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Feb 8

What should a patient expect before, during, and after fine needle aspiration (FNA)?

Before FNA

Prior to the procedure, Dr. Kroeker goes through a very thorough explanation of the procedure, so that a patient is fully aware of what is going to happen. She will inject the skin overlying the thyroid nodule or neck mass with a local anesthetic called lidocaine. This can burn a little bit.

During FNA

Following the lidocaine injection, Dr. Kroeker proceeds with the biopsy using a very small needle. The skin will be numb, but the patient may feel some pressure as the needle is going into the thyroid nodule or neck mass.
Every once in a while, a patient will have referred pain which goes up to their head or into their jaw or mouth, which has to do with tiny nerves that are too small to see even with the ultrasound device.

There can sometimes be a little discomfort during this procedure, but most patients tolerate it very well.

After FNA

Following the fine needle aspiration (FNA) procedure, symptoms can vary. Some patients have no bruising, while others will bruise very easily, so they may have a little bruise or swelling underneath the skin.

For patients experiencing any pain, bruising, or swelling, Dr. Kroeker will recommend that they put an ice pack on the neck at home and take some Tylenol and Ibuprofen as needed for the discomfort.

Fine needle aspiration and the comfort or discomfort level felt by each patient is a very personal thing and can vary widely. Dr. Kroeker is happy to discuss options with patients who are anxious about needles or the procedure in general.
Most of the time, patients will tolerate fine needle aspiration very well with very little pain, but there are some patients that do experience some level of discomfort. Dr. Kroeker will always stop the procedure if it becomes too painful and is very cognizant of a patient’s level of comfort throughout.

Feb 7

What is the difference between thyroid and parathyroid surgery?

The thyroid is the gland that hangs over your trachea like a dumbbell and looks like a butterfly. It produces thyroid hormone. Surgery is performed on the thyroid for:

  • Cancer
  • Nodules that are suspicious for cancer
  • Compressive symptoms
  • Hyperthyroidism/Graves’ disease
  • Very rarely for cosmesis- for instance, if someone had a very large goiter and did not like the way their neck looked

The parathyroid glands have nothing to do functionally with the thyroid gland, but they are physically attached to the thyroid “capsule.” The parathyroid glands are their own entity and produce parathyroid hormone, which keeps the body’s calcium levels normal.

For parathyroid surgery, when the parathyroid gland/s is removed, it is for something called hyperparathyroidism. Hyperparathyroidism is where a gland/s can produce too much parathyroid hormone, which causes high calcium levels. This can cause many problems within the body (heart, kidneys, bones) as well as cause a lot of horrible symptoms (dementia, depression, problems concentrating, insomnia, to name a few).

Feb 6

When to call for advice following thyroid surgery? What is cause for alarm?

If Dr. Kroeker sends a patient home on calcium and vitamin D—meaning the patient was in the 15-percent of people after a total thyroidectomy who’s parathyroid glands were not functioning very well and needed calcium supplementation—if that patient goes home and has any symptoms of low calcium, it is advised for the patient to call Dr. Kroeker immediately.

The symptoms of low calcium are:

  • Numbness and tingling around the lips and the mouth
  • Numbness and tingling in the fingertips and toes

When a patient is experiencing these symptoms following surgery, Dr. Kroeker should be called immediately.

Another reason to call for advice would be if a patient had massive neck swelling or problems breathing, which would be an indication of bleeding.

If a patient is going to bleed, it usually happens within the first 20 hours after surgery, which is why Dr. Kroeker keeps all of her patients in the hospital overnight for observation.

Feb 5

Is radioactive iodine treatment recommended? Why or why not?

Radioactive iodine treatment is recommended for certain patients with thyroid cancer depending on the final pathology. Factors like the size of the cancer, the extent of the cancer, and whether or not a patient has metastatic disease to the lymph nodes in the neck are all considered when deciding whether or not to recommend radioactive iodine treatment.

When Dr. Kroeker sees her patients for their one week follow up after surgery, she usually has an idea as to whether or not they are going to need radioactive iodine. She will then refer the patient to an endocrinologist who will talk to the patient about the risks and benefits of radioactive iodine, and whether or not they would recommend further treatment. Dr. Kroeker is always willing to work with the endocrinologist to help make a recommendation for or against radioactive iodine treatment.

The procedure itself entails taking a radioactive iodine pill and typically has quite a few rules and guidelines a patient must follow before and during treatment, which the endocrinologist will review with the patient.