guest article written by Maria F.
What’s it like to have a hemithyroidectomy?
What on earth is a … whatever? It means that half your thyroid is taken out. „Hemi“ means half, „thyroid“, that’s the thyroid gland in your neck, and „ectomy“, that’s the surgical removal of a body part. Doesn’t sound like fun, does it? So, why would anyone want to do this?
The thyroid is a butterfly-shaped gland located in the front of the neck. It produces hormones that regulate the metabolism. The thyroid hormones T3 and T4 influence how the body converts food into energy, affecting processes such as heat production, oxygen consumption, and the utilization of nutrients, thereby helping maintain energy levels necessary for various bodily functions.
So, all in all, a pretty important organ. But it can of course, like all your organs, also give you trouble. One well-known condition of the thyroid is a goiter, which means that the thyroid just grows and can be seen as a swelling on your neck. Another problem, and that was what I had, is a thyroid nodule. Many people have these without even knowing. I didn’t know either until I had an MRI of the neck for other reasons.
There are „hot nodules“, which produce large amounts of thyroid hormones. This can lead to symptoms of hyperthyroidism, such as heat sensitivity, nervousness, agitation, weight loss, And there are „cold nodules“, which are basically like little bits of lazy thyroid that produce less hormones than normal. Still, they need to be checked out, as they can turn malign.
So, first, I went to my GP who palpated the thyroid and did an ultrasound. I didn’t like what I saw on that ultrasound at all. The left half of my thyroid was normal, but the right half had a rather large nodule that was dark with a white dot in it. I just had a bad feeling about it. So, I got a referral to a nuclear medicine physicion. The idea was that they’d give me radioactive iodine, or maybe it was technetium, I can’t remember. This substance is only a little radioactive. They told me that I should stay away from small children for 24 hours just to be on the safe side. But for diagnostic purposes, you don’t get those massive doses where they have to keep you confined for 48 hours.
They discovered that this was a „cold nodule“ I had. You can treat „hot nodules“ with radioactive iodine. They inject it, then it all goes to the nodule and destroys it with its radiation. When you have this treatment, you need to stay in a single room for 48 hours, and you are not allowed to leave. They feed you of course, but other than that, they keep their distance. And when you’re done, the nodule is destroyed, without needing any surgery.
I would have liked to do that, but mine was a cold nodule, so if I wanted it out, surgery was the only option.
But does it really have to come out? Well, not necessarily. If it’s small and benign, it can stay where it is. And there’s only one way to determine whether it is benign or not: a fine needle biopsy. This means they punch a little hole into the nodule and get out some of the cells to have a look at them.
The doctor was kind enough to perform the biopsy right then and there, without the need for a second appointment. She was of the opinion that you didn’t need any anaesthetic, with the reasoning that it made no difference whether you insert the needle to apply the anaesthetic or to perform the biopsy. But I disagree. I found the procedure very painful and if I ever need that kind of biopsy again, I will ask for some ice or numbing cream or maybe an anaesthetic injection.
I was asked to lie down, then the physician inserted a needle at the base of my neck, at the right side where the suspect nodule was. Then, she jabbed upwards, towards my chin, in three different places. She held the needle in one hand and the ultrasound in the other, so she knew exactly where to jab. That way, she hit the thyroid three times, in different locations. It hurt.
By the way, I had this procedure done in Augsburg, because both in Munich and in Düsseldorf, I would have had to wait several weeks for an appointment. It took me almost two hours to get to Augsburg by train, so this is why I had never done it, even though I wanted to see the Fuggerei. The Fuggerei was founded by Jakob Fugger, aka „Jakob the Rich“, in 1521. It was the first ever social housing project in the world, and to this day, 150 financially challenged people live there, for a rent of EUR 0.88 per year plus utilities. They even say three prayers for Jakob each day. Pretty impressive, to have people pray for you even after all these centuries.
When the doctor was done extracting cells from my thyroid, I got a band-aid and was asked to wait for 20 more minutes. Then, she did another ultrasound to see whether there had been any bleeding. This can become dangerous, not only because of the blood loss, but also because the blood needs to go somewhere, and this can compress the airways. It is a very rare complication in this kind of biopsy, but it can happen, and it’s better to spend 20 more minutes reading magazines and make sure everything is alright.
After the biopsy, I went home by train. There were no small children anywhere near me. I left a seat on either side of me free, and when a young man wanted to sit next to me, I warned him that I was radioactive right now. Just the polite thing to do, I think. He wandered off in search of a different seat.
It takes a week or two to evaluate the cells havested in a biopsy. And unfortunately, the result was not clear. They couldn’t say with certainty whether these cells were benign or not, and gave me two options. Either have a second biopsy in a couple of months, or have the suspect nodule surgically removed. So, since I didn’t fancy another biopsy, I asked for a referall to a surgeon. And I decided to have the procedure done in the ISAR Klinik in München. This hospital is very centrally located, and yes, I know that you are not supposed to leave the hospital while you are an in-patient, but I also know that many people do this and the doctors don’t really care as long as you are a little discreet about it.
So, I made an appointment at the ISAR-Klinik. More on this in part two.