Tale of the nodule

Disclaimer: I am not a medical professional. The things I write here are just based on my own personal experience, how I understand my doctors’ explanations, and some online research I did to help me understand more about what was happening to me.


It was just a lump. One fine day in July while I was putting on moisturizer on my face and neck, I felt a firm lump at the front left part of my neck near the base. It felt as big as a cherry (or specifically I described it as like having a “sinigwelas” stuck in my neck). I knew it wasn’t there before, not that big to be felt anyway. My mom was around that time so I told her about it. She told me to have it checked by the doctor.

I never thought I would be dealing with any major medical issue anytime soon, but that’s how simply I discovered it.

I went to the GP to have it checked. He did a simple physical examination of it, then sent me for an ultrasound. The ultrasound confirmed a solitary thyroid nodule in my left thyroid about 3.3cm. I went back to the GP with the results, and he sent me for more tests, blood tests to check my thyroid hormones, and fine needle biopsy (FNB) for the nodule. This entire thing, from the first GP visit to the FNB results, went on for a few weeks. When my GP got my FNB results, he referred me to a specialist.

I went for a consult with the specialist, who then sent me for another set of tests – more blood tests, and a thyroid scan (where they give you a small amount of radioactive iodine which should be absorbed by the thyroid and shows the level of function of the thyroid). Immediately after my thyroid scan (I think my specialist was around during the scan, and came over while I was still on the scanning bed) told me that my nodule was cold (or it wasn’t absorbing the radioactive tracer, thus, was non-functioning thyroid tissue) and that he would need to refer me to a surgeon on my next visit. So I went back a week after when the rest of the test results were ready, and the specialist referred me to the surgeon, who luckily had a free slot for a consult on the same day.

I went to the surgeon who checked through my previous test results. He checked my thyroid again with an ultrasound in his own clinic, and noted that the nodule was around 3.7cm (but initially he said the size difference from the first scan may just be due to viewing variances). He also did a nasolaryngoscopy to check my throat and vocal chords. He explained to me the results of my test, and why surgery was recommended to take it out. During that first visit with the surgeon he scheduled me for an operation in less than a month (which I eventually rescheduled a little bit later to time it when my mom can come over to provide support).

During the following weeks while waiting for my surgery, I was starting to feel the lump as a mild pressure inside my throat. Perhaps it was getting a little bit bigger, or maybe it was shifting positions, but I couldn’t really tell.

I don’t think I ever stopped reading any and all online references I could get my hands on on the subject of thyroid nodules and thyroid cancers. I’ve read about the different kinds. I’ve read maybe a hundred times (a lot of times the same articles) about how they are diagnosed and treated. They were mostly saying the same things. And somehow, most were also pointing to the direction that all the characteristics of my nodule were somehow indicating higher risks for malignancy.

Just to review, here were the characteristics of my nodule:

  • Solitary – there were no other visible nodules in the scan
  • Cold – it was comprised of non-functioning thyroid tissue
  • Atypia of undetermined significance – it could not be determined if the mass was benign or malignant based on the FNB alone
  • Bigger than 3cm
  • Thyroid hormones normal
  • Family history – mom had her entire thyroid removed a few years ago and findings include microcarcinoma

I guess that’s the reason why all the doctors I consulted recommended to immediately remove the mass to get a definitive finding if it is benign or malignant. I was undergoing a hemi-thyroidectomy – removing the left lobe of my thyroid. The doctors told me that there is a possibility that they may need to do a second operation to remove the rest of my thyroid if the nodule turns out to be malignant. So I was also trying to ready myself for that possibility.

Mid-November, I finally had my surgery and it went smoothly. The only thing that got me is the horrible nausea and headache after the operation, which was probably the side effects of the anesthetics. Once I got over that, recovery went well.

A little over two weeks after the operation, I had my follow-up appointment with the surgeon and he told me the results of the biopsy. Findings was Hurthle cell adenoma – it was benign! I was relieved. I get to keep the rest of my thyroid for now. The surgeon also told me that it was a good that we have already removed the nodule because there may be a risk of it becoming malignant if it wasn’t removed.

There is a “thin line” between Hurthle cell adenoma (benign) and Hurthle cell carcinoma (malignant).

“If vascular invasion, invasion of adjacent tissues or complete capsular penetration (if the tumor is encapsulated) is demonstrated the tumor is considered malignant” (http://www.med.harvard.edu/JPNM/TF99_00/Nov23/WriteUp.html).

“Unlike many cancers, Hürthle cell cannot be definitively diagnosed with a fine needle aspiration (biopsy). While the biopsy may be suggestive of a tumor that may or may not be cancer, called a Hürthle cell neoplasm, the large majority of these will be found to be benign (called a Hürthle cell adenoma). The only way to confirm the diagnosis of cancer is by identifying capsular or vascular invasion (that is, invasive growth that is seen with cancer). This can only be determined after the nodule is surgically removed and examined by a pathologist in the laboratory… Once there is a diagnosis of a Hürthle cell neoplasm, surgery to remove the affected thyroid lobe is typically the next step to clarify the diagnosis. Only 15-30% of patients will receive a diagnosis of carcinoma after surgery, with the remainder finding the nodule was benign.” (https://www.oncolink.org/cancers/thyroid/all-about-huerthle-cell-carcinoma)

I’m super glad that its Hurthle cell adenoma and not Hurthle cell carcinoma.

“Hürthle cell cancer has the highest incidence of metastasis among the differentiated thyroid cancers… The lungs, bones, and central nervous system are the most prevalent sites of metastases.” (http://emedicine.medscape.com/article/279462-overview)

“No widely accepted paradigm exists for the pathogenesis of follicular and Hürthle cell cancer of the thyroid. Some evidence suggests that a multistep adenoma-to-carcinoma pathway may be involved; however, this concept is not universally accepted. Many of the cells probably develop from preexisting adenomas, but a follicular carcinoma in situ is not recognized pathologically.” (http://emedicine.medscape.com/article/279462-overview#a5)

During that same follow-up, I also asked the doctor about the size of the nodule they removed, since I had a feeling before the surgery that it was slowly getting bigger. He told me that it was possibly around 4cm – indeed a little bit bigger than when it was first diagnosed just four months earlier. I’m so thankful for the perfect timing of when I noticed the lump, when it was diagnosed, when the doctors decided to take it out, and when I finally had the surgery. Otherwise if I or any of my doctors have ignored it, the outcome may have been different.

I’m almost back to my normal self, although I’m still avoiding heavy physical activities and my wound is still recovering from the swelling. I can move my neck, but not yet 100% back to its normal range. I have yet to see my specialist to find out if my remaining half-thyroid is producing enough hormones or if I need to take hormone supplements. But everything is good and well. I no longer need another operation or other therapies. I can start planning my life for 2017.

Christmas came early this year

There are just so many things that should excite me in the coming days. There’s the Coldplay concert next week, the family trip pre-Christmas, and most of all, spending Christmas and New Year back home. There are even more exciting things coming early next year – Adele, travels, and so much more. But somehow I feel like I’m not as excited as I should be for all those other things.

Perhaps it’s because of the health-scare I’ve had in the second half of this year. It’s quite unsettling to be face-to-face with that big word – cancer. I had a solitary thyroid nodule which was suspicious on tests. They couldn’t determine from initial tests if it was benign or malignant, and a lot of parameters were pointing to a risk for malignancy. The only way they could find out is to take out the entire lobe and do a biopsy of the entire mass.

Hence, I headed for surgery mid-November. I’m super thankful to my mom who came over to help me out pre- and post-operation. And my brother who has always been great support. I was lucky that I got myself a good private health insurance earlier this year. I am also very happy that I have good doctors and an amazing surgeon.

Christmas came early for me this year, as two weeks after my surgery, my surgeon gives me the great news that my nodule was benign! It’s the best news for me all year. Thank God.

Let me savor this moment to realise how truly blessed I am.

 

Post script:
Being the inquisitive geek that I am, I have been reading and I continue to read about my entire thyroid nodule saga. So beyond what my doctors were telling me up front, I was also researching and reading relevant references in my own time, because I wanted to know what it was all about. My surgeon just confirmed with me the findings of the biopsy, and I am also reading more about it. I might do another post later on with the more medical side-story.

Red is almost black

Just an extremely random thought that I had to write about. Red is almost black. You’ll probably completely disagree, but I’ll explain a little bit why I state it as so. Here are some things I may have known at the back of my mind and pulled out from the dusty file drawers in my brain when the need arises.

The Red LED

On the streets of Bangkok back in November, I came upon some digital LED alarm clocks that I have been wanting to get for some time. I asked about the one with the green LED, and the salesman said it costs THB400. I heard another buyer ask about the one with red lights, it was only THB300. It was exactly the same design, only the color of the LED display differs. I verified the prices with the salesman, and he confirmed that the one with red LED is THB100 cheaper than the one with green LED.

I ended up buying the one with the red LED, but not just because it was cheaper. I intended to put it inside my bedroom, within view from my bed. I knew that if I bought the one with the green LED, it may be too bright at night when I turn off the lights. The one with the red LED would fit my requirement better. Indeed, it works well for me right now.

Thinking through it, I was brought back to the time in high school and college when I tinkered a lot with LED bulbs and electronic circuitries. We would by all the individual electronic components from our beloved store, Alexan. I had a box full of different resistors, capacitors, LEDs, logic gate chips, programmable microchips, breadboard, PCBs, and whatnots. I had my own soldering iron back then. When we bought LED bulbs, we knew that the red ones were the cheapest. If I still remember correctly, it was the white and blue ones that were thr most expensive, especially the superbright ones. I do remember being told that the differences in cost is because different diode materials generate different wavelengths, and therefore different colors of light.

Red in B&W Photographs

When my college friend was coaching me about black-and-white photography (the traditional one with the film, not digital ones) as I was preparing to take photographs for a competition I was entering. Specifically, he told me that reds always appear black or almost black in B&W photographs. Seems strange when you’re so familiar with how vivid red is in color photographs. When I took the photographs, indeed they were, all reds were black in the photographs. Red is black, or almost black.

Red Pigments

I can’t remember exactly what show I was watching and on what channel, but they were featuring how industrial pigments were produced. Apparently, the red pigments are produced by using the same material as the black pigments, but the black pigments are heated and oxidized to produce the red pigment.

Sunsets

Have you noticed, that while the sun is high up in the sky, the sky is color bright blue, but when sunset comes, just before it turns pitch black, it usually turns a certain hue of red or orange?


I’m not actually so certain what the exact explanation is why red is black or almost black. Maybe it has something to do with the wavelength of red light (remember, it’s at the end of the ROYGBIV visible spectrum of light), or the composition of red pigments. But it’s quite interesting to think about it.

Interstellar – a short and (hopefully) “painless” review

interstellar_new_poster

I finally pulled myself out of the office chair (and/or the house couch) and went to the cinema to watch a movie. Since it was at the tail-end of its run in most cinemas in my city, I went off to watch Interstellar. Perhaps I’ll go watch Hunger Games and/or the Penguins next time.

Anyhow, Interstellar. It was ok. Not great or grand, just ok, not a waste of money or time. I do found it entertaining enough and thought provoking enough. However, it was quite obvious that the storyline of the entire movie was not for “dummies”… you needed a background in physics, at least an understanding of space-time continuum or relativity. But that’s maybe less than 10% of the movie-going population. After the movie, I could hear people around the cinema telling each other that they did not understand much of what happened — honestly that could totally spoil the beauty of the film.

I saw the beauty of the film (thanks to my physics background in high school and college, and my natural science geek sense), including the black holes, space travel, relativity of time, and the prospect of finding another human-habitable environment in the universe. However, I was not quite happy with the events leading to the conclusion of the story. Suddenly everything seemed too absurd, too “fantastic”, too “magical” for a movie that had a storyline mostly based on science. What the heck happened after he fell into the black hole? It’s supposed to be a gravitational singularity, a “a one-dimensional point which contains infinite mass in an infinitely small space, where gravity become infinite and space-time curves infinitely, and where the laws of physics as we know them cease to operate”. And I quote:

“Current theory suggests that, as an object falls into a black hole and approaches the singularity at the centre, it will become stretched out or “spaghettified” due to the increasing differential in gravitational attraction on different parts of it, before presumably losing dimensionality completely and disappearing irrevocably into the singularity. An observer watching from a safe distance outside, though, would have a different view of the event. According to relativity theory, they would see the object moving slower and slower as it approaches the black hole until it comes to a complete halt at the event horizon, never actually falling into the black hole.” (http://www.physicsoftheuniverse.com/topics_blackholes_singularities.html)

The movie showed a pretty odd interpretation of what lies behind the event horizon, what’s in the singularity. It’s taking me so much time thinking of how I could describe it in words, but perhaps I should not even attempt. I do understand what they were hinting at, and maybe it is ok if just taken in an overly-simplified way. But what they communicated may create so many implications. I will not even start.

Over-all, the movie did appeal to the science geek in me. I would recommend it to anyone who knows who Albert Einstein is and understands at the very least the concept of space-time continuum and general relativity.