What to expect when losing a perfectly good kidney: Hashimoto's edition.
November 11, 2017 9:45 AM   Subscribe

In a few days I have pre-op exams for the removal of a 8cm fatty benign tumor (angiomyolipoma) on my kidney. There's a good chance the kidney will also be removed because of size and position. I have also started synthroid about 6 weeks ago for newly diagnosed Hashimoto's. Trying to Google what to expect from this possible confluence is giving me a lot of Woo. What can I expect from losing a perfectly good kidney (possibly adrenal too) with Hashimoto's?

First I'll just underline that I live in Italy, so yay socialized healthcare gives me one less thing to worry about. This is my first major surgery. I've also named the tumor George. No offense to any Georges out there.

The urology department obviously will attempt to leave my kidney intact, but my admittance documents have "Partial Nephrectomy" in the Procedure field. Laproscopy is right out, and they basically won't know until they get in there if George is going to be an asshole or not. In my mild shock at this development, I blanked on my high school biology and didn't ask if the adrenal gland would be taken out as well (because George is wrapped around the upper part).

At about 6 weeks out, I'm not sure if my synthroid needs upping (Holy cystic neck acne and loooong periods, Batman) but it seems like something that would need finessing after surgery? Or should I bring this up at the pre-op appointment?

In addition to asking about the adrenal gland, what else should I be asking at the pre-op appointment? What should I be asking about post-op scenarios?

What legit science based sources might I check out for this trifecta? I've looked up Mayo and NHS for each individual issue, but together I get a whole lot of sketchy looking Leaky Gut and Adrenal Fatigue results.

Lastly, I have perused threads here and elsewhere about kidney donation surgery, but any tips and advice are welcome, especially about recovering from major abdominal surgery when you have two kids <= 5 years old.
posted by romakimmy to Health & Fitness (6 answers total) 2 users marked this as a favorite
It's nice to have two kidneys but having one removed will not affect your day-to-day life at all, after the initial healing period. One healthy kidney is more than enough for the human body. You would want to be more cautious about things that are unkind to kidneys, like dehydration, untreated UTIs, kidney stones, smoking, and certain medications (e.g. NSAIDs like ibuprofen), but those are good behaviors for everyone in general. Obstruction (e.g. by a stone) is the biggest increased risk for someone with one kidney, because those patients can go from full renal function to minimal or no renal function from a single insult. Like everyone else, you would want to be especially vigilant of warning signs like blood in your urine, pain with urination, very high blood pressure, severe flank pain, or not urinating for a long time.

I honestly can't really think of any particular medical issues that would arise from the combo of hypothyroidism and having a solitary kidney, which is probably why everything you find that deals with both of them is the kind of unscientific material broadly peddled to people with every kind of problem. There are some reports that thyroid disease is associated with an increased risk of co-incident renal disease, but if you end up with a solitary kidney you will regardless end up following all of the guidelines that would be recommended for someone at an increased risk of renal disease (good follow up and minimize risk with lifestyle modifications as described above).
posted by telegraph at 10:00 AM on November 11, 2017 [1 favorite]

Can't speak to the kidney specific part of this but a new diagnosis of Hashimoto's will likely mean that your levels will need to be adjusted a bit. In terms of recovery from major surgery with little kits expect that you will run out of energy all at once like hitting a wall and that's hard with little ones. Ask for help re food, taking kids places, etc. I have always found that anesthesia hits me hard and leaves me wiped out and spacey for a long time post surgery - don't know if it's Hashimoto's or something else though. Recovering from surgery and anesthesia with hypothyroid issues has not been something any doctor has considered worth mentioning to me and I've had a lot of surgery. Feel free to PM me.

And the whole leaky gut, higher incidence of gluten issues coincident with hypothyroid is real but finding non-woo-y info on it is definitely challenging.
posted by leslies at 10:05 AM on November 11, 2017

I don't think you can count on it, but you might get a remission of your Hashimoto's.

Immune systems do attack tumors, and whenever the immune system is attacking one tissue, there is a danger it will also do some damage to 'closely related' tissues ( which is how strep throat can develop into joint pain and then severe heart problems).

The thyroid and adrenals are both endocrine glands, and if your immune system is attacking your adrenal gland it might also be attacking your thyroid (the central pathology of Hashimoto's).

I would take this "confluence" as not at all conclusive evidence that your lipoma arose from adrenal tissue in the first place.
posted by jamjam at 10:17 AM on November 11, 2017

Pretty sure that I can't answer most of your questions, but I can tell you about my experience of kidney surgery. I had a partial nephrectomy about 5 years ago (open surgery, not keyhole - for a non-benign tumour), and recuperated surprisingly quickly. I had about 4 days in hospital, another week or so kicking back and taking it easy and was back at work inside two weeks. My kids were slightly older than yours, but not much (my youngest was 6). I dropped the pain meds within a week, but was generally careful not to over-exert.

Abdominal surgery sounds hella scary, but it genuinely wasn't too bad. I've had a bout of sinisitus that left me feeling worse and had a longer recovery time.
posted by bifter at 10:50 AM on November 11, 2017

I had a relative who had terrible pain for days post-kidney surgery due to the abdomen having been inflated with gas so the surgeons could see better inside. But if you aren't having laparoscopic surgery this may not be an issue.
posted by RobotVoodooPower at 11:11 AM on November 11, 2017

I have anecdata only, but you're welcome to it. I've been hypothyroid for 30 years although no one ever mentioned Hashimoto's. Over the years, my synthroid dose has gone up a bit sometimes, down a bit sometimes, but has been stable most of the time. There are often tweaks to the dosage in the early-going, though, until your proper dose is found. Five years ago, I lost a whole kidney (and the crappy malignant tumor strangling it). It was done laparoscopically, so no muscles were cut. In my case, I went home from the hospital the next day, flopped around on the sofa for three more days feeling sorry for myself and taking ibuprofin for the pain, then resumed my normal patterns including an hour at the gym each morning. There was no mention of rechecking my TSH, and I can't imagine how the two would be related. You should ask at your pre-op appointment what sorts of post-surgical accommodations will be necessary (e.g., not lifting the kids) and plan accordingly. Oh, and you might ask about the expected duration of the surgery. My rule of thumb is that there is one month of recovery time per hour of surgery.
posted by DrGail at 2:27 PM on November 11, 2017

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