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Self-portrait of my right eye, nearly six years after surgery

The Rising Tide of Thyroid Cancer
A headline in Parade earlier this month jumped off the page as soon as I saw it:

“Thyroid Cancer: Why Is It on the Rise?”

The brief item, by health and nutrition journalist Camille Noe Pagán, addresses the fact that for reasons which remain unclear, thyroid cancer diagnoses rose a staggering 173 percent between 2002 and 2012, making it one of the fastest-growing types of cancer in the United States. I received my diagnosis in 2006.

Noe Pagán interviewed Dr. Robert Smallridge, chair of the division of endocrinology at the Mayo Clinic in Jacksonville, Florida. He attributes part of the increase to better screening and detection, but points out that “research suggests other factors must be at play.”

What could those other factors be? Radiation exposure, such as the type found in dental X-rays, is a known cause of thyroid cancer. Because I’m an ounce-of-prevention girl, I get my teeth cleaned and checked regularly. I’m sure, though, that I’ve had no more than the recommended allotment of dental X-rays; I can’t believe that a lifetime of systematic devotion to dental hygiene caused my thyroid cells to mutate. Or did it?

And here’s something else to think about: The thyroid is an endocrine gland. So are the ovaries. A benign tumor and cyst obliterated my ovaries 30 years earlier. Did that have anything to do with what was now happening to my thyroid gland?

The nodular cyst on my right eye was clearly an anomaly, an interloper in the perverse parade of cellular dysfunction traipsing through my body for more than half my life.

These are some of the questions and observations I had for Dr Y, a young and personable endocrinologist from Romania. Not surprisingly, she had no answers. But she did amplify the nature of my cancer:

“The pathology report actually showed two malignancies. Yours is papillary thyroid carcinoma, and if you have to have cancer, that’s the kind to have because it has such a high cure rate—80 to 90 percent survive ten years after diagnosis. And your tumors were small and encapsulated. The prognosis for patients with these types of tumors is very good.”

“So what do we do for treatment? Chemotherapy?”

“No, not chemo. I want to stress that Dr. M did a wonderful job removing your thyroid—surgery would have been the first step. But as good a job as she did cleaning out your thyroid, there’s always the chance that some thyroid tissue remains. These emit chemical signals that can confuse the results of future tests. And, despite the fact that your tumors were encapsulated, there’s always the possibility that a rogue cell could migrate to any remaining bits of tissue.”

“Okay, so I had the surgery and the thyroid is gone. That’s a good thing. The cancer’s out of me. But if I don’t have chemo, what do I do? Radiation?”

“Not what you normally think of as radiation. You need to know that I presented your case to all of my colleagues in the department. I had my own idea of how we should proceed, but I wanted to get their opinions first. These guys are the best at what they do, and our consensus is that we proceed aggressively. And that was my inclination.”

“What do you mean by ‘aggressively’? Are you suggesting another operation to make sure everything’s gone?”

“No. Look, there are really only two options. The first is to do nothing, to trust that the surgery got all the cancer, and not worry about any likely or unlikely remaining bits of tissue. The second option is to kill off whatever remaining bits of tissue exist with a single, low-dosage treatment of radioactive Iodine-131.”

“How does that work?”

“In about five to six months, you return here to the Clinic, to the Nuclear Medicine Department, after preparing yourself to take the pill. You prepare by stopping your Synthroid and going on an alternate hormone-replacement therapy for two weeks, followed by no hormone-replacement therapy at all. You’ll also have to be on a completely iodine-free diet. The Thyroid Cancer Survivors’ Association has the list of foods to avoid and a cookbook to help you with recipes for what you can eat. You can find all that on the Internet. It’s important to be completely, totally iodine-free when you take the radioactive pill, because if there’s even a trace of iodine in your system, the radiation will zero in on it, doing more harm than good.”

This was a lot to take in. I tried to process all she was saying: No additional surgery. No chemo. No radiation per se, but a radioactive pill instead. This sounded promising, but I couldn’t get past the prohibition on medication. I’ve never been what you’d call a dynamo. Now, without my trusty pills to keep me on an even keel, I could see myself sleeping all the time.

“How will I function? I won’t have any energy if I stop taking my Synthroid.”

“It is difficult, it will be difficult. But you get through it. You get through it because you have to. We really believe this is the best course of treatment for you. It’s aggressive, and we think we really need to be aggressive.”

I was glad D was with me. I wasn’t sure I was following any of this, and I knew he was taking good notes. I also didn’t have to decide on the spot. Dr Y told me to go home, get some rest, and think about it.

By now I’d dodged so many bullets. Maybe taking one bullet-sized radioactive pill wouldn’t be so bad. As risk-averse as I am, it sounded better than the alternative, which was to do nothing.

And I’m not a “do nothing” kind of girl.

To be continued …

Part 1: The Baby’s Nightmare
Part 2: The Nightmare Returns
Part 3: Room 101 and the Masquerading Marauder
Part 4: The Eye as Metaphor
Part 5: The Back Story
Part 6: It’s Nature’s Way
Part 7: Help From the Man on the Street
Part 8: A DES Daughter?
Part 9: Speak, Memory
Part 10: The Needle and the Damage Done
Part 11: Can I Get a Discount?
Part 12: A Call During Dinner
Part 13: First There is a Cancer, Then There is no Cancer, Then There Is
Part 14: Through a Glass, Far Too Brightly
Part 15: Anatomy of an Eye Operation
Part 16: At Peace
Part 17: Redux: First There is a Cancer, Then There is no Cancer, Then There Is

© 2012 Marci Rich
All rights reserved.