Was Diagnosed With Papillary Thyroid Cancer. Had Thyroid Removed. Why Are My Periods Delayed With Dizziness And Low Calcium?
Thanks for the query. I have gone through your detailed history.
As per your details you have undergone total thyroidectomy with lymphadenectomy for papillary carcinoma of thyroid. Currently the symptoms of excessive and irregular periods are suggesting dysfunctional uterine bleeding associated with anemia. And as conservative treatments have failed to stop bleeding your doctors have suggested hysterectomy.
My opinion is as follows:
I fear whether or not you are on proper replacement therapy as your levels have been resistant for a long time. Besides parathyroid glands which maintain calcium metabolism are also get removed during total thyroidectomy. Both these conditions play an important role with menstrual periods and control of bleeding. Perhaps visiting an endocrinologist would be a good option if you haven't seen one yet. If it is established that you are not on proper replacement therapy, your most complaints including menstrual problem will be addressed if proper replacement therapy is instituted.
I am glad that you thought of hematological problem as a cause. You are very much correct. Hematological problems also can influence the regularity and amount of bleeding during periods. We need to look at your complete hemogram, peripheral blood picture, platelet counts, complete coagulation profile, antiphospholipid antibodies, etc. to rule out hematological condition. A competent hematologist will be able to streamline the test and evaluate you comprehensively.
So if I were to be your treating doctor, my advice to you would be as follows:
1. At this juncture without complete knowledge of thyroid and hematological status, you need not undergo hysterectomy, unless deemed life threatening because of uncontrollable blood loss.
2. I would refer you to an endocrinologist to study on your thyroid state and treat it appropriately.
3. Hematologist consult will also be needed simultaneously to rule out hematological causes.
4. If the above 2 conditions are ruled out and if bleeding doesn't stop, hysterectomy can be considered as the last option.
5. In the mean time, I would like you to be on iron and folic acid supplements to prevent anemia.
Your condition needs a multidisciplinary approach consisting of an endocrinologist, hematologist and gynecologist. Working with these specialists, we will be able to handle your problem in the best possible means and there is a chance to avoid hysterectomy. Having said that any delay in the management of the above problems is not safe.
Hope this information is useful to you. Let me know if you have any further concerns.
All the best
Truly,
Dr. J. Ticku