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.

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.

>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.

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.

Oh Nola if you go private they can try to help you get insurance one for the surgery and hospital stay.

The calculations for whole period of stay is quite easy to count la actually.

Since thyroid surgery is quite simple which will take maybe 1-2 hours, charges most probably will vary from 1-5k. Depending on docs reputation.

Anesthesia will cost around 200-600 depending on doctor.

If you stay in a 4 person ward it will most likely cost less than 100 or maybe slightly more(depends on hospital) per night. 2 person ward will be more expensive and single ward will be the priciest.

The charges of doctor when they visit you during your stay will probably cost from 0-500. Also depends on how money minded is your doctor.

After including medications, your total cost may vary from 3-7k, depending on doctor and hospital.

My 2 cents la.

i think it's super dangerous to take advice from forumers here...
Well, since there's no establish diagnosis for your condition, there's very little information here and all these while you've been managed by a GP...

To be on the safe side, go and see an endocrinologist first before any further decision.
You need further investigation on your thyroid ds.
Yes, you're definately hyperthyroid judging from your symptoms and presentation, but the underlying cause must be investigate before further management.

to the med students here...
I think it's important to establish a sets of differential diagnosis before you give advice to your patients in future practice.
Misleading information could lead to lots of stress and anxiety to our forumers...

example :
Hi, thanks for d info, really helpful b4 I make any decision. Seem like I gt no othrr choice than go for a surgery :-(

When a pt failed medical treatment, something to ponder in our mind :

1) what cause the treatment to fail ? incorrect diagnosis? non compliance to medication? drug drug interaction? or inadequate therapy.
Bear in mind that the treatment has been started by a GP...
plus, we don't even know the TSH/T3/T4 trending on treatment over the year.
How low is low?
So, you should ask her to provide these valuable information before further decide whether or not this is truly a failed medical treatment.
we don't even know whether pt's on maximum dose of carbimazole etc.
Maybe she's just on chicken dose started by GP...who knows?
2) You should also ask for associated symptoms and well known complications which is associated her thyroid problem.
eg: thyroid eye ds, AF...
should any of above present, she should immediately seek a specialist review.

Dear Karen,

I think u seriously need a specialist review, they are available in any general hospital/university hospital.
You may want to speak to your current doctor to provide a detail medical report/referral.
Bring your medical report/blood reports along and book an appointment.

You may not need to worry about surgical review for now as judging from your progress, you responded to the previous treatment, it just tat it rebound back quite fast.

There's pt who r on medical treatment for years before opted for surgical  intervention.

---

Added on September 6, 2011, 8:33 pmi think it's super dangerous to take advice from forumers here...
Well, since there's no establish diagnosis for your condition, there's very little information here and all these while you've been managed by a GP...

To be on the safe side, go and see an endocrinologist first before any further decision.
You need further investigation on your thyroid ds.
Yes, you're definately hyperthyroid judging from your symptoms and presentation, but the underlying cause must be investigate before further management.

to the med students here...
I think it's important to establish a sets of differential diagnosis before you give advice to your patients in future practice.
Misleading information could lead to lots of stress and anxiety to our forumers...

example :
Hi, thanks for d info, really helpful b4 I make any decision. Seem like I gt no othrr choice than go for a surgery :-(

When a pt failed medical treatment, something to ponder in our mind :

1) what cause the treatment to fail ? incorrect diagnosis? non compliance to medication? drug drug interaction? or inadequate therapy.
Bear in mind that the treatment has been started by a GP...
plus, we don't even know the TSH/T3/T4 trending on treatment over the year.
How low is low?
So, you should ask her to provide these valuable information before further decide whether or not this is truly a failed medical treatment.
we don't even know whether pt's on maximum dose of carbimazole etc.
Maybe she's just on chicken dose started by GP...who knows?
2) You should also ask for associated symptoms and well known complications which is associated her thyroid problem.
eg: thyroid eye ds, AF...
should any of above present, she should immediately seek a specialist review.

Dear Karen,

I think u seriously need a specialist review, they are available in any general hospital/university hospital.
You may want to speak to your current doctor to provide a detail medical report/referral.
Bring your medical report/blood reports along and book an appointment.

You may not need to worry about surgical review for now as judging from your progress, you responded to the previous treatment, it just tat it rebound back quite fast.

There's pt who r on medical treatment for years before opted for surgical  intervention.