The Diagnosis

It all started with a slight neck discomfort when lying down, which I felt within the first two weeks of May 2016. There was no pain, no difficulty in swallowing or breathing. ZERO history of any thyroid illness.

My husband and I have also been trying to conceive and my period was supposed to be due around that time so when I missed my period, I was more sensitive and aware of anything unusual with my body in the hopes of being pregnant. I actually read somewhere that a swollen thyroid is one of those of pregnancy symptoms. However, I also had irregular periods due to polycystic ovaries so it’s possible that the monthly visit was just delayed. The pregnancy test did turn out negative.

When I felt a slight swelling, a small lump at the base of my neck, like a swollen lymph node just above my left collarbone, and had no cough or cold or any other infection (which is usually present when you have a swollen lymph node), that’s when I knew to have it checked. The neck discomfort when lying down was also increasing as the days go by.

May 27 – The First Checkup

On May 27, 2016, I had my initial checkup. Instantly, the general physician said it was goiter. (A goiter basically means an enlarged thyroid gland.) She was actually surprised when she checked and felt my neck because according to her, the goiter felt big, and yet I only started noticing it a couple of weeks prior. At that time, all I knew about goiter was that something’s wrong with the thyroid gland that’s why it’s swollen. I’m also aware of hyperthyroidism/hypothyroidism so I thought that it might be either of the two but when the doc asked me for symptoms related to those conditions (i.e. sweating, palpitations, sudden weight loss/gain, fatigue, tiredness), I said I’m not experiencing those. The doc requested for a thyroid ultrasound and thyroid function test (FT4, FT3, TSH) and I had them done on the same day.

(If you’re still wondering what the thyroid gland is—its anatomy and functions, click here.)

The technician who did my ultrasound was also surprised at how big the goiter was. She even had the resident radiologist verify the scan. That wasn’t good to hear at all.

Physically when you look at my neck, you won’t notice anything abnormal, until you touch and feel the area where it’s swollen.

I got the ultrasound results right away; the thyroid function test results were released a few days after.

These were the thyroid ultrasound results:

Thyroid Sonogram

I have a bit of a medical background having studied general anatomy, pathology and radiology in dental school so I’m quite familiar with the terms, and it’s alarming to see the words “solid”, “cystic” and “mass” all together in your own test results, let alone an enlarged left thyroid lobe.

Being the instant researcher I am, I purposely stopped myself from researching further about the ultrasound results until I got the thyroid function test results and met with my endocrinologist (the gland and hormone doctor expert; ‘endo’ for short) a few days after. I knew that I would just get myself worried and overly anxious if I tried to search about anything and everything online at that point. You bet it was so hard to control myself because I could so easily do a search with just a few clicks and taps. But I managed not to.

I got the thyroid function test results right before my appointment with the endo. These were the results:

Thyroid function test

As far as thyroid function is concerned, everything was normal. Was that a good thing? Of course! But, on the other hand, what did the ultrasound findings mean then it if my thyroid seemed to be functioning properly?

So, I finally met with the endo and showed her the lab results. It was my first time to consult with her and she was also surprised when she checked and felt my neck. She said that the goiter seems big already and she asked when I started noticing it and if I had any personal and family history of thyroid disease. As with the first doctor, I said that I only noticed it in May, and no history of any thyroid illness (but family history with other illnesses, oh yes—I tick nearly all the boxes whenever I fill up that part in the patient information form and that’s another story).

The endo then referred me for an ultrasound-guided fine needle aspiration biopsy of my left thyroid (the one that was enlarged). If you want to know how exactly it is done, you can watch this video. The final diagnosis will only be determined after that test is done. The endo didn’t explain much (barely explained actually) why the procedure had to be done and what can be expected. I tried to ask but got vague answers. As far as I know, a biopsy is usually done to get a tissue sample of a mass to find out whether it’s benign or cancerous.

Immediately after the checkup with the endo, I headed to the hospital’s radiology department to get the earliest schedule for the biopsy, and it was on June 4, just a week after my initial checkup. Things were really happening so fast. I was in and out of the hospital for tests and follow ups nearly every day.

Since I already knew what a biopsy was for, I had to prepare myself for the procedure—financially (my medical insurance won’t cover the doctor’s professional fee for the procedure), physically, mentally and emotionally. There was still positivity left in me—I had faith that everything’s gonna be alright, and at the same time, I had to be prepared for the realities of what was to come, whatever treatment was needed to address my enlarged thyroid because either way, it really had to be treated but the course of treatment would be determined by the biopsy result.

As part of my preparation, I finally had to face the music and do my due diligence in researching. As a self-admitted control freak at times, I gather all the info I need to prepare for literally anything new I’m about to get myself into, whether it’s a new place my friends and I are planning a trip to, a new restaurant I’ve been wanting to try, a new gadget, you name it—you bet I’ll thoroughly research about it. I always want to be prepared and to manage my expectations, and I hate being caught unaware.

Also, a pre-requirement for the biopsy was a test to find out whether or not I’m a bleeder because if I was, additional precaution would be necessary. But good that I wasn’t.

So finally, the morning of the biopsy came. I’ve watched the video of the procedure so I knew what to expect. If you’ve seen the video, it’s not as comfortable as it seems (or maybe it does seem uncomfortable for some). It took less than an hour for the actual procedure. Only the injection for the local anaesthetic and first pass of the aspirating needle were painful, but other than that, it was okay. The waiting time for the pathologist to confirm if the tissue samples were viable was actually longer than the actual procedure. Fortunately, the samples taken were enough so it didn’t have to be repeated. They just put a band aid on the part where the needle poked my skin twice, and I was sent home. I was given painkillers for the pain just in case, but it was very minor and didn’t feel too sore. I got to take off the band aid that evening and saw two tiny puncture holes on my skin.

So after that, all I had to do was wait for the biopsy results—but that 4-day wait felt like a very, very long time. During that waiting period, kept my faith, and I continued with my research so that I know what possible outcomes to expect. Of course, I was rooting for the ‘better’ outcome—the one wherein the mass would shrink through medication, or if in case surgery was absolutely necessary, only the enlarged part would be removed, then I could move on with my life.

June 8 – The Biopsy Results

My husband also had a follow-up checkup with the same endo since he was diabetic so I decided to go with him just in case the biopsy results were ready. The results were indeed ready for release on that day. I was alone when I got the results because my husband still had to get his letter of authorization from our medical insurance. We agreed to just meet  once we’re both ready to go the doctor’s clinic for our checkup.

These were the results:

Biopsy result

I got the paper and saw one word, and one word alone—CARCINOMA, which I knew meant cancer, and I didn’t read everything else anymore. That was the last thing I expected to see on that piece of paper. I knew that it was a possible outcome based on my research, but of course, who in their right mind would hope for that? I had to hurry to meet up with husband so we could catch our doctor. I tried my best to hold back my tears and emotions as I walked down the hospital halls and rode the elevator. All I could do was whisper, “Jesus, Jesus, Jesus…” amidst the wave of thoughts, fears, emotions running through my mind and heart, and that helped me from breaking down and losing it. I didn’t want my husband to panic so I didn’t tell him yet of the news when I saw him. I just told him that we needed to hurry to the clinic because we’re late (we really were) and the doctor will just read the result.

Read more about that doctor’s visit here because I have a LOT to say about finding the right doctor

What was on the paper is exactly the diagnosis. The doc just read it out loud—papillary thyroid carcinoma—and the only treatment option was a total thyroidectomy (removal of the entire thyroid gland). I got a second opinion, not necessarily for a second opinion per se because I knew that was really the necessary course of treatment based on what I researched, but I had to find another doctor I trusted and was at ease with. We saw the second endocrinologist the day after, and then met with the head and neck surgeon she recommended the following day. My surgery was then scheduled on June 15, barely three weeks since my initial checkup.

See my post about the surgery and preparation here.

 

 

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