Graves’ Disease? A Thyroidectomy? But I’m a Singer!
Singing has always been a part of my identity. Having sung since I was a child, I graduated college with a degree in musical theatre and moved to New York City to pursue my career. After performing in various concerts and regional theatrical productions, I took a break to learn how to do what nearly all of my voice teachers thought was impossible: belt contemporary music. I’d always been a soprano with a voice well-suited for classic melodies from the Golden Age of Broadway. But I wanted to play the quirky, powerhouse musical theatre roles, and to do that, I’d need to be able to belt. It was what I wished for every year when I blew out my birthday candles or threw a penny into a fountain. My previous teachers said my voice simply was not built for it. How wrong they were! I just needed the right teacher – and I found them. Learning how to belt was one of my most meaningful accomplishments.
As I was exploring new techniques and dimensions of my voice, I was also experiencing alarming changes to my health. What began as fatigue and a diagnosis of an underactive thyroid turned into a rapid resting heart rate, shaky hands, and weight loss. I was diagnosed with Graves’ disease, an autoimmune condition resulting in an overactive thyroid.
My endocrinologist started me on a low dose of methimazole, a medication that would block thyroid production to an extent and ideally put my thyroid levels in a healthy range until I hopefully went into remission. She explained that in her experience remission would normally happen within two years of symptoms appearing. I asked, “What if it doesn’t? What if I don’t respond well to the medication?” She told me there are two long-term solutions in that case: I would undergo radioactive iodine therapy or have my thyroid surgically removed – a thyroidectomy.
“No thanks,” I thought. I’d rather stick with the medication than have a thyroidectomy. I knew the nerves that control the vocal cords are extremely close to the thyroid, and about 1% of people who undergo a thyroidectomy experience permanent vocal damage. But I had just learned how to belt! I was living my dream, and I wasn’t going to let anything derail my hard work and the career ahead of me. I said a thyroidectomy was off the table.
Things didn’t go as planned. For almost two years, I didn’t respond well to the medication, and we struggled with finding the right dosage. Everything was either too high or too low, and I wildly swung from having too much to too little thyroid hormone. I felt like my body was completely out of control. I remember one of my doctor’s colleagues saying to me, “Wow, that number isn’t supposed to go up when we change your medication this way.” Great.
Meanwhile, I had already begun experiencing symptoms of thyroid eye disease (TED), a condition that affects many people with Graves’ disease. It was an emotional moment when I realized that one of my two long-term treatment options was off the table. Radioactive iodine therapy could exacerbate my already severe TED symptoms and lead to very serious long-term consequences, so unless I suddenly started responding well to my medication, I would have little choice ahead of me.
As the two-year mark crept closer and closer, I began to experience intense, overwhelming anxiety. Every abnormal test result brought me another step closer to what I knew deep down would be the only thing that made sense for my health: a thyroidectomy.
I took a deep breath as I walked into my endocrinologist’s office the day we made the decision together. It was the end of the day, and she sat with me for at least an extra half hour, helping me come up with a plan to find a surgeon who specialized in working with singers.
I texted my voice teacher; could they reach out to their larger network of singers, actors, and composers to ask for thyroid surgeon recommendations? Surely I wasn’t the only singer in New York City with Graves’ disease. Armed with a list of names from both my endocrinologist and voice teacher, I started researching. It wasn’t long before I found her. It was like she wrote her bio knowing I was looking for her: a surgeon whose specialty is thyroid surgeries with an emphasis on vocal preservation.
I met with the surgeon a few weeks later, and we just clicked. We laughed together at my awkward jokes. I told her how happy I was to find her, and she explained that she and her colleagues work with professional singers frequently. After hearing about my struggles with medication, she said, “It’s time for you to feel better.” We booked my surgery that day. I left feeling reassured. If I had to do this, I was at least in good hands.
And then COVID-19 hit New York City. My surgery was originally scheduled for the first week of the NYC COVID-19 shutdown in 2020. It was canceled with no guess as to when it would be rescheduled. The anxiety and sadness that had been painfully building for the previous six months only grew as I waited. Would I get to keep my voice or would I lose it? Was my voice on borrowed time? I had no idea when I would get that answer, and meanwhile I was left waiting, still responding poorly to my medication.
I got the call two months later. Would I like to have surgery in a week? I’d be one of the first patients back when the operating rooms re-opened. “Yes!” After a whirlwind of a week, I was wheeled into the operating room. My surgeon announced, “We have a singer!” I remember the anesthesiologist asking if I was performing in any shows she may have seen, but I was already drifting off. I woke up with my surgeon by my bed in the recovery room. The surgery had gone well, and my vocal cords were doing great.
I was told it would take time for my singing voice to return after the surgery, and likely my lower notes would return before the higher notes. True to form, nothing went quite as expected. My middle and upper vocal range came back relatively easily and quickly. But what about my lower notes and belt? I waited for months with anxiety building, but my surgeon was confident it would return.
After several months of healing and numerous speech therapy appointments, I had a final appointment with both my surgeon and therapist. They snaked a camera up my nose and down my throat, and said, “Now, belt!” My voice, strong and confident, filled the room. It was the most joyous doctor’s appointment I’ve ever had. I left with a photo of my very happy vocal cords, and to this day it hangs on my fridge. It’s a memory of the struggles, but also a reminder that I came out on the other side.