Tipper Gore underwent surgery yesterday afternoon at Johns Hopkins Hospital to remove a nodule from her thyroid gland, which doctors will test for cancer. They'll know the results in about a week.
Earlier tests on the lump had been inconclusive, so physicians recommended that Gore have the surgery, according to statement released last night by Gore's spokeswoman, Camille Johnston.
"The only way to find out what this is is to have it removed and have it tested," Johnston said. She said Gore and her husband, Vice President Al Gore, planned to stay over at Hopkins last night.
The surgery, a right thyroid lobectomy, lasted two hours and five minutes and was done by Dr. Robert Udelsman, chief of the division of surgical oncology and endocrine surgery at Johns Hopkins University School of Medicine. He is widely considered one of the best endocrine surgeons in the country.
In a statement, he said, "The surgery was performed without complication, and Mrs. Gore is resting comfortably."
Gore, 51, was expected to be discharged from the hospital today.
The thyroid, a butterfly-shaped gland just below the Adam's apple in the neck, produces hormones crucial for the normal development of children and the regulation of metabolism in adults.
When the gland is either overactive or underactive, it can cause problems with heart and lung function, as well as skin and other tissues. These conditions are easily treated.
Lumps that arise in the thyroid, called nodules, are common -- up to 5 percent of the general population has them, according to Hopkins. But only about 5 percent to 20 percent of the nodules are malignant, doctors say. Typically the size of a pea, these lumps may be made of abnormally growing cells, cysts, or swelling caused by thyroid inflammation. As in Gore's case, they usually don't cause any symptoms.
Doctors first detected the nodules in the vice president's wife a few months ago when she saw her primary care physician for a follow-up visit for an exercise-related injury to her neck.
Gore had no thyroid-related symptoms such as fatigue, mild weight gain or dry skin, and tests revealed that her thyroid is functioning normally, Johnston said.
Typically, patients undergo a fine needle aspiration biopsy, to draw out cells from the swelling and test for malignancy. If the findings are uncertain, as they were in Gore's case, physicians say they might monitor the nodule for several weeks, using medication to try to shrink it. One in five nodules cannot be definitely diagnosed by biopsy, Hopkins doctors say.
If a malignancy has not completely been ruled out, surgeons might remove the nodule and, usually, half of the thyroid gland along with it. (Despite this, the gland still functions normally, and no medicine is needed to compensate for the lost half.)
For the operation, patients are put under general anesthesia and usually spend one night in the hospital. Doctors make an incision a few inches long in the front of the neck, usually along a fold of skin to minimize the scar.
There are few risks, said Dr. Bruce Weintraub, professor of medicine at the University of Maryland School of Medicine and head of the thyroid cancer program at the Greenebaum Cancer Center. At most, the next day, Gore will have a scratchy voice and some pain in her neck.
It will take about a week to determine whether the nodule removed from Gore's thyroid is malignant, doctors said. Generally, thyroid cancers are among the most treatable, Weintraub said, and removing the gland usually cures the patient, although follow-up is always needed.
The Gores spent many days at Hopkins in 1989, when their son, Albert Gore III, was hit by a car and seriously injured as he and his father left Memorial Stadium from the Baltimore Orioles' Opening Day game.
"The Gores have a long, established relationship with Johns Hopkins," Johnston said, "and they feel very comfortable with the quality of their care."