A Dentist Appointment I’ll Never Forget: A Patient Story
By Karen A. Avitabile
My dentist saved my life. Yes, my dentist.
During a routine six-month cleaning, my dentist checked my neck and under my tongue. This was not foreign to me. He explained years earlier cancers of the throat, tongue and jaw were on the rise, and it is his job to make sure everything is normal with each patient.
While feeling my neck, he noticed a lump on the right side. “It may be a swollen gland, but if it doesn’t go away in a few weeks visit your medical doctor,” he said.
Nearing age 40, I led a busy life. In addition to my full-time job as a travel editor with AAA, I had just returned to college to pursue a second degree and volunteered in my community. I exercised regularly and watched my diet.
I never had a swollen gland, but I didn’t think it was something that was going to slow me down – I couldn’t see the lump, it didn’t bother me and I felt perfectly fine.
A week later, I visited my gynecologist for my annual exam. I told him what the dentist said and asked him to check my neck for a swollen gland.
“Swollen gland?” he said. “That’s your thyroid and you should see your regular doctor.”
OK, maybe there was something wrong with my thyroid, I thought. So if I have to take medication, it wasn’t the end of the world.
I went to my general practitioner the next day. He scheduled blood work and an ultrasound to “see what’s going on.”
Results of the blood work didn’t show any problems with my thyroid but the ultrasound showed a three-centimeter lump leaning on the right side of my thyroid. I was referred to a surgeon to discuss options.
“You’ve got this large lump which will never go away,” the surgeon said. “In fact, it will probably get bigger. We can biopsy it to ensure it is not cancer, or just keep an eye on it. It’s your call.”
“Is a biopsy going to tell us 100 percent if I have cancer?” I asked.
“Nope. Ninety-five percent,” he said.
That 5 percent gray area was all I needed to hear to make my decision -- I wanted to have the lump removed. This also meant removing the right side of the thyroid. In my mind, there was no way around it. I wasn’t willing to take a chance with my life.
Prior to the surgery, my father was diagnosed with Lou Gehrig’s Disease, a progressive neurodegenerative disease which causes patients to become paralyzed and leads to death. He was one in 50,000 people annually diagnosed with this debilitating disease.
I remember thinking those were crazy odds and certainly didn’t think I would be one of the over 35,000 people diagnosed with thyroid cancer each year.
Some family and friends thought I was crazy for going through with the surgery. “Why don’t you just get it biopsied each year? Why would you want to remove most of a vital organ if you don’t have to?” some asked.
The answer was simple – because I refused to gamble my life away.
The morning of the surgery, the doctor explained that it would take about 90 minutes to remove the right lobe of my thyroid. He added that they would be testing the right lobe for cancer. He asked if he could remove the whole thyroid if that was the case. I granted my permission.
The clock on the wall was the first thing I saw in the recovery room when I woke up. I quickly did the math. More than three hours had passed. I knew this was a bad sign.
My fears were confirmed when my doctor entered the room.
“You had cancer,” he said. “We had to remove your entire thyroid.”
When I arrived in my hospital room, I tried to compose myself before facing my family. “In a few minutes,” I repeated to a nurse who kept coming in to tell me my family was waiting to see me.
Like me, my family knew something was wrong based on the length of time the surgery took. My doctor gave them the news before they came in to see me.
No one, especially me, could believe this had happened to me.
The next morning, the nurse came in to give me my first dose of levothyroxine – a thyroid replacement medication that I would have to take daily for the rest of my life.
I was not looking forward to what lie ahead, who would? In addition to my daily medication, I would have to undergo radioactive iodine therapy, ultrasounds and ongoing monitoring.
After a few days, the lab tests confirmed I had papillary thyroid cancer, one of the more common types, and I was expected to make a full recovery.
Within two months, I underwent radioactive iodine treatment – to ensure any remaining thyroid cells in my body would be destroyed – and another ultrasound. All tests came back negative for additional cancer.
Four years later, I remain cancer-free. I see my endocrinologist every three months, have an annual ultrasound examination and ingest a small amount of radioactive iodine each year as a precaution. My endocrinologist monitors my TSH (thyroid stimulating hormone) levels. If they are either too high or too low, he may choose to increase or decrease my dose of levothyroxine. He also organizes my ultrasounds and radioactive iodine treatments.
Other than that, I’m back to living the life I’m used to. I graduated from college for the second time in May 2009, still volunteer in the community, exercise and continue to travel the globe as part of my work at AAA. Of course, my levothyroxine is the first thing I pack now.
When you first hear the word “cancer,” the natural response is fear. As I have come to learn firsthand, however, thyroid cancer is very treatable and manageable.
I may be one in 25,000 people to be diagnosed with thyroid cancer, but I still consider myself lucky in many regards.
And I thank my dentist every time I see him.
Editor's note
We were delighted to receive Ms. Avitabile’s unsolicited contribution to our magazine. Previously, endocrinologists belonging to AACE submitted all magazine pieces featuring patients.
Ms. A’s decision to undergo surgery regardless of the result of a biopsy based on her wishes to eliminate uncertainty is a well-accepted basis for having surgery. Although a fine needle aspiration may be inconclusive, it is standard practice to do one before surgery. In some cases, in addition to establishing whether or not to remove both sides of the thyroid, it could lead to further preoperative evaluation in order to determine whether even more extensive surgery such as lymph node removal will be required (see sections on thyroid cancer). While her family and friends advised her to “get it biopsied each year”, yearly biopsies are not necessary when a nodule appears to be benign and is not growing. Lastly, although yearly ultrasounds are routinely done for several years after papillary thyroid cancer is diagnosed, most cases do not require yearly radioactive iodine imaging.
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David S. Cooper, MD, is a graduate of Johns Hopkins University. He received his medical degree from Tufts University School of Medicine where he was elected to Alpha Omega Alpha, and completed his Internal Medicine residency at Barnes Hospital/Washington University School of Medicine. He completed his Endocrinology Fellowship training at the Massachusetts General Hospital/Harvard Medical School. He is Professor of Medicine and International Health at the Johns Hopkins University School of Medicine and the Bloomberg Johns Hopkins School of Public Health, and Director of the Johns Hopkins Thyroid Clinic. He is a Contributing Editor of the Journal of the American Medical Association (JAMA), and is the Deputy Editor of the Journal of Clinical Endocrinology and Metabolism. He also serves as Editor-in-Chief for Endocrinology at Up-to-Date. He is the current Chair of the Subspecialty Board for Endocrinology, Diabetes, and Metabolism of the American Board of Internal Medicine. Dr. Cooper is the past Treasurer and the past President of the American Thyroid Association, and is also the recipient of the American Thyroid Association’s Distinguished Service Award.
Steven I. Sherman, MD, is the Naguib Samaan Distinguished Professor in Endocrinology, the Chair of the Department of Endocrine Neoplasia and Hormonal Disorders, and Medical Director of the Endocrine Multidisciplinary Center at The University of Texas M. D. Anderson Cancer Center in Houston, Texas. After graduating from Harvard College magna cum laude in Biochemistry and Molecular Biology, Dr. Sherman earned his medical degree from the Johns Hopkins School of Medicine in Baltimore, Maryland. He stayed at Johns Hopkins for his internship and residency in internal medicine, and clinical fellowship in endocrinology and metabolism. He joined the faculty at Johns Hopkins upon completion of his training, and in 1993 was recruited to the M.D. Anderson Cancer Center.
