Karen Smyers is a triathlete, competing at the sport’s highest level. On August 15, 2001, she gained America’s top ranking, finishing first in the U.S. Triathlon Championship.
During her college career at Princeton University, she both swam and ran the mile and mile-and-a-half in track. For a time after graduation, she worked for a computer consulting service, but maintained her fitness and her love of competitive sports. Gradually, her love of sports won out and now she is a full-time triathlete. Currently, she keeps in shape by running four times a week, biking four times a week, and swimming four times a week. But hers are no ordinary distances. In each week she runs 40-60 miles, bikes 100-120 miles, and swims 2-4 miles to maintain her top physical condition. In competition as a triathlete, she must run 20 miles, bike 120 miles, and swim ¼ to one mile. For the even more rigorous Ironman competitions, she must swim 2.4 miles, bike 112 miles, and then run 26.2 miles (marathon distance).
In September 1999, Karen went to see her doctor because of what seemed to be swollen glands in her neck. Her physician alertly noted that it was the thyroid and nearby lymph nodes that were swollen and referred her to an endocrinologist. An ultrasound examination showed that part of her thyroid was enlarged and there were five or six other nodules nearby in the neck. A biopsy was done, but no definite diagnosis of cancer could be made. Nevertheless, it was clear that Karen needed to have her thyroid removed because the microscopic findings and her clinical picture were suspicious for thyroid cancer.
Now she was faced with a dilemma: she knew she needed thyroid surgery, but wanted desperately to compete in her second Ironman competition just one month away. She asked her doctor whether it was possible to postpone surgery and compete. Her doctor replied that even if it were a thyroid cancer, it was probably growing very slowly and doubted that the short delay in surgery would add much risk for her. Karen competed and placed second.
"I felt great," she says, "and told my doctor I wanted to enter one more competition in Mexico before the operation."
She did this too, but in the course of the race, a woman bicycling in front of her fell, causing Karen to fall as well and break her collarbone. This extremely painful fracture limited her ability to train for months.
In December 1999, Karen had her thyroid surgery. Fortunately, her tumor proved to be a papillary cancer, which tends to be more easily contained than other forms of cancer and is often curable.
In Karen’s operation, her thyroid gland and all of the swollen lymph nodes on the left side where the cancer was located were removed. After surgery, the surgeon told her that there was a great deal of abnormal-appearing tissue in her neck, and he could not be sure that the entire tumor had been removed despite the six hour operation. A radioiodine scan was needed to look for evidence of more thyroid cancer.
I asked Karen whether she was able to continue to exercise while preparing for a "withdrawal scan" for which she had to stop all thyroid hormone and become profoundly hypothyroid. "Exercise actually helped me," Karen recalls, "I never experienced the extreme fatigue and muscle cramps that my doctors thought might occur."
Unfortunately, the new scan showed that despite her previous surgery there were five or six more lymph glands that appeared to contain thyroid cancer. Karen would need a second operation.
Karen knew she needed the operation but she had to think of her career as well. Her collarbone fracture had healed, and she was now able to train without pain. Moreover, the Olympic trials were just three weeks off, and she desperately wanted to make the team. Despite her illness and inability to train properly, Karen placed seventh in the U.S. Olympic Trials. Unfortunately, she needed to be fourth or better to make the team.
Guided by the radioiodine scan, her surgeon was able to remove the remaining thyroid tissue and cancerous lymph nodes. Unfortunately, she woke up with severe neck pain, apparently due to the positioning of her head during surgery which was required to expose the part of her neck where the cancer remained. But like the true professional she is, she got the necessary physical therapy and did the needed stretching to control the pain and return to her usual training program.
Karen did win the U.S. Triathlon in August of 2001, and when I spoke with her in September she was preparing to go to Hawaii for the Ironman competition there. In order to compete and advance her career, she obtained permission from her physicians to take thyroid hormone to suppress the activity of any cancer cells that remain, and postpone her next thyroid scan and radioiodine treatment.
"I appreciate my doctors’ understanding how much these events mean to me and my career," she says. "We’re working together to plan my tests and treatments so that we control and cure the cancer, yet interfere as little as possible with my training and competitions."
After talking with Karen, I was impressed by her commitment to excellence in her career as a triathlete, but also impressed by her knowledge and understanding of her thyroid problem. Clearly her doctors had educated her about the timing of necessary tests and treatments. Then they were able to collaborate and develop a plan to dealing with her thyroid tumor that satisfied both their desire to give her the best possible treatment for her cancer, and her determination to succeed as a triathlete.
All of us at the Thyroid Foundation of America send best wishes to Karen in her continuing remarkable career as a triathlete. We also wish Karen and her physicians the very best as they work together to help her completely recover from her thyroid cancer.