Thinking through your preferences and choices

There’s been a lot of information to review. Sometimes it’s helpful to take time to consider how you feel about various treatment aspects. By responding to the following statements, you might be prompted to return to review treatment information in more details, or you might find things are clarified in your mind.

The information you provide here is just for you. It will not be reviewed by your doctor, and is not linked to your health record in any way.
You can choose to email yourself a record at the end if that would be useful. You don’t have to answer questions if you don’t want to.
There are three brief sections to review.

My preferences

How important are various outcomes to you?

In this section, we are going to ask you to consider whether various possible treatment outcomes are influencing your decision.
For some choices, we will present extra information to help with your decision.  Feel free to explore your preferences and change your responses.

Think about the chance of requiring long term tablet therapy (eg thyroid hormone or calcium)

The chance of needing to take thyroid tablets for the rest of your life are:
– 100% after total thyroidectomy
– 33% after hemithyroidectomy
– Zero whilst under active surveillance

The chance of needing to take calcium tablets for the rest of your life are:
– Less than 5% for a total thyroidectomy
– Close to zero for a hemithyroidectomy
– Zero for active surveillance

 

Think about the chance of needing to go back for a second thyroid operation

Surgery to remove half the thyroid is usually sufficient for a low risk thyroid cancer.
Sometimes, when the cancer is examined in the laboratory, it has some unexpected high risk features.  When this happens, your doctor may recommend that you have the other half of your thyroid removed, usually to allow treatment with radioactive iodine.
In general, the chance of this happening is around 1 in 3 (30%) chance.  Your doctor can tell you how likely they think this is for your circumstance.
If you choose active surveillance, the cancer is monitored with ultrasound.  If it grows, this is a reason to consider surgery then.  

You’ve indicated that reducing the chance of needing a second operation is important to you. We understand that. However, it’s worth knowing that for most people, removing half of their thyroid is sufficient treatment. If you were to choose to have only half your thyroid removed, this would be the only operation you would need in between 50 and 70% of cases. Talk to your surgeon about how likely they think this would be for you.

 

Thinking about voice, thyroid surgery can be associated with a small chance of major voice change (usually less than a 1 in 20 chance).

Minor changes in voice quality can occur when any thyroid tissue is removed from the neck.  
Major changes in voice pitch and volume are uncommon, and are due to damage to the nerves to the voicebox.
The chance of major voice change is:
 – Lowest with active surveillance
 – Lower with hemithyroidectomy than with total thyroidectomy.  

Think about how you feel about surgery or not:

Think about the reasons you made this choice.  
Is there a particular thing that you are trying to avoid? 

Considering all of the factors on this page, which is the most important factor to you in deciding about treatment
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