A true story of how a patient's bike accident led to the discovery of thyroid cancer
By Laura Lee Bloor
Reviewed by William C. Shiel Jr., MD, FACP, FACR
When Ken Brown,* of Orange County, California, broke his left collarbone (clavicle) in a dirt-bike accident, he never imagined it might help save his life.
Ken went to Jawbone Desert, California, with a group of friends to ride dirt bikes. The getaway weekend took a turn for the worse when Ken wrecked his bike while going about 60 mph. Ken was lucky that his only injury was the broken collarbone.
The emergency room doctor prescribed hydrocodone/acetaminophen (Vicodin) to manage Ken's pain until he could be seen by a surgeon who specialized in shoulders. Within a week of the accident, Ken had surgery to repair his clavicle, using a plate and screws.
The surgery went smoothly, or so Ken thought, until he started experiencing numbness in his pinky finger afterward. Over the next couple of weeks, the numbness traveled up his elbow and caused painful muscle spasms in his arm and back.
Brown went to his doctor who determined that he did not have carpal tunnel syndrome but couldn't find an explanation for the numbness. He referred Ken to a neurologist.
Within the next few days, Ken visited the neurologist who ordered a spinal MRI scan of his neck. When the neurologist contacted Ken about his MRI results, he asked if Ken was aware of a lump in the front of his neck (his thyroid area). "No," Ken said. The neurologist was concerned about the lump, known as a nodule, especially with its large size of 3 cm.
He took the neurologist's report to his doctor who referred Ken to a thyroid expert (an endocrinologist).
First, the endocrinologist interviewed Ken about his medical history. When Ken discussed his weight gain and lack of energy, he had attributed them to stress stemming from the misery of a divorce. He was surprised to learn that these were actually common symptoms of a thyroid disorder.
"Everything just kind of fell into place," Ken said.
He was prescribed a thyroid hormone replacement called levothyroxine sodium (Synthroid), which is supposed to suppress the nodule's growth and prevent new ones. It also is supposed to normalize the hormones. The trick is finding each individual's balance. Ken started a monthly check-in with the endocrinologist to monitor his hormone levels and adjust his Synthroid as necessary.
"The endocrinologist generally starts people off with small doses and slowly increases," Ken said. He found this especially difficult because whenever the doctor increased his Synthroid dosage, he'd feel great. However, within days his body would adjust to the new levels, and he would slip down again, feeling lethargic.
"So, it was kind of a roller-coaster ride," Ken said.
Soon thereafter, the endocrinologist performed an aspiration biopsy of the nodule.
During a fine-needle aspiration biopsy, an endocrinologist uses an ultrasound to visualize the structures of the neck while using a giant needle to collect samples from the nodule. The samples are then tested in a laboratory to see whether they are cancerous. Unfortunately, the procedure is not highly accurate, Ken said.
The aspiration biopsy revealed that the thyroid nodule was benign. Ken was told to come back for another ultrasound in 6 months.
While his family was relieved at the results and thought all was well, Ken was still concerned. They dismissed Ken's doubts.
"I'm always the one thinking positive, but for whatever reason, my gut feeling was that it wasn't good," Ken said.
Ken's next ultrasound checkup revealed the nodule had grown, which was not a good sign. Even though the statistics were low that it could be cancerous based on his lack of risk factors, such as age and gender, Ken was worried.
Upon knowing that his thyroid nodule grew when it should have shrunk, Ken discussed surgery as the next option with his doctor. Surgery was the only 100% way to verify if the nodule was cancerous. After mutual agreement, the doctor arranged a surgical procedure to remove a portion of the thyroid (partial thyroidectomy).
During the surgery, the half of the thyroid where the nodule resides is removed, and a pathologist is on standby to confirm or deny if it is thyroid cancer. If it is, then the other half of the thyroid is removed. If not, the other half of the thyroid is left alone.
Ken opted for surgery. Ken chose the surgeon who had inserted tubes in his son's ears to stop his chronic ear infections 13 years ago. Ken also felt comfortable with the surgeon because when they met, the surgeon showed him information and pictures straight from MedicineNet.com!
By the time Ken underwent the surgery, the thyroid nodule had grown to roughly the size of a walnut. The pathologist confirmed that it indeed was thyroid cancer, so Ken's entire thyroid was removed.
"The scary thing with having surgery on your thyroid is that they're cutting open right where all your vocal cords are, and they make you sign all this paperwork that X, Y, and Z can happen," Ken said.
After the surgery, Ken was weaned off his medication because it would interfere with the radiation therapy he needed to ensure all the cancer was eradicated. His radiation therapy consisted of one megadose of radioactive iodine followed by 3 days of isolation.
After the radiation treatment, he was able to begin his thyroid hormone replacement with Synthroid again, although it took a few weeks to take effect. Without it in his system, Ken's speech and movement slowed significantly, which made his work as a designer extremely difficult. So, in addition to the Synthroid, Ken was prescribed liothyronine sodium (Cytomel), which was to work quicker and stronger than the Synthroid in getting his hormone levels back to normal. However, Ken was soon taken off the Cytomel because his hands and feet started peeling as a side effect from the drug.
Today, 48-year-old Ken is cancer-free and on Synthroid for life. His hormone levels are right on target and he regularly gets his blood checked for this. Once a year, he has a nuclear scan to make sure he's still cancer-free.
Ken has lost weight and is back to surfing, running, and keeping up with his two teenage kids.
"I think mentally, for me, dropping the extra 35 to 40 pounds was a big boost," Ken said. "The fact that you're able to lose the weight: It helps stimulate everything else; it kind of puts you back on the right track, at least it did for me."
In just a few years, Ken conquered cancer and is back to normal. He said he feels fortunate, especially when so many others with his condition are still struggling with their medication, weight, or both.
"I definitely have a new perspective on life. When you have a scare like that, things like, I want to go here, do that, see this...I'm taking the steps now to do those things. For example, I've always wanted to go to Australia, and so I just recently booked the trip," Ken said. "Traveling for me has always been kind of shelved, but why wait? Why put it off? If it's something you truly want to do, do it. Because you know, 2 years from now, you may not be around!"
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* The patient's name has been changed to protect his privacy.