January 14, 2010

I went to see Dr. Ley late last week to discuss whether he thought I was healthy enough to have my thyroid nodule removed or not. He ended up doing another ultrasound and I found out that there are two nodules he doesn't like, though one is in his really dislike column. Because of my "sensitive" nature with food and medication, he really doesn't want to perform the surgery unless it's really necessary. I understand and I'm sure that my insurance company is very happy to hear that, too. He decided to send me for a thyroid scan, which will happen tomorrow morning. So how did he come to this decision? Well, let me tell you...

I had to lay still without speaking for a long time while he performed the ultrasound, taking lots of pictures. Laying there isn't bad, and not speaking isn't bad, but both expected at the same time is torture for me. We won't even discuss the gel that gets squirted all over your neck. ew.

Dr. Ley started showing me the pictures and said he had a lot of concerns about these nodules, even though they are so small. The edges are not uniform, they are full of calcifications (one having a normal kind, and the other a not good kind?), and they are exceptionally vascular. They light up the screen nearly as much as the large artery or vein on the screen. He said that normally they wouldn't do a thing with nodules this tiny, but because of these factors and especially the vascularity, he thinks that the probabilities tilt more towards cancer than not.

The only other thing he thinks it could be are that these nodules are hot spots. Normally the thyroid or parts of it turn on and off as the need for hormones changes. Some areas can turn permanently on, which makes the other parts turn off, so the vascularity would increase to these hot spots as they are doing all of the activity. If this is the case, my blood work would look normal, even though the thyroid wasn't functioning normally, because these areas would produce everything my body would need. Actually, almost more than my body would need since my levels are nearly hyperthyroid.

Anyway, Dr. Ley said that the scan would show if the nodules are indeed hot spots (they will absorb most of the iodine and show up as bright points of light), at which point he would leave them alone. However, if the nodules show cold or little absorption of the iodine, ( they will not absorb most or any of the iodine and show up as dark spots), then he really wants them gone. He is no longer wishy washy at all, which makes me sure we're doing the right thing, but also causes me some alarm. I guess I'm just tired of having this discussion and am ready for action. I'm just grateful I trust him to take the right action, whatever that might be.

Dr. Ley told me that he was happy to see me feeling better. I was so full of energy that day I literally wanted to run laps in the room. I told him that it was nice to have him see me feeling so good since he was one of the few to see me at my lowest point in the hospital last summer. He smiled and said "And I believed you then, too." It reminded me of how grateful I am to have finally met a doctor who believed that there was something wrong physically, not something wrong in my head. Now while my problems seem to originate from food reactions and not endocrinology problems, he helped guide me to where I am now. He reminded me at each step to not look for every little sign to figure out what was causing this, but to enjoy each day as much as I could, then take notice when something was really different. Without that little nugget, I don't know that I would have noticed the food reactions, which has led me down this path. I also told him that I thought my whole summer was part of some grand plan to lead us to find these nodules. Without my hospital stay and my swearing something was wrong with my thyroid, we wouldn't have found them. I'm hoping that all we really find is two bright spots on the scan I can name the teeny weeny hot spot and the itty bitty hot spot, but have faith that we'll be able to handle whatever comes my way.

Wish me luck for tomorrow. I have to lay still.