Beverly found out she needed surgery while driving home from work. It was the day before Thanksgiving in 2009, and her endocrinologist called to talk about Bev’s most recent thyroid ultrasound. He came right to the point.
“He told me, ‘It doesn’t look good. We need to get it out,’” Bev says.
“I knew nothing about how to deal with that news. I guess I’d always thought thyroid nodules were rarely cancerous,” she adds.
A Chance Discovery
Thyroid nodules are lumps, or growths, in the thyroid — a butterfly-shaped gland in the front of the neck, centered just above where the collarbones meet. It’s highly common for nodules to form with age, especially in women.
Bev’s doctor had been following a nodule on her thyroid gland for about six years through regular ultrasounds. She can still vividly recall the moment that set her medical journey in motion.
“I was at a small social gathering with some women friends celebrating my engagement. I was 50 and it was a second marriage for me,” Bev says.
While chatting with her friends, Bev felt a pain in her neck unlike any she’d felt before. She thought to herself, “I’ve got to get this checked out.”
Bev made an appointment with an ear, nose, and throat (ENT) specialist who did ultrasound imaging and discovered a nodule on her thyroid. Bev thought the nodule was unlikely the direct source of her pain and believed it may have been caused by a lymph node reacting to the nodule.
In fact, most thyroid nodules don’t cause symptoms; whether Bev’s neck pain was related or coincidental, her nodule was a fortuitous discovery.
Bev’s doctor recommended she have a fine needle aspiration (FNA) biopsy to determine if the nodule was cancerous. She went to a hospital in Bucks County, Pennsylvania for the test, but the doctor performing the biopsy stopped the procedure before he could obtain a tissue sample.
Bev’s nodule was moving and because it was positioned close to her carotid artery, the doctor felt it was too risky to continue repositioning the needle, in case he nicked the artery.
“He told me my options were to have my thyroid removed preemptively, or to monitor it through ultrasound. I opted to monitor it, since the nodule could have been benign,” Bev says.
While only a small percentage of nodules turn out to be cancerous (malignant), it’s important to monitor a nodule over time to make sure it isn’t growing or changing. Ultrasound is a noninvasive way to get detailed images of the thyroid — including any nodules — by using high-frequency sound waves.
A specially trained radiologist will look at the nodule’s edges (margin), consistency, shape, and other features and assign it a score of 1–5 using the American College of Radiology’s Thyroid Imaging Reporting and Data System (TI-RADS). A score of 1 means no evidence of cancer and a 5 is highly concerning for cancer.
Advanced Expertise: Thyroid Lobectomy
Bev began seeing an endocrinologist and, for the next six years, had ultrasounds of her thyroid every six months. That is, until the day her endocrinologist called with the news that it had to come out. The nodule had become more vascular, meaning it had greater blood flow than before, and the borders had become irregular, making its appearance highly suspicious.
After receiving the news, Bev asked her doctor who he recommended she see for treatment.
“He said, ‘Well, this kind of goes against the protocol of my [non-Penn Medicine] physician network, but there’s someone in Philadelphia at Penn Medicine I highly recommend.’ That’s how I ended up at Penn Medicine’s Abramson Cancer Center,” Bev says.
Bev was able to get in quickly to see an associate at that practice: Rachel Kelz, MD, now the co-director of Penn Medicine’s Thyroid Disease Team.
“At our first appointment, she instantly put me at ease. She had a really good sense of humor and was articulate and confident, which you want in a surgeon,” Bev says.
One of the reasons Bev’s endocrinologist recommended Penn Medicine was because they were among the only groups at the time to offer thyroid lobectomy for treatment of thyroid cancer — removal of only one lobe instead of the whole gland.
“His thinking was you save as much of the organ as you can,” Bev says.
On December 23, 2009, Dr. Kelz removed the left lobe of Bev’s thyroid gland. The surgery was a success and Bev was able to go home the same day.
Precautions Against Recurrence
About a week after her surgery, Bev met with Dr. Kelz to review the pathology of her nodule and discuss the recommended path forward. The nodule was cancerous, but it was removed before it had a chance to spread to Bev’s lymph nodes.
Dr. Kelz prescribed a low dose of thyroid hormone replacement medication, which Bev needs to take for the rest of her life. The drug helps prevent a recurrence of thyroid cancer by suppressing the level of thyroid stimulating hormone (TSH) in her blood. Had Dr. Kelz removed the entire thyroid gland, Bev would have needed a much higher dose.
In addition to taking thyroid medication, Bev sees her endocrinologist annually.
“I have a nodule on the other side, which he continues to monitor with ultrasound. Every few years I also get what’s called a lymph node mapping to make sure the cancer hasn’t returned,” she says.
Putting Thyroid Cancer Behind Her
Bev felt like she was in good hands having her treatment at Abramson Cancer Center.
“Everything was seamless — they really had their procedures well integrated from one person to the next,” she says.
“The presurgical testing was so easy. I just walked down the hall to get my blood work done and down another hall for my EKG. I didn’t have to make appointments or drive somewhere else. I could have everything done in one visit, and when you’re driving from out of town, that’s really important,” she says.
“Dr. Kelz gave me a prescription for voice therapy,” Bev explains. “I was teaching at the time and using my voice a lot. My only regret is that I didn’t take the time for the voice therapy. Looking back, it’s something I should have done.”
Bev’s bout with thyroid cancer is just one experience in an adventurous life. She was 56 when she had her surgery and is now 70, retired from teaching, and more active than ever.
“I ski, play golf, and love to hike. I recently learned how to play the piano and guitar, and I also act professionally on commercials and TV,” Bev says. “I used to act and dance and model as a kid, but I never liked it because it wasn’t on my terms. I always said I’d go back to it when I retired and now I love it.”