that time and my endocrinologist (you should see one if you haven't already) said that the risk of thyroid cancer is only about 1% and is the most easily treated type of cancer that there is. I had my RNY in 11/01 and my endocrinologist is thrilled with my results and has now referred other patients to my WL surgeon to help them the same way he helped me. I would NOT want to be put on the bottom of the list again. See a specialist and get there opinion and then you and the WL surgeon can decide what is best for you.
   — Patty H.

February 4, 2004
I agree with the others that you have to make your own decision. I had a right thyroid lobectomy and isthmusectomy a year before my WLS. I had enormous complex, stage 1 cancerous cysts. I had needle aspiration biopsies before thyroid surgery, and the endocrinologist said that my excess weight made no difference in their ability to get to the cysts, bigger neck - longer needle. On the other hand, my surgeon told me that if I was thinner my surgery would have been easier. I had WLS last year and sometime this year, my left thyroid lobe will have to come out due to new cystic growths. My new surgery should go easier now that I am down 100lbs. Thyroid and Prostate Cancers are the most curable if that's what you have, but having that is rare. I am not you and no one here can really advise you because we truly do not know the whole medical situation and we are not qualified. Note that cysts, can sometimes obstruct the air passages and make intubation more difficult, so that needs to play a factor in your decision. I was told, that if the cyst is cancerous, they have to get it out right away so it doesn't spread through the endocrin system. Dr's don't like doing major surgeries that close together because it is a greater health risk - Best wishes -
   — M B.