The Question

Thyroid disease and pregnancy
Be careful what you ask for...
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It all began with a question. I am still trying to decide whether it was a good question or a bad question.

 

I returned to my obstetrician for the reason most people visit the obstetrician: I was happily expecting my second child. In the routine examination the doctor performed at the first visit, she mentioned that I had an enlarged thyroid, but all the blood tests came back perfectly normal. Remembering that the same thing had happened when I was pregnant with my daughter, I asked the question. “Is this something I should get checked out further?”

I am a person who sees a problem and gets it fixed as soon as possible. I do not particularly enjoy sacrificing my blood unless it is benefiting me somehow. Performing the same blood test more than once to get the same results seemed unnecessary. The obstetrician nodded slowly, “Yes, I would mention it to your family doctor when you see him.” “When I see him?” I thought. I am the type that avoids doctors. It’s not anything personal, but I firmly believe the old adage, “An ounce of prevention is worth a pound of cure.”

Nevertheless, I went home and called the office to make an appointment. Since I was a new patient, the doctor had to do a complete physical—my second one in a month. He noticed the enlarged thyroid and a heart murmur. Choosing a thorough doctor seemed like a good idea when I was choosing a family doctor for my children, but now it was an inconvenience.

A few weeks later, I was at the hospital for a thyroid ultrasound and an electrocardiogram. I later found out that the heart murmur was only a non-threatening complication of my pregnancy, but I had imagined all kinds of horrible things in the meantime. I just knew I was going to have a heart attack in the middle of childbirth or become a person who had to pop nitroglycerin tablets to keep themselves alive.

As the technician detached all the sticky circles, I asked where I was supposed to go next. She looked at my chart, then looked at me quizzically, “Is your thyroid in your neck?” I did not express my thoughts which ran something like, “And this woman just checked my heart? I need a second opinion!” Aloud, I told her yes, my thyroid was in my neck since that is where the doctors kept probing me in exams. She said, “I just needed to know where to send you.”

After the thyroid ultrasound, I had to play the waiting game. Yes, I was waiting on those elusive but indispensable lab technicians again. Finally, my doctor let me know the results. I would have to go to another doctor that specialized in the thyroid. Thinking I would finally have an answer to the enlarged thyroid problem, I went to the specialist only to find that I would need to go for more tests.

I don’t remember all that the specialist said, but two words emblazoned themselves in my mind while simultaneously draining the blood from my face. One was “biopsy” and the other was “cancer”.

The day arrived when I was to have my biopsy. “Piece of cake,” I thought. “They just have to poke a needle in my neck, and it will all be over. I’ll know the worst.” The team of doctors turned out to be a lone doctor with an obviously congesting head cold and a couple of assistants.

The quick, painless needle biopsy promised was a little understated. I congratulated myself on having got through it bravely and waited while the pathologist at the hospital checked the results. The doctor with the head cold received a phone call from him. Bad news. Not enough information. A further biopsy would be needed.

The doctor hung up the phone and cheerfully commented, “I thought that would happen.” I tried to keep a calm expression on my face while inwardly stewing, “More of my precious body tissue sacrificed to the friendly lab technicians!” This time it would be a core biopsy, she explained. They would be actually snipping a piece of my thyroid, and I would be called with the results (surprise, surprise) in a week or so.

The zealous doctor went to work, washing her hands again, pulling on rubber gloves and swiping her nose with the back of a gloved hand. At least she was protected from my germs.

She and her team administered a local anesthetic. It must have been localized to the smallest of my skin cells because the pain and pressure were tremendous as she began to literally jam an instrument into my neck with sheer force. Childbirth labor was admittedly more painful, but I didn’t remember it lasting so long.

When I felt like I couldn’t take much more without being put to sleep, the doctor triumphantly held up a miniscule piece of my thyroid in a little tube for my inspection. I gingerly nodded, not sure what I was supposed to say. “Good job!” and “Yep, I sure will miss it” didn’t seem quite appropriate.

They explained that there were four possible results of this biopsy: malignant, benign, non-conclusive and indeterminate. I wasn’t sure what the difference between the last two results was, but I knew in my heart that it would be one of them.

Sure enough, a week later at the specialist’s office I learned that the results were ‘indeterminate’. “So does that mean I have to have another biopsy?” I asked with trepidation. “No, another biopsy will not tell us any more than we know.”

My raised hopes were quickly dashed by her next statement. “The only way to know for sure if this is cancer or not, is to have half of your thyroid removed by surgery. If they find out it is cancer, they can remove the other half of your thyroid before they close you back up.”

If one thinks I am stingy with my blood and tissue, one should know that I am even less generous with my body parts. I agree with a comedian that remarked once, “God doesn’t create us with spare parts.”

After much discussion, my husband and I decided that the best thing would be to know for sure. The specialist recommended I wait to have the surgery until after my baby was born, so I had about 4 more months to worry--or not to worry. That was the new question.

I had settled into a somewhat peaceful attitude about the situation when I got a call from my obstetrician. There had been a problem with my blood (remember those generous donations to the lab techs?). My platelet count was low which could be dangerous during pregnancy. I would have to see another specialist. I was scared! Not that I really wanted to suffer or die myself, but now my unborn child was involved.  I would have to see a high risk obstetrician for the baby and a hematologist for myself.

The rest of my pregnancy was scattered with visits to six doctors. One was the high risk obstetrician who put me on steroids to protect my baby and to raise the platelet count so that I could have an epidural if I so chose. I still remember him leaning back in his leather chair behind the expensive-looking desk in his consultation room and commenting, “There is no danger of the baby being deformed further due to the steroids. If he has deformities, they have already occurred.” And that was supposed to make me feel better?!

Despite my difficult pregnancy, I had an excellent childbirth. In 3 hours, I labored and delivered my eight pound baby boy.

I was never so glad to get home although each day brought me closer to surgery and the final results of my condition. I have never heard God speak in an audible voice nor do I expect to in the future, however He spoke to me through a tiny, elderly foreign doctor in the pre-surgery testing wing at the hospital. I had to have some blood tests (yes, those wonderful things again) and a urine specimen had to be taken to see if I was pregnant. My son was less than 6 weeks old, but miracles do happen.

The doctor came in to ask me some questions and give me last minute instructions. Right before she left the room, she came over and stood right in front of me. I looked up to see what else had to be done, but she took both of my hands in hers. “The Lord will work through the hands of the surgeon.” Without another word, she turned and quietly stepped out of the room, but I felt as if an angel had made a heavenly announcement.

The day of surgery arrived, and I was blessed with caring nurses. Even the anesthesiologist took the time to talk with me about the low risk of the nodule on my thyroid actually being cancer. Family members from out of town came to spend the day while I was in surgery. All of these small blessings were magnified when the doctor came in and told me that the surgery was successful and there was no sign of cancer in my thyroid.

I recently saw the thyroid specialist while visiting someone in the hospital. She was busily making her rounds when I greeted her. She didn’t recognize me at first. Then she smiled and said, “I didn’t remember your name, but I remembered you by the scar on your neck.”

I wasn’t offended by her omission. She may not remember, but I do. Now I hug my children and husband a little more tightly and I thank God every day that He saw fit to spare me from cancer when so many others have suffered from it. Which brings me to another question—why? I don’t know, but it is enough for now.

 

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