Hello!
From browsing the healthcare section of LYN forums, I notice that many forumers are asking for medical advice on different conditions/illnesses. Some advice are good advice, some are common sense, and others can be very bad advice which can lead to bad outcomes.

Therefore, I'm taking the initiative to start a topic where health care workers can give their advice/opinions to different needs or questions from forumers. The idea is to link all healthcare professionals here with people who may benefit from their expertise in one topic.

TAKE NOTE THAT THE ADVICE GIVEN HERE IS NOT MEANT TO REPLACE A FORMAL CONSULTATION BY A QUALIFIED DOCTOR AND THE CONTRIBUTORS HERE CANNOT BE HELD RESPONSIBLE FOR ANY MISHAP THAT MAY OCCUR AS A RESULT OF ADOPTING OR NOT ADOPTING THE ADVICE GIVEN.

There are limitations: we cannot examine you for any physical signs. This topic is only meant to give a general idea of the condition and to screen for serious illnesses.

To those who are interested in giving advice here, please state your designation (doctor, medical student, nurse, etc) and your area of specialty/interest (medical, orthopaedics, O+G, etc)

It is my hope that the LYN community may benefit from this.

List of Healthcare Professionals active in this thread:

Feel free to post here and we'll try to get back to you ASAP.

This post has been edited by aeternalis: Sep 17 2011, 05:27 AM

Name: <I prefer other forumer to call me as stated on my nickname.>
Designation:House Officer
Area of interest: Medical Dept, Emergency Dept.

This post has been edited by Mr.Docter: Dec 6 2015, 09:11 PM

Hi, I need some advice on my thyroid prob, had been taking camazol for a year. N my doctor said it's better if i go for a thyroid gland removal surgery since I can't rely in this medi for long term. Should I? I an so afraid of d side effects from d surgery, such as lost vocal voice, can't get pregnant in future n etc etx, n I oso donno which hospital to go in kl which is more reliable, any advice? Fyi, I'm lacking tsh hormone....

Name: zstan
Designation: Pharmacy student
Area of interest: Clinical pharmacy

Hope to learn from everybody here

Err. I believe you have hyperthyroidism, which is why you're on carbimazole (generic). But you're making it unclear at to which type of cause it is, whether thyroid tumours or the autoimmunes (I'm assuming it should be the more common ones in young adults). And the surgical procedure would be to remove the lobes to reduce the over-production of the thyroxine (T4) hormone. I'm not sure if TSH plays a part in your condition unless its pituitary adenoma. And that requires another surgery to another anatomical part. Or radiotherapy.
The thyroid tumours are another different ballgame altogether so I'm not making any assumptions here.

Has no doctor advised you for radioiodine therapy instead? It should be a viable route also.

If for surgical route, I would advise to find for ENT specialists who do thyroid glands, they should work quite delicate and more discriminate in this matter. Sorry I can't recommend anyone as I have no idea who's who in KL, but the general advice is what I've gleaned from observing the surgical considerations the surgery teams do.





This post has been edited by trencher10: Sep 5 2011, 09:42 AM

Hi zstan,

You are in which year currently?



This post has been edited by Mr.Docter: Sep 5 2011, 11:22 AM

Hi karenkow,

Low TSH means that it is due to negative feedback from your overproductive thyroid gland to produce T3 and T4, which is in other word - Primary hyperthyroidism. There are several causes of primary hyperthyroidism (you can just wiki it by yourself actually for an extra reading) and most of it involve either surgery or specific destruction of hyperactive thyroid tissues using isotope (contraindication - during or planning for pregnancy in shortest time) .

The side effects as you already stated above are the potential complication, which is not uncommon especially hoarseness of voice due to the damage of the laryngeal nerve and its recurrent. But total lost of vocal nowadays is uncommon because improved technology and skills. You may undergo linguistic physiotherapy about a months if you face those problem post-operatively.

Regarding pregnancy, you just need to consult your doctor for an increment of dosage by time. There would be a tight schedule compared to the normal dosage that you take after the operation, relatively. Adherence to medication and its specific dosage as suggested by your doctor play an important role in the situation.

Lastly beware of thyroid storm. This is not under your (patient) role but more to the surgeon instead. Pre-operative preparation is vital for thyroidectomy.

SPOILER : Picture of removed thyroid gland due to malignant tumor.


This post has been edited by Mr.Docter: Sep 5 2011, 11:26 AM

Yeah they told me abt radio therapy as well, but bcz of my gland had swollen, so d doc said better go for surgery, but due to d doc I consult now is d normal clinic doctor, nt a specialist in thyroid or surgery, so really need more professional opinion on this. Ofcoz im going to look for.a specialist on thyroid b4 really decided on operation.... Thanks for ur info it's really helpful :-)

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Added on September 5, 2011, 11:54 amHi, thanks for d info, really helpful b4 I make any decision. Seem like I gt no othrr choice than go for a surgery :-(

Bt I still have to take pill to replace my hormone after surgery right?

What's really bothering me is which hospital to go, it might be a small operation for doctor but it could be d biggest to me in my life, so really afraid to make a wrong decision in choosing hospital... Any suggestions on which hospital or doc which is really good on thyroid problem?


This post has been edited by karenkow: Sep 5 2011, 11:54 AM

>swollen gland = better perform surgery since it will fix the hyper-functional state and cosmetic aspect as well.

Yes, its vital for you to adherence to your medication as an hormonal replacement. But looking at your history in rough, you'd already familiar with the pills (carbimazole). Being hypothyroid state is dangerous as you skip your medication.

Hmm I am personally do not familiar with hospital in Malaysia as I am an overseas student. Kindly consult your doctor for their specialist recommendation.

If your glands are swollen, it not necessarily means a surgical route is a given. However, this is due to the fact that I still have no idea what type of hyperthyroidism you have as the symptoms list is still short for me to assess. Plus, if this is an acute inflammation of the thyroid tissue, rather than hyperplasia, even surgery will have to wait medical management first.

Regarding carbimazole continuation, this is dependent upon your T4 levels and the extent of the thyroid tissue removal that they do (and there will be another complication with para-thyroid glands as well, if they were removed as well). The doctors will monitor your T4 levels and try to achieve a euthyroid state without requiring medication.

Thyroid glands removal is quite routine (general surgeons also can & do this surgery, and sometimes the cardiothoracic teams are called too when they have thoracic thyroid tissue to deal with), but which is why I recommended searching for ENT specialists as they are the people most discriminate with the throat area.

Lastly, good luck and hope you'll be in best of health.

Ya.... I act tried to stop d medi 1 month, but d anxious n hyper symptoms all came back, can't really get sleep at night but shin felt tired in d morning, my doc said it's mean it's come back very fast... Coz initially we plan to try stop for 3 mths, if my.body can produce d tsh hormone without d medi, msybe I can escape from d operation, but obviously it's not work for me...

Really thanks for ur advice, I felt more relief now coz it seems like a common surgery... hope things get better after surgery... Cheers ;-)

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Added on September 5, 2011, 6:57 pmThanks thanks, so meaning to say it's nt necessary for d same doc to observe me to do d operation for me as well? I mean d thyroid specialist might nt d one do d operation for me?


This post has been edited by karenkow: Sep 5 2011, 06:57 PM

It sound better, but actually its not necessary.

The referral later from your current GP to the doctor that will perform the surgery will be sufficient


I don't think we have thyroid specialist, in specific. I don't think you should worry this part. Make sure you go to the respected hospital since management over there is relatively better.

This post has been edited by Mr.Docter: Sep 5 2011, 07:29 PM

Hi guys! Thanks to Mr. Docter and trencher10 for their input. Was on-call so didn't post recently. Glad to see that the ball is already rolling.

To karenkow: Good advice from them so far. Just a few things to add. Any surgery will have potential complications. You need to weigh the pros and cons of doing any procedure. That being said, it's rare nowadays to see the more serious complications such as losing the voice, etc.

I think the 'thyroid specialist' you are seeing is probably an endocrinologist (doctor expert on hormone related disease). The person performing the surgery is either an ENT surgeon or a general surgeon. So the person who you are seeing most likely won't be present for your surgery.

Thyroid surgery is very commonly done, so most surgeons will have plenty of experience.

As for the choice of where to go for surgery: one main factor is whether you want to do it in a private hospital or a public hospital. This will differ in terms of cost.

If you go to a private hospital, the cost will be high but you will get a specialist surgeon to perform the procedure for you.
If you go with the public hospital, you are not guaranteed to get a more senior or experienced surgeon. Sometimes, more junior medical officers will perform the surgery under the guidance of their seniors. But the cost of the operation and stay will be much lower.

If you want, I can enquire about the cost of the surgery from a private hospital and public hospital during office hours tomorrow.

Well about hospitals, you can cross out gleneagles. Te prices there are exorbitant. There's this dr siti who's an endocrinologist at Sunway medical if I am mistaken. But she's a physician not a surgeon if I can remember correctly.

Is thyroid surgery covered under insurance? Do you even have health insurance in the first place?

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Added on September 5, 2011, 11:08 pmFor public hospitals, you can be assured that the maximum cost of your operation and stay there(excluding medications) will not exceed rm500 based on my experience there last year during my attachment. Not sure whether prices have increased. But how long more can you wait? That's te golden question.

This post has been edited by zstan: Sep 5 2011, 11:08 PM

Ahhh endocrinologist! that's the keyword that I been searching for somewhere in my brain. It is more precise compared to ENT when we talk about thyroid gland

Hi,

first year 2nd sem only.

Oh, but you have a knowledge like a final year student!

Nice knowing you.

Haha. I've still got a lot more to learn la.

Nice meeting you too.

Hi aeternalis.... Thanks soooo much, I get so many useful information here, really appreciate it :-)

Yeah that's what I'm worried if go government hospital, but if private r too exp then I've to... :-(

It's will be really nice of u if u can get d price of d surgery to me, at least I can have a rough budget on it....

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Added on September 6, 2011, 10:52 amHi tan, hmm too bad my.insurance din cover for me cz when I gt this policy I ord under medication. But I wonder if my.company medic card can cover for me..... :-(


This post has been edited by karenkow: Sep 6 2011, 10:52 AM

I would also suggest if you could glean info on their surgical considerations as well, if they actually leave it to the ENT team or general surgeries. Especially the public hospitals. In my place, even in the public hospitals the consultant specialists are adamant in this matter. Plus, internal word-of-mouth is a great way to know where the best public hospital specialists are located.

This post has been edited by trencher10: Sep 6 2011, 12:22 PM