Singer and songwriter, Judith, recently appeared on the BBC2 health show ‘Your Body Uncovered.’ With the help of augmented reality technology, viewers saw why her multiple thyroid nodules (multinodular goitre*) were causing problems with her breathing and singing. The programme followed Judith through her surgery and on the road to recovery.

Judith kindly shared her story with us to encourage others to get any lumps or swellings in the neck checked out by a doctor and not ignore the symptoms.  She is also keen to highlight how thyroid problems primarily affect women.

Judith’s story

Hello, my name is Judith Nicholas. I am a singer and songwriter and this is my story of diagnosis with thyroid nodules.

In the spring of 2014, I discovered a lump in the left side of my throat while I was away working and performing in Los Angeles.

I had suffered from laryngitis numerous times in the past and my throat always became inflamed. So I put it down to that.

I wasn’t experiencing any pain or discomfort so I carried on and made a decision that I would see my doctor once I got back to London. When I saw my GP, he scheduled a hospital appointment for me to have a biopsy done.

This procedure was awful. It involved inserting a needle in my neck to draw a sample to be tested. I found it extremely painful, uncomfortable, and it was not something I wanted to experience again.**

The results came back two weeks later. Because they were inconclusive, the hospital required the test to be repeated. This was not music to my ears because the procedure had been so horrible! This time, my sons accompanied me to the hospital for moral support.

The biopsy was repeated and they said the results were benign. This was good news, however, they suggested I should look into having the nodule removed.

I went away scared but glad that it wasn’t cancer. No one mentioned that there was a possibility that the nodule would grow. My GP said if it wasn’t bothering me then surgery was not necessary.

This all happened in 2014 continuing into 2015.

In 2016, I started having a lot of coughs and issues with my throat. Again, I thought nothing of the nodule in my throat. However, in 2017 I did notice my weight increasing and my neck swelling more. To hide my neck I always wore scarves in winter and tops that covered the side of my neck over the summer months.

I went to see my GP. This was a new doctor as my original doctor had retired by then. She examined my throat and said that she felt the goitre and recommended I should have another biopsy done.

Once again I said I was fine and did not want to discuss surgery. At that point, I had no clue the nodule was growing. I was in complete denial.

During the summer of 2017, I was taking part in a jazz festival in Macedonia. I didn’t want to miss it so ignored all the signs about my health. When I look back I was extremely unwell. My body and neck were swollen, including my feet, legs, and hands yet I still ignored the signs. I could have gasped or stopped breathing at any time*. I was so afraid to face what was happening to me. So I pretended nothing was wrong.

I still acted like everything was fine and from 2017 to 2018 I still chose to ignore the symptoms. At this point, I was becoming increasingly sick each year. I had bad colds with troubling coughs. By this point, breathing had become a problem. I felt out of breath and struggled with my weight. I was slowly becoming very depressed.

Then, in 2019, my father suffered two heart attacks and passed away on 4 April. It knocked the wind out of me and I noticed my neck started to look a lot bigger. I was at a low point. My employer was not very supportive and thought I was lying about being sick. So I would go into work struggling for fear of colleagues gossiping.

That’s how the rest of 2019 went, working while I was sick and in a lot of pain.

Then Covid-19 struck in 2020. This was one of the worst and best things to have happened to me!

Whilst at work on February 28 2020, I was ok one minute. Then all of a sudden I had a temperature and felt extremely sick. By the time I got home, I had a temperature off the charts. I was hot and cold and the coughing started. I could barely breathe; the wheezing was so bad that my GP had to come to see me.

He gave me antibiotics and mentioned that the goitre was very large. The antibiotics helped a little but, at that point, we did not know what this virus was. All we do was hope the antibiotics would work. I could barely move, sleep, breathe or eat.

I was completely wiped out and could not go to work. After two weeks the major symptoms passed. By then the whole of the country was locked down.

Despite getting over the virus, the cough and the wheezing never stopped. I started suffering from extreme nightmares, migraines, joint pains, weight gain, chest pains. On top of that, I had fibroids which I had to schedule to have removed.

The coughing continued through 2020. I’ve never had a persistent cough like this so I was worried.

In May 2021, I called my GP and requested a chest X-ray. By this time the coughing and wheezing were unbearable. I wanted to know if having Covid-19 had caused problems in my lungs. I didn’t even consider that the goitre could be affecting my health. That’s how much in denial I was!

Two weeks later my GP called and said she needed to talk to me urgently about the X-ray results. She said it was serious and that I needed to sit down. She explained that the goitre had grown to 11 cms and that I needed to go to have a CT Scan and MRI scan straight away.

I sat down on my bed in shock. I knew I could no longer avoid what I had been running away from for six years. The truth was that I had a goitre in my neck, which was steadily growing bigger. No amount of denial or wishful thinking was going to remove this goitre. The only thing that would was surgery. I could no longer hide from this serious health issue. I had risked my health for six years because of fear!

Being a singer my voice is my instrument. Without my voice, I feared how I would function. I found the biopsy procedure so frightening and painful it had put me off having, or even considering, surgery. This was detrimental to my ever-increasing health issues.

Once I started going to all the scans, I slowly realised I had no choice but to have the surgery. While attending one of the consultations, the surgeon, Miss Aimee di Marco, asked whether I would be interested in participating in the show. My son was with me at the time and encouraged me to do it. I was unsure so said I would think about it.

A few days later I got a call from the BBC. We talked in-depth about the symptoms and I took the decision to do the documentary. If it meant I could raise awareness of thyroid nodules, and how they predominantly affect women, then it was something I wanted to do.

When the day came for me to see my goitre in 3D, I was very nervous. This was because I had refused to look at my neck and acknowledge that I was unwell for so long. I knew it would be tough seeing this. And I was right! It shocked me to see on the 3D imaging just how bad things had become in my body and neck. It caused me to break down and cry.

Off-camera, I sobbed. My sister and Kate Garraway came in from the adjacent room to comfort me. They held my hand and said they could see how hard the images had hit me but that it was not too late to change the outcome.

I kept looking at the goitre from every angle and saw how my windpipe was twisted. This explained why I could not sing the way I could before and why I was constantly struggling to breathe or sleep at night. I couldn’t even raise my arms to brush my hair properly because if I did I could feel the goitre rising in my throat.

Writing this down, I can see I was truly in denial and was jeopardising my health because I was afraid of losing my voice. But by leaving this for so long I nearly lost my life.

If it wasn’t for surgeon, Aimee, asking me to take part in this documentary and seeing this goitre I would have tried to wriggle out of the surgery again. Thank goodness I was offered this technology because it saved my life by changing my perception of the surgery that I needed.

After seeing the 3d imaging, I made the decision to have the surgery. I couldn’t live in fear anymore but mostly I wanted to get back to how I was before and get back to singing again.

The surgery was scheduled for 13 October 2021. My son Fabian accompanied me to Hammersmith Hospital. He could sense I was very nervous. Even though I knew I had to go through with the surgery, I was still scared I would not sing again and that my voice would not be the same. Nevertheless, I was here and there was no turning back from this. It needed to be done.

I had a great team of experts who were going to do the surgery and, with Aimee Di Marco as my consultant, I had faith that all would be well.

From the footage, you can see it was a complex operation. Because of where the goitre was positioned, they needed to be extremely careful not to overstretch the nerves near my voice box. Aimee had to take her time and I thank her for that. When I came to in the afternoon I was drowsy and sore. I was very hoarse but was able to say some words. This reassured me that had done what they set out to do. It would just be a matter of time to see how I would recover.

When I got home I was in a lot of pain and sore from my chest up to my throat. I could not make any sudden moves or sleep on my side. I had to lie slightly upright; it was the only comfortable position to be in.

Talking was out of the question while my throat was extremely hoarse. I could only drink soup and liquids over the next three weeks.

After around six weeks, I could start singing again. I couldn’t push it too hard because my throat was still sore. As you can see from the final part of the documentary, I was able to sing again.

It’s now Spring 2022 and I’m still taking it day by day. I had a slight setback after having the booster jab in December. I developed a cold and started wheezing. I contacted Aimee Di Marco, and she asked me to come and see her. Aimee checked my breathing and could hear it sounded noisy when I lay down. So she prescribed some meds to help and so far it’s working. This had nothing to do with the surgery. I believe it was a reaction to the booster jab.

My remaining thyroid seems to be working fine and I’m now I’m starting to do some light exercises to get back into shape. I’ve gained weight over the last seven years with this issue. So, now I have to work hard at getting myself fit again which will not be easy and will take time.

I want to say to anyone who discovers a lump in their throat, or any other part of their body; get it checked out. Talk to your doctor and have a family member go with you for support if needed. Most of all know that by reading information and discussing everything in great length you will feel more empowered and less afraid.  I only wish that it hadn’t taken me seven years to have the surgery. Had I done it sooner, perhaps it would have prevented a lot of the other symptoms that I went through. I’m glad I had the surgery in the end and, one day at a time, I’m getting better.

Thank you for listening to my story.

Judith 

BTF comment

Thyroid nodules (lumps) and goitres (swellings) are common. By the age of 60, almost half of people have at least one nodule in their thyroid. The vast majority (approx. 95%) are benign, do not cause any problems and do not require treatment. A larger nodule, or more than one nodule, does not mean a higher risk of cancer either. However, you should always get them checked by your doctor in case they are cancerous or likely to cause problems, such as hoarseness, voice changes or breathing difficulties. Your doctor may wish to conduct a blood test to check your thyroid function and may refer you for further investigations, such as an ultrasound or Fine Needle Aspiration Cytology (FNAC) if necessary.

There are different types of thyroid nodules and swellings. Sometimes they are ‘hot’ meaning they produce too much thyroid hormone and, less commonly (around 5 in 100), they can be cancerous.

*Judith had a multinodular goitre. This is where there are multiple nodules on the thyroid gland. In many cases, multinodular goitres are not visible and are incidentally picked up on a scan being performed for another reason. They can appear in someone with normal thyroid function, thyroid overactivity or thyroid underactivity.  

This form of goitre is common and usually does not require an operation unless there are problems with swallowing and/or breathing or if the goitre becomes unsightly. Judith’s goitre had grown down into her chest causing compression on her airway. In such patients, surgery is usually required. Complete blockage of the windpipe due to a multinodular goitre is extremely rare (around 6 in 1000 in people with known multinodular goitre). The vast majority will go through life either not knowing they have a goitre or with minimal or no symptoms.

** Fine Needle Aspiration Cytology (FNAC) is a procedure in which some of the thyroid nodule cells are removed using a thin needle. The cells are then examined under a microscope. There may be some discomfort but the procedure is usually quite quick. For most people, and in experienced hands, this is similar to having a blood test taken with a fine needle being inserted through the skin. The fine needle (as the name itself implies) is then moved up and down a few times (in a drilling motion) so that enough material is obtained into the needle. Some people can opt to have local anaesthesia prior to the procedure although many prefer not to have this done as it involves an additional needle insertion.

Information about thyroid nodules and swellings 

Judith appeared in episode 3  of ‘Your Body Uncovered’ on BBC 2 on 16 March 2022

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