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How to manage a complicated case of thyroid?

Q: A case of thyroid problem: I was operated 15 years ago for left thyroid which was quite big in size with nodules. 7 years ago I was again operated for right thyroid which was also big in size with nodules. But after the operation on checking with the ENT specialist I found out that my vocal cords have palsy. 2 years later I was again operated for left arytnoidectomy in Saudi Arabia. I was suffering from strider and shortness of breath. At present I am feeling well. I went for a ultrasound and found out that I had a swelling again on midline trachea and also I had gone for a FNAC test which says it’s a benign thyroid cyst. I am really tensed. I would like to meet a doctor upon arriving to India on vacation in Hyderabad. The medication using daily includes 150 mcg of eltroxin, for the last 7 years, 600 x 3 tablets of calcium and 1mg tablet of One Alpha (vitamin D). After taking all these medicines my tests are normal.

A:Going by your case history, it seems to me that probably the entire thyroid must have been removed in the second operation and you must have developed bilateral vocal cord paralysis due to injury to the nerves that supply the voice box. Initially the vocal cords must have been spaced so nothing happened for a year and then you must have developed some swelling due to infection and thus had strider. That is the reason you had strider. And thus an arytnoidectomy was done to make a space through the closed paralysed vocal cords to help you breathe. Going by the medicines that you are having, it seems that even parathyroids have been removed. It is surprising to note that a cyst has developed and it shows a thyroid tissue, maybe some tissue was left behind. More clinical details of your surgery are needed: 1. FNAC report before surgery. 2. Ultrasound report of the thyroid before surgery. 3. Thyroid scan report of the nodules before surgery (Important). 4. Histopathology of the removed thyroids. (Important) 5. Larygoscopic picture of the vocal cords after thyroid surgery. 6. Larygoscopic picture before arytenoid surgery. 7. Thyroid scan of this small swelling in front of the trachea (Important). I want to assure you that there is no need to have any tension and please relax. There is nothing to worry and the worst is over. Any centre in India is better for this treatment, even a city like Hyderabad has very good hospitals and expert surgeons.

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