Thyroid Office Visit
What questions will I be asked?
When a thyroid nodule is detected, the physician will ask you about your medical history and perform a complete physical exam. Symptoms such as pain, swelling in the neck, difficulty with swallowing, shortness of breath, difficulty with breathing, or a change in your voice should be discussed. Your family history is also important, as some thyroid cancers have a genetic basis and run in families.
Your physician will ask questions about your risk factors for thyroid cancer. Features that make surgeons more suspicious of a nodule are rapid growth, family history of thyroid cancer, family history of a condition known as Multiple Endocrine Neoplasia 2 (MEN-2), young age at diagnosis (less than 20 yrs old), male gender, history of head or neck irradiation, and compressive symptoms such as problems swallowing or breathing.
When your physician performs an exam, he/she will be particularly focused on features that can be associated with thyroid cancer. These characteristics include size of the nodule (greater than 4 cm in size), rock hard texture, fixation of the nodule to surrounding structures, paralyzed vocal cord, or enlarged lymph nodes.
The doctor will review all of your records, will specifically look for prior imaging studies that have been done (neck ultrasound), and look at any biopsies that may have been performed (FNA biopsy). You should be sure to bring the reports of these studies to your office visit. In many cases, the physician will want have the actual biopsy slides reviewed by another pathologist and most endocrine surgeons also perform their own ultrasound in the clinic.
Questions you might ask your surgeon
The first question to ask your surgeon is whether surgery is indicated. Your surgeon should be able to describe the specific reasons for surgery and discuss any possible alternatives, such as repeat biopsies, observation with repeat ultrasound in the future, etc.
If your surgery is indicated, the next question is which operation is best for you. Generally, the decision is between removing half of the gland (lobectomy) or the entire gland (total thyroidectomy). Your surgeon should explain the reasons for one choice versus the other. You should ask your surgeon if lymph nodes will be removed or biopsied.
You should be comfortable with your surgeon and feel confident that you are in good hands. Some patients find it useful to ask their surgeon – “How many of these operations do you do each year?” It is a good idea to have your operation performed by a surgeon with considerable experience in thyroid surgery (usually that means at least 50 thyroid operations/year).
Some other questions include:
- What are the risks of the surgery, and what are the chances of having a complication?
- Am I going to need to take thyroid replacement pills after the surgery?
- What kind of anesthesia will be used?
- How long will I be in the hospital?
- How long will the recovery be after the surgery?
- Will I need pain medicine after surgery?
- When can I shower after surgery?
- When will I be able to go back to work and do all normal activities?
- When will I be able to drive a car?
- Will I have any blood tests performed after the surgery?
- Will I need to take calcium supplements?
- Will there be problems with swallowing, breathing, or hoarseness of the voice?