Can Hashimoto's disease be managed by medications and lifestyle changes?

Hello,

I am a 26-year-old female with hypothyroidism and was recently recommended a total thyroidectomy by my doctor, and I am not sure if it is the best decision.

I was diagnosed with hypothyroidism at the age of 12 (autoimmune Hashimoto's) and have been taking Euthyrox (Levothyroxine) daily. I started with 50 micrograms. Currently, I am taking 88 micrograms daily, and my hormone levels are stable. I have had two small nodules in my left lobe for several years, non-growing and monitored.

However, during the pandemic, I had a particularly stressful and traumatic week. A few weeks after that, a bigger nodule appeared in my thyroid isthmus. It appeared two years ago and was 5x10x12 mm. It is markedly hypoechoic, inhomogeneous, sharply demarcated without perfusion, and palpably stiff. A fine needle aspiration biopsy was performed, but it was inconclusive (Bethesda III) because the sample did not include thyroid cells. Seven months later the nodule was 13x7x12 mm. Six months later after that, it was 13x7x16 mm. This is when my doctor recommended a total thyroidectomy. Another fine needle aspiration biopsy was performed. This time the sample had thyroid cells, and it came out as a benign diagnosis (Bethesda II).

The result said, "In the blood background, there is a flood of immune-transforming lymphocytes individually and in numerous tissue microfragments. In cytoblock sections 302P or 22 Topelex, s.r.o., similar findings. A lymphoplasmocellular infiltrate predominates here, but in the sections stained with H and E, however, in contrast to the smear, in the micro fragments there are distinguishable micro follicle residues with oncocytic epithelia." The doctor says it suggests inflammation, but others have said that there is potential for cancer there. Another thing, when I am stressed or nervous, sometimes the isthmus or the growth hurts a bit as if there was inflammation there.

Last year, the nodule was still 13x7x16 mm. At the beginning of this year, I took Prednisolone for another condition for 10 days. Shortly after that, I had another endocrine appointment one month ago, and the nodule was 13x6x13 mm, so it shrunk a bit. So the last doctor's note says that there is a 13x6x13 growth in my isthmus, inflammatory changes, and negative calcitonin. The last FNAB was about a year ago, and the result was the benign outcome.

My doctor still recommends a total thyroidectomy and says life without a thyroid and on medication is the same. I know it can be like that on paper, but is it really like that? I am very nervous because there are many accounts of people that say that life after thyroid removal was not the same for them, even with medication, and I would also become completely dependent on the medication. I currently do not have any noticeable negative symptoms connected with my hypothyroidism because it is well managed, so the removal of my thyroid would be preventive to avoid the possible development of thyroid cancer in the future, which I would like to avoid. I am scared that my quality of life will go down after removal. will go down after removal.

I am very confused because endocrinologists recommend removing my thyroid, but for example, holistic doctors say lifestyle changes can cure my thyroid, and, to be honest, I have not implemented any yet, like a gluten-free diet or stress management. Do you think a holistic treatment could really help my thyroid and avoid its removal? I regretted not trying holistic approaches much earlier. I have a total thyroidectomy scheduled in a month, but I am not sure if it is the right decision to go through with it, mainly because of the life quality concern.

Please, do you have any advice?

Hello doctor,

I wanted to ask you, I asked my endocrinologist again, and she claims there is no cancer and it is just inflammation; therefore, there is no rush to remove the thyroid if I want to continue to have it and attempt to reduce the nodule. I am so confused now. I was not expecting my endocrinologist to say something like this since she suggested that surgery might be a good idea already a year ago. Since there is no active cancer found, do you think it is safe to delay the surgery? Can I help my thyroid in some ways?

Kindly suggest.