Patient StoriesThyroid Cancer

Understanding the Link Between Thyroid Cancer and Hypothyroidism

Julie Salman chronicles her experience with thyroid cancer, including dealing with a new reality and coping with radiation.
February 2017 Vol 3 No 1
Julie Salman
Avon Lake, OH

I have always considered myself healthy, and I stay active by biking, playing with my kids, running, and walking the dog. In fact, the few times I have been in a hospital as a patient were to give birth to my 3 sons. The idea that I was at risk for cancer never crossed my mind.

All that changed in 2011. It started as a typical day in my position as a marketing manager at a local hospital, where I gave a presentation to a group of physicians and administrators.

During this meeting, I noticed that one of the doctors was looking at me intently. Immediately after my presentation, he came up to me to ask about a bump he noticed on my neck. Initially I brushed it off, joking that I had yet to lose my “baby fat” from my third child. He did not give up and encouraged me to have my thyroid examined.

A Bump in the Road

When I got back to my office, I mentioned this to a co-worker, a physician, who immediately said, “You mean your goiter.” Twice in 1 day I was shocked that anyone even noticed a lump on my neck; I thought I looked perfectly normal. I immediately took steps to have it checked.

Initially, my primary care physician didn’t seem overly concerned, but she scheduled an ultrasound. The results showed a nodule on 1 of the lobes of my thyroid gland. She recommended that I meet with a surgeon who specializes in thyroidectomy (removal of all or part of the thyroid gland). I was stunned. I could not believe how quickly my life was changing. One minute I had nothing more than a small bump on my neck, the next I was having a surgical consult about removing part of my thyroid. Even before discussing surgery, the doctor recommended that I get a biopsy.

Over the following few weeks I had 2 biopsies, which showed inconclusive results. I consulted with 2 of my sisters, who are nurses, and my husband, and did extensive research online. I trusted and respected the surgeon, who said if I were his wife, daughter, or sister, he would encourage me to have 1 lobe of my thyroid removed, which he described as a simple outpatient surgery. The idea that I might have cancer still seemed unbelievable, since I had no symptoms and felt fine. I scheduled the surgery, planning it around my son’s first communion and an upcoming family wedding.

Waking Up to a New Reality

I woke up from surgery and instantly sensed something was wrong. Eventually, one of the nurses told me that they had to remove my entire thyroid gland. When I was under anesthesia, the surgeon was not confident that the nodule was benign, even though the pathology report showed inconclusive results.

My husband was forced to make the difficult decision to remove my entire thyroid gland. We hadn’t even discussed this possibility. I felt terrible that he had to make such a stressful decision on my behalf, but it turned out to be the right decision. The pathology report confirmed that the nodule was cancerous. I was diagnosed with stage I papillary thyroid cancer.

Despite being told that my surgery would be fairly routine, recovery was difficult and painful. I began treatment with thyroid hormone replacement, which is necessary after the thyroid gland is removed. In fact, I would need to be on this medication for the rest of my life.

This was an especially challenging time for me, physically and emotionally. I shed many tears and was frequently exhausted.

During recovery, I was not permitted to lift anything heavier than 5 pounds, so holding my youngest son was not possible.

Coping with Radiation

My surgeon and endocrinologist followed up with me a few days after surgery, both recommending that I receive radioactive iodine ablation therapy to remove any residual thyroid cancer cells. This was described as a standard procedure after thyroidectomy for patients with thyroid cancer. After radiation therapy, I would need to be isolated for several days. I couldn’t be around my family or go to work.

I began to think about all the preparations I would have to make to help my family during this isolation period. I reached out to family and friends for help with my youngest son, as well as rides for my other children, and help with meals and other details. For the radioactive iodine treatment to be effective, I needed to be in a hypothyroid state; therefore, I would have to stop taking my thyroid hormone replacement medication about 2 to 3 weeks before treatment.

That was when I first learned about the effects of being hypothyroid, the term used to describe the condition when the body does not have enough thyroid hormone. Soon after I stopped the hormone medication, I began to experience symptoms, including weakness, fatigue, depression and irritability, dry hair, weight gain, and unpredictable emotions. I looked and felt terrible.

I think of myself as a tough and strong person, and I did not anticipate feeling this way. I asked my endocrinologist if there was anything I could do to prevent these symptoms. He said that this experience occurs when you stop taking thyroid hormone replacement medication. He also recommended that I take some time off from work and get help with the kids during this period.

It was especially difficult to keep my symptoms from affecting my family. I still get emotional when I think about how my middle child, Jack, didn’t understand why he wasn’t allowed to come into my room during the isolation period. It was one of the most challenging aspects of my cancer treatment.

My first scan after receiving treatment was negative, but my endocrinologist found trace amounts of thyroid cells still present in my neck at my 6-month follow-up. He encouraged me to undergo radioactive iodine therapy again.

Fortunately, I had a better experience during my second round of radioactive iodine therapy. I did not have hypothyroid symptoms or fatigue or depression. I had more energy and a more positive attitude, and I didn’t have to take more time off work beyond the isolation after radiation.

Raising Awareness to Hypothyroidism

This journey has not been easy, but I am now cancer-free. I celebrated with my family when I heard the good news. I still follow up regularly with my endocrinologist and have blood tests to confirm that the cancer has not returned.

I now take steps to help raise awareness of the risk of hypothyroidism to make sure that more people can avoid or better manage these symptoms. I encourage all patients to get as much information as possible, and to discuss all their treatment options with their physician, to help make the best choices possible. It was a struggle to get to this point, but now I look back and consider my experience a bump in the road, and count my many blessings.

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