This is a common problem when the surgeons insist they know the right treatment for you. Even when you express your opinion about what treatment is best for you, they commonly refuse to listen and force their opinion or refuse to treat you if you don’t follow their advice.
Case Example From My Center:
One year ago patient was diagnosed with hyperparathyroidism. She elected to have a right parathyroidectomy. No Pre-op Ultrasound was done before the surgery. During the surgery the thyroid surgeon elected to remove the right lobe. There was a 6 mm micropapillary cancer. There was 1/3 positive level VI lymph nodes. 6 month examination and first neck ultrasound only one 1.8 ml ( 1.2×1.4×1.8 ) right level IV was found. There were no nodules in the left lobe. The size suggested it was there at the time of the first surgery 6 months before and not discovered without endocrine neck ultrasound before the parathyroid surgery. PE: Neck scar and no palpable neck masses. She has Hashimoto’s Thyroiditis on LT4. TSH,FT4 were normal TPO was 22 N <9
The Surgical Plan
At Tumor Board The thyroid surgeon’s recommendation was completion thyroidectomy and bilateral Modified Neck dissection. The patient was not against the parathyroid surgery but was unhappy they took the left lobe without justification in her opinion. She refused the extensive treatment. The surgeon was unhappy. “No one ever refused my treatment plan for thyroid cancer before.” A presentation to the university tumor board she refused the treatment plan. The surgeon offered no alternative. Lay member was unhappy with the surgeon for failing to listen to the patients desire not to have extensive surgery, and not offering alternatives. The patient found there were alternatives in the internet. These included palliative “cherry picking of just the lymph node, Ethanol or radiofrequency ablation RFA. She is presently awaiting RFA in a week. The RFA plan to explore the carotid artery connection to the node. Hydrodissection if successful the node would be ablated. If no space can be formed between node and carotid then the procedure could be aborted. Alternative 3 would be the limited palliative surgery to just remove the node.
Always make sure your voice is heard when planning a thyroid cancer surgery. If you are ignored then ask for a tumor board review or get outside expert opinions.
Call me for my opinion at 310-393-8860 or secure email to thyroid.manager@thyroid .com.
Ask for Alicia
Dr.G.
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