Monday, April 30, 2012

Faces of Thyroid Cancer: Reggie Deal

Thyroid Cancer Survivor Reggie Deal is Blind

From his seat in an upper-reserved section of Rangers Ballpark on Sunday night, Reggie Deal couldn't see the ballgame the Rangers and Rays were playing.  But he could hear it, he could smell it, he could sense it. For Deal, baseball provides a pull that goes beyond the boundaries of the blindness he's been inflicted with virtually all of his 39 years. Baseball is his passion, if not his outright obsession.

"There are a lot of things you're able to experience," he said, "when your faculties take over and supplement what's not there."  Simply being there -- in the stands, with the game playing out in front of him, his fellow fans beside him and the sounds of the sport surrounding him -- is an experience that means a lot to Deal.And that's why Sunday was the start of something special.

In the span of 30 days, Deal is going to visit each of the Major Leagues' 30 ballparks. He'll traverse the country, mostly on his own, via bus and plane, taxi and train, all with an end goal of fulfilling a lifelong dream while simultaneously showing others his is a life without all the perceived limits.

Crazy? Sure, it's a little crazy.

But having survived a thyroid-cancer scare a few years back, having married a woman who's a big believer in scratching items off life's "bucket list" and having spent weeks poring over team schedules and laboring over the logistics, Deal, an Afton, Wyo., resident, realized this little dream of his was just crazy enough to come true.

"I want people to have a different visual of what blindness entails," he said. "People get caught up in the negative, but there are ways to work around it."

Deal has had to work around it essentially from the beginning. He was born prematurely in 1973, and doctors told his parents his odds of survival were one in four. He was placed in an incubator that helped his lung tissues develop and heal, but the environment was 90 percent pure oxygen, or roughly 4 1/2 times the typical atmospheric setting. The prolonged exposure caused Reggie's retinas to hemorrhage and detach from his eyes, permanently blinding him.

"They're much more watchful for signs of issues now than they were back then," Deal said. "While it's still a threat for kids born that early, it's something they can mitigate now, more than 35-40 years ago."

He's never felt cheated, never felt wronged. His blindness is all that he's known, and it certainly didn't stop him from earning his bachelor's degree in journalism at Texas A&M or his master's in education counseling from Texas State University-San Marcos. Yet it wasn't until the cancer diagnosis four years ago when Deal truly gained perspective on life's fickle and fleeting nature. And that only further fueled his desire to do the 30-in-30 tour.

"I had planned to meet a friend in California, and we were going to go to a Padres game and then an Angels game," he said. "But I had to cancel that at the last minute because I had not been feeling well. Only a couple weeks after that, the doctors noticed I had an enlargement on the thyroid. They said, 'This has got to come out.'"

The cancer diagnosis came in late June of 2008, and the surgery was performed on July 14. One week post-op, Deal met with his doctor and was given a green light to start traveling again. He went straight from the doctor's office to the airport, hopped on a flight to Philadelphia and took a train to New York to see consecutive games at Yankee Stadium and Shea Stadium.

Yep, it's an obsession, all right.

"With everything that went on that summer, baseball was the one distraction that I had," he says. "It kept me halfway sane." And so when Deal, now cancer-free, met his wife, Lorna, through an online dating service in 2010, she quickly caught on that baseball is part of the package. "He picks up on so many aspects of the game," she said. "He can explain to you everything that's happening, and he just has an intense passion."

The passion to experience every park became a little more realistic when Deal left his job in student affairs at a Texas community college to move to Wyoming to be with Lorna, a teacher. He'll be looking for a new job in the fall, but in the meantime, he's taking full advantage of the time off. And when he inherited some money after his father passed away last year, he had funding to apply to the trip.

So Reggie plotted his Major League map as soon as the 2012 schedules came out. His travels will involve some tight turnarounds, late nights and early flights. And though he'll be meeting up with several friends along the way, he'll largely be flying solo.

"It makes me a little bit nervous," said Heather Compton, a friend of Reggie's who accompanied him to the Rangers game, "because it's so easy for somebody to take advantage of him. But he's pretty aware. He's learned how to handle himself, and he's one of those people that it only takes a few minutes to become friends with him. You can be perfect strangers one minute and friends the next."

Deal plans to make many new friends on this trip. At each game, he'll have the local radio broadcast playing in one ear -- loud enough to follow the action but quiet enough to interact with those around him. He'll be recapping his experiences on his MLBlog and on his Facebook page, and he'll also be wearing a wristband and shirt promoting ThyCa (the Thyroid Cancer Survivors' Association) -- a cause that's obviously grown near and dear to his heart.

Why would a blind man go to such great lengths to experience and document something he'll never see? Easy.  Because he can, and because he wants you to know he can. "People ask me, 'How can you enjoy the game without seeing it?'" he said. "I say, 'You don't realize how much of the game you can pick up on until you close your eyes.'"

Article by Anthony Castrovince is a reporter for Read his columns and his blog, CastroTurf, and follow him on Twitter at @Castrovince. This story was not subject to the approval of Major League Baseball or its clubs.

A blind fan's journey through the Major Leagues
April 29: Rangers Ballpark, Arlington
April 30: Minute Maid Park, Houston
May 1: Turner Field, Atlanta
May 2: Busch Stadium, St. Louis
May 3: Kauffman Stadium, Kansas City
May 4: Tropicana Field, St. Petersburg
May 5: Citi Field, New York
May 6: Nationals Park, Washington, D.C.
May 7: Oriole Park, Baltimore
May 8: Citizens Bank Park, Philadelphia
May 9: Yankee Stadium, New York
May 10: Fenway Park, Boston
May 11: Target Field, Minneapolis
May 12: Chase Field, Phoenix
May 13: The Coliseum, Oakland
May 14: AT&T Park, San Francisco
May 15: Dodger Stadium, Los Angeles
May 16: Petco Park, San Diego
May 17: Angel Stadium, Anaheim
May 18: Rogers Centre, Toronto
May 19: Comerica Park, Detroit
May 20: Coors Field, Denver
May 21: Safeco Field, Seattle
May 22: Miller Park, Milwaukee
May 23: Progressive Field, Cleveland
May 24: Great American Ball Park, Cincinnati
May 25: PNC Park, Pittsburgh
May 26: Marlins Park, Miami
May 27: U.S. Cellular Field, Chicago
May 28: Wrigley Field, Chicago

Friday, April 27, 2012

Thyroid Surgery Complications: Low Serum Calcium

One of the risks factors associated with a total thyroidectomy is the possibility of low serum calcium after the operation, either on a temporary or permanent basis.

There are four small glands, a little less than pea-size, that live next to the thyroid gland that are called “parathyroid glands’. They get their name from their location and have absolutely nothing to do with thyroid gland function.

These glands make a hormone called PTH, or parathyroid hormone, a hormone whose job it is to keep the level of calcium in the blood normal. It does this by many mechanisms, helping you absorb calcium from your diet, managing the calcium in bones, and so on.

If one were to lose all four of his or her parathyroid glands, the serum calcium would take a serious drop and replacement calcium and Vitamin D would probably have to be taken for life.

When performing thyroid surgery, it is prudent to look for and preserve these glands immediately after locating and preserving the recurrent laryngeal nerve, discussed elsewhere. On the surface this seems like a simple thing to do, but it isn’t always for several reasons.

  • First, not everyone has 4 parathyroid glands, some have 5 or more and others may have only three or less. 
  • Next, their location in the neck can be extremely variable, in fact, one or more may not actually be in the neck at all, but rather in the upper chest or other atypical location. 
  • Finally, they are sometimes rather nicely camouflaged sitting in the soft fatty tissues of the neck. It can often require an experienced thyroid surgeon to discern the very subtle color differences between parathyroid tissue and normal adjacent fat and soft tissue.

If one were to lose all four glands, or if all four glands died from lack of blood supply secondary to the trauma of surgery, that patient would in all likelihood have permanent low calcium after surgery. This, of course, assumes the patient has the normal number of parathyroid glands. It is possible to lose the function of one or two parathyroids and have no calcium difficulties whatsoever, because the remaining two glands can almost always take up the slack and maintain normal calcium levels. This is why we virtually never see even temporary low calcium after only a partial thyroidectomy since the glands on the unoperated side are left unmolested. 

Again, this always assumes the patient started out with 4 parathyroid glands, and there is never any guarantee or that. Temporary low calcium levels can be seen after thyroidectomy simply because the parathyroid glands became bruised or swollen after surgery, thus making it difficult for them to produce normal amounts of parathyroid hormone. These patients may have a temporary low calcium that requires minimal or no calcium replacement and in time the parathyroid glands function well once again.

When a patient with thyroid cancer undergoes a radical or total thyroidectomy  all of the thyroid gland is always removed and there is the risk of low calcium after surgery. The treatment for low calcium after total thyroidectomy is to supplement the diet with calcium and perhaps Vitamin D until the situation corrects itself. 

There are a number of calcium supplements in various forms such as pills, syrups, and liquids that perform the job quite nicely. Most instances of temporary low calcium resolve in as little as a few days to as long as a month or two. As long as sufficient living parathyroid tissue is left behind after surgery, the calcium levels should ultimately be just fine.

Wednesday, April 18, 2012

Thyroid Nodules Treatment

If your nodule is not cancer and is not causing problems, your doctor may watch your nodule closely. If your thyroid nodule is causing hyperthyroidism, your doctor may recommend a dose of radioactive iodine, which usually comes in a pill that you swallow. Your doctor may have you take medicine (antithyroid pills) for a few weeks to slow down the hormone production. Your thyroid hormone level needs to be normal before you can be treated with radioactive iodine.

If your nodule is cancer or is so large that it causes problems with swallowing or breathing, you'll need surgery to remove the nodule. You may also need treatment with radioactive iodine to destroy any left over cancer cells. After surgery, you may need to take thyroid medicine for the rest of your life.

Thyroid Nodule Surgery:  The extent of your thyroid nodule or tumor surgical removal will be determined by your doctor after evaluation your health history and diagnostic tests, family history and other factors.But in general either a partial or complete thyroidectomy (thyroid removal surgery), is recommended for:

  • Thyroid cancer or indeterminate lesions that cannot be classified from a fine needle aspiration biopsy.
  • Large thyroid nodules that cause obstructive symptoms, such as problems breathing or swallowing.
  • Thyroid nodules that cause pain.
  • Cosmetic reasons, to remove large visible thyroid nodules.
Radioactive Iodine: Iodine-131 concentrates in the thyroid tissue and cause tissue destruction. I-131 can be administered as a capsule or in liquid form.

  • I-131 can be used to treat multinodular goiters with nodules that are producing extra thyroid hormone. Such cases are indicated by a low TSH level and elevated thyroid hormone level in the blood or a "hot" nodule on radionuclide thyroid scan. 
  • After I-131 destroys the thyroid, the patient develops an underactive thyroid (hypothyroidism) and requires thyroid hormone replacement for life to maintain a normal level of thyroid hormones in the blood. Thyroid hormone replacement consists of simply a pill taken once daily by mouth, which is safe, easily tolerated, and relatively inexpensive.
Thyroid Hormone Suppression: There is controversy regarding whether physician-supervised administration of thyroid hormone may shrink the size of thyroid nodules. Many doctors believe that thyroid hormone does not effectively shrink nodules. Furthermore, there is the risk of high blood levels of thyroid hormone in patients with multiple thyroid nodules (multinodular goiter). However, clinical trials have shown that suppressive therapy may be successful in shrinking some thyroid nodules. Doctors may make this decision on a case-by-case basis and studies are still ongoing to determine the efficacy of this type of treatment. It is important to discuss the pros and cons of suppressive thyroid hormone therapy with your doctor.

Sunday, April 15, 2012

Diagnosing Thyroid Cancer: Radionuclide Scanning Of The Thyroid

Thyroid Radionuclide Scanning

  • This test is performed by a nuclear medicine specialist. After a small, safe amount of radioisotope (I-123 or Tc99) is taken by mouth or injected into a vein, the radiologist obtains pictures of the thyroid.
  • Nodules can be seen as dark spots (called "cold") or bright spots (called "hot").
  • Nodules that concentrate the radioisotope are "hot" and are usually making excessive thyroid hormone. "Hot" nodules are rarely associated with cancer and may not require FNAB investigation.
  • Nodules that do not concentrate iodine are "cold" and are usually making less than normal amounts of thyroid hormone
    • More than 80%-85% of all thyroid nodules are "cold".
    • These nodules are typically more worrisome for cancer, and require evaluation with FNAB.

Thursday, April 12, 2012

Diagnosing Benign Thyroid Nodules vs. Thyroid Cancer


A biopsy is the only way to tell if a thyroid nodule is cancerous. But cancer may be more likely if you have:
  • A single, hard lump that feels very different from the rest of the thyroid tissue or other thyroid nodules.
  • A nodule that keeps growing for weeks or months.
  • A nodule that does not move when you touch it.
  • Swollen lymph nodes in your neck.
  • A hoarse or scratchy voice that does not go away.

Some other conditions that cause similar symptoms include hyperthyroidism and thyroiditis.
  • If a thyroid nodule is larger than 1 cm, or it has other worrisome characteristics seen on ultrasound or other imaging tests, then a FNAB may be performed.

  • This office procedure does not require anesthesia and consists of passing small needles (similar to those used to draw blood from the arm) into the thyroid nodule in the neck. This is a quick and usually painless procedure.

  • This procedure may be done on multiple nodules.

  • Ultrasound guidance may be used to assist in the FNAB of nodules that are bigger than 1-1.5 cm but cannot be felt on physical examination.

  • A sample of the contents of each nodule (to include fluid, blood, or tissue) are removed in the needle and examined by the pathologist under a microscope.
  • Pathologists can identify certain features in the nodule sample.

FNAB results are characterized as one of the following:
  • Benign: This is the most common outcome of a FNAB. The typical finding is a nodule filled with colloid protein, a normal component of the thyroid. Benign nodules can be followed over time with serial physical exams or ultrasound exams. Further intervention is only necessary if enlargement occurs or new symptoms develop. 

  • Malignant: Some thyroid cancers can be diagnosed directly from the FNAB results (for example, papillary thyroid cancer). Other thyroid cancers cannot be diagnosed from the FNAB results (such as follicular thyroid cancer) because the diagnosis rests not simply upon the appearance of the tissue within the nodule, but also on the level of the invasion of surround blood vessels and tissue by the nodule. For these nodules, surgical removal of a portion or the entire thyroid is recommended.

  • Indeterminate: This is neither definitively benign nor malignant. Given that the risk for cancer is increased by 20% in such cases, surgical removal of a portion or the entire thyroid is typically recommended. Often, a radionuclide scan will be done to obtain functional information (if the nodule is actively producing thyroid hormones) in order to avoid an unnecessary surgery.

  • Non-diagnostic: This means that there are not enough of the tissue cells present in the sample to make a diagnosis. Non-diagnostic FNABs will typically result in a repeat FNAB or definitive surgery.
Cystic nodules more often result in a non-diagnostic FNAB due to higher fluid content than solid content in the sample obtained from the nodule.

Monday, April 9, 2012

Thyroid Nodule Diagnosis: The Basics

A physician performs an exam of you neck using his/her hands.
  • Larger and more anteriorly (front) located nodules can be felt by the examiner.
  • A physician will ask about any other medical history and any risk factors for thyroid nodules or cancer, including family history of thyroid cancer or radiation exposure of the head or neck.

Blood tests

  • Thyroid stimulating hormone (TSH) levels and levels of thyroid hormone can indicate whether the thyroid is under- or overproducing thyroid hormones.
  • Anti-thyroid antibody levels can indicate the presence of autoimmune thyroid inflammation that can be seen with Hashimoto's thyroiditis (underactive thyroid disease) or Graves's disease (overactive thyroid disease).
  • Calcitonin levels in the blood can indicate a specific type of thyroid cancer, known as medullary carcinoma of the thyroid. However, calcitonin testing is generally not recommended as part of an initial evaluation of a thyroid nodule.

Ultrasound of the thyroid

This is a test that uses sound waves to take a picture of the thyroid. Similar to the prenatal ultrasound of the fetus, a cold lubricant jelly is placed on the neck; then, using an external probe, ultrasound images of the thyroid gland are obtained.
An ultrasound can reveal which thyroid nodules are larger than 1-1.5 centimeters, requiring further evaluation for cancer. In addition to size, other nodule characteristics that can be noted on a thyroid ultrasound include the following:
  • number of nodules,
  • location of nodules,
  • distinctness of borders,
  • fluid versus solid contents,
  • other nodule contents, such as calcium deposits, or
  • the amount of blood flow (certain newer ultrasound machines can assess blood flow to the thyroid and its nodules).

Friday, April 6, 2012

Thyroid Nodules Symptoms

Most people with thyroid nodules have no symptoms. 

Most thyroid nodules do not cause symptoms and are so small that you cannot feel them. They often are found during a physical exam or when another test, such as a CT scan or ultrasound, is done for a different reason. If your thyroid nodule is big, you may be able to feel it or you may notice that your neck is swollen

Patients may notice the following:

  • A lump seen in the neck.
  • A lump felt in the throat.
  • Hoarseness of the voice.
  • Difficulty swallowing and/or breathing.
  • Other enlarged glands or lymph nodes in the neck.
  • Rapidly growing lump or swelling in the neck. 
  • Pain is only rarely associated with thyroid nodules.

    Nodules may be found:
    • By a physician during a routine physical exam
    • During computed tomography (CT scan), magnetic resonance imaging (MRI), or ultrasound of the neck

    Tuesday, April 3, 2012

    Thyroid Nodules Causes

    Causes of thyroid nodules can be classified as benign or malignant. 


    Experts do not know the exact cause of thyroid nodules. But they do know that people who have been exposed to radiation have a greater chance of developing thyroid nodules. Exposure to environmental radiation or past radiation treatment to the head, neck, and chest (especially during childhood) raises your risk for thyroid nodules.

    Experts know that thyroid nodules run in families. This means you are more likely to have a thyroid nodule if one of your parents has had a thyroid nodule. Also, if you have another thyroid condition (such as goiter), you may have a greater chance of developing thyroid nodules.

    Benign Thyroid Nodules

    • Multinodular goiter: Multinodular goiter is an overall enlargement of the thyroid gland (called goiter) can result from nodules containing too many normal thyroid cells (referred to as hyperplasia) and/or filled with extra colloid. Colloid is the protein-containing substance normally storing thyroid hormone inside the thyroid gland.
    • Hashimoto's thyroiditis: Hashimoto's thyroiditis is the most common form of underactive thyroid disease, this form of hypothyroidism can be associated with thyroid nodules and goiter.
    • Thyroid Cyst: Commonly caused by a nodule which is bleeding or degenerating (breaking down), these blood or colloid-filled nodules can be associated with thyroid pain.
    Benign thyroid tumors (thyroid adenomas)
    • Hurthle cell adenoma
    • Follicular adenoma
    Malignant Thyroid Nodules

    Thyroid Cancer (also called thyroid carcinomas)
    • Papillary thyroid carcinoma
    • Follicular thyroid carcinoma
    • Anaplastic thyroid carcinoma
    • Medullary thyroid carcinoma
    • Thyroid lymphoma
    • Metastatic cancers from other sources, including breast, kidney and lung cancers

    Sunday, April 1, 2012

    Thyroid Nodules Overview

    Most thyroid nodules do not cause problems and are not cancerous. They are often hard to notice because they are so small. Lots of people have thyroid nodules that are never found or treated. There are three kinds of thyroid nodules: solid nodules, nodules that are filled with fluid (cystic nodules), and nodules that are partially cystic. You can have one thyroid nodule or several thyroid nodules (multinodular goiter). 

    You can also have some nodules that are solid and some that are cystic. Solid nodules may grow slowly over time. In rare cases, cystic nodules bleed, which can cause them to grow suddenly and become painful. Thyroid nodules usually do not prevent the thyroid gland from doing its job. But sometimes a noncancerous thyroid nodule can cause:

    • Hyperthyroidism. - when one or more nodules makes too much thyroid hormone. Hyperthyroidism is treated with antithyroid medicine, possibly radioactive iodine, and very rarely, surgery. Hyperthyroidism from thyroid nodules is not very common. It occurs in fewer than 1 out of 100 people who have thyroid nodules.

    • Difficulty breathing or swallowing. -Sometimes, one or more large nodules can press on your windpipe (trachea) or on your esophagus. These kinds of nodules have to be surgically removed.


    • Only about 5 out of 100 thyroid nodules are cancerous.
    • Thyroid nodules are simply "lumps" which are either solid or fluid-filled. 
    • The main function of the thyroid gland in the neck is to make thyroid hormone, which is essential for normal growth and metabolism.
    • Autopsy studies have revealed that up to 50% of all adults die carrying at least one thyroid nodule. These people may or may not have been aware of the presence of their thyroid nodules.
    • Thyroid nodules are found more commonly as people age.
    • Most of these thyroid nodules are benign and not cancerous.
    • Only 5% of all thyroid nodules will be discovered to be thyroid cancer. 
    • Finding cancer in a thyroid nodule is more likely in a person under the age of 30 or over the age of 60.