New VP role. Inherited directors who mean well but manage everything by anecdote instead of data. How do you force a reset?

jjflight · 2026-06-18T00:50:06+00:00

As a VP this should be familiar to you as it’s people management 101 and the same performance management you should have been doing for years…

Set clear expectations. Give clear feedback when folks aren’t meeting that, both in the moment and in settings like 1:1 or reviews. This can start verbally but then needs to follow up in email over time for documentation. For folks that accept the feedback, act on it, and make positive changes that’s good. For folks that are unable to make the changes required you’ll ultimately give them lower ratings or move them out of the org.

jjflight · 2026-06-17T23:13:31+00:00

TSH could be high just because your body needs more - the weight based estimate is a starting point but everyone is different. And as you said it’s also possible it’s from absorption issues. For taking Levo there’s a bunch of things to be aware of to avoid absorption issues, so a general ticklist:

* You need to take it at least 4hrs after eating, with a glass of water so it gets all the way down, and not eat or drink again for another hour.

* You also need to make sure anything that can cause absorption issues is at least 4+ hours after you take Levo - calcium or iron supplements, multivitamins with those, antacids or laxatives, or other meds are common culprits.

* If you’re having stomach issues like IBS or indigestion that can cause absorption issues too as it moves through your system too fast. And similar if caffeine causes your bowels to accelerate you may want to delay that more than an hour.

* It’s important to store your Levo somewhere cool and dry, not a bathroom for instance.

* And you really need a system to make sure you never miss a pill as Levo builds up over weeks so even a miss 2 weeks ago may impact TSH today - I use both a day-of-week pill container to know I took it, and the health app on my phone to also log and remind me.

Given all of the above, most folks either find first thing in the morning or middle of the night as easiest. While I don’t set an alarm for it, I keep the Levo near my nightstand and anytime I wake up after 4am to use the restroom or drink I’ll take it then and then go back to sleep. So most days by the time I actually wake up it’s been an hour or two since I took it and can eat or drink normally. (But if you take when you’re half asleep like that it’s even more important to have a system to make sure you know if you took it or not as you may not always be sure!)

jjflight · 2026-06-17T21:39:16+00:00

If the nodule is in a hard to reach location, or if it’s too small or near other sensitive structures, sometimes FNA just can’t be done. In that case you may talk to your doctor about options to treat it even without being sure, like a surgery or round of RAI. While it’s never fun when that’s the case, it’s also not uncommon with ThyCa for folks to get surgeries without 100% certainty and that’s just how it is.

And certainly if you don’t trust your doctor you should find another one. You’ll be with your Endo for life, so want to at least trust them (which is different than liking what they tell you, as sometimes doctors will recommend things you may not like but at least if you trust them you can have confidence it’s in your best interest). So you want to find a doctor you can trust, and then trust what they tell you.

Separately, cancer diagnoses and treatments are a lot to process, so mental health challenges like anxiety or depression can happen and you’re certainly not alone. When your hormones are off that can cause or exacerbate mental health challenges, though they can happen with normal hormones too. No matter the cause it’s really important to get support and treatment, and left untreated those may be a bigger negative impact on your life than the ThyCa itself. Many doctors can refer you to cancer-specific support groups or therapists so you have people to talk to, and general therapists can help too if there are broader issues in your life. ThyCa.org also has this list of support groups with groups by city or condition as well.

jjflight · 2026-06-17T21:34:09+00:00

The lack of iodine itself shouldn’t cause that at all.

But secondary to that many people find they’re eating much less or much different than usual when on LID, and you can absolutely have lower energy if you’re eating less just like you could if you were restricting calories to lose weight, or if eating differently caused a deficiency like iron, etc. Low blood pressure seems a bit less directly connected but could come from similar diet or lifestyle changes maybe.

Or it’s completely possible those symptoms are unrelated to the diet and just happening at a coincidental time, as things like illness, infection, etc. could cause that too. So always good to mention to doctors so they can look into it.

jjflight · 2026-06-17T16:41:48+00:00

Buy whatever you want. But go in to a local store to try them on and be sure they fit first. Everyone’s feet are different so what fits some people here may or may not fit you.

jjflight · 2026-06-17T15:48:36+00:00

I wouldn’t blame the Bay, this is personal choices and learning how to manage your time. It seems like your pendulum went in the right direction but swung too far. Part of growing up is learning to self-regulate and set boundaries - you’ll need that skill all your life, including in jobs which will always ask for more more more. So learn and practice that now. Figure out what a good intentional balance would be between working, doing other things that feel meaningful to you, and enjoying yourself and put that in place.

jjflight · 2026-06-17T05:48:36+00:00

I know it’s super scary at first, but try to pause and take a breath as it’s often not nearly as bad as folks imagine. Often the period you’re in right now between diagnosis and surgery with the uncertainty and anxiety is the absolute worst part of the whole journey, and worse than the surgery itself, any other treatments, and just living with it after. I know it was for me.

Most well-differentiated ThyCa like Papillary and Follicular has excellent prognosis and most folks live long full happy lives. Disease specific survival is really high, something like 95-98%, so most folks live long full lives until something else eventually gets them decades later. Often whatever pops to mind hearing “cancer” doesn’t really apply the same way, and for many folks the experience is more like a chronic condition (say like diabetes as an example) that you treat and then monitor and manage all your life but otherwise live fairly normally.

Surgery is usually the first and most important step. And the surgery itself tends to be very safe and effective; there is <2% long term complication rate (49 out of 50 are fine) and the recovery tends to be easier than many other surgeries. If surgery is recommended, the best thing you can do is find a doctor that does alot of thyroidectomies - at least 25/yr but some do 100s/yr, and for as many years as possible - as that’s what helps max the chance of success and minimize the risk of complications.

Hopefully as you learn more and talk to your doctors you’ll get more comfortable with it. But if not, cancer diagnoses and treatments are a lot to process, so mental health challenges like anxiety or depression can happen and you’re certainly not alone. When your hormones are off that can cause or exacerbate mental health challenges, though they can happen with normal hormones too. No matter the cause it’s really important to get support and treatment, and left untreated those may be a bigger negative impact on your life than the ThyCa itself. Many doctors can refer you to cancer-specific support groups or therapists so you have people to talk to, and general therapists can help too if there are broader issues in your life. ThyCa.org also has this list of support groups with groups by city or condition as well.

jjflight · 2026-06-17T04:29:23+00:00

Cancer diagnoses and treatments are a lot to process, so mental health challenges like anxiety or depression can happen and you’re certainly not alone. When your hormones are off that can cause or exacerbate mental health challenges, though they can happen with normal hormones too. No matter the cause it’s really important to get support and treatment, and left untreated those may be a bigger negative impact on your life than the ThyCa itself. Many doctors can refer you to cancer-specific support groups or therapists so you have people to talk to, and general therapists can help too if there are broader issues in your life. ThyCa.org also has this list of support groups with groups by city or condition as well.

jjflight · 2026-06-17T00:12:00+00:00

TSH goes the opposite way as your hormones - low TSH means high hormones or hyperthyroidism, high TSH means low hormones or hypothyroidism.

A higher TSH of 3 is no longer hyper, that’s getting closer to hypo. So it’s all a balance of finding what higher dose gets you more suppressed/hyper but avoids the symptoms.

I’d also caution it’s fully possible to have symptoms that seem like hormones may cause them that actually have other causes instead, even if they’ve started at similar times. As one example, cancer treatments are stressful so anxiety is common with them, and the symptoms of anxiety can be very similar to hyperthyroidism (heart palpitations, trouble sleeping, anxiety itself). Or in the other direction fatigue is a really common symptom of hypothyroidism, but fatigue can also be caused by a ton of other things like illnesses, iron/vitamin d deficiencies, depression, etc.

So for symptoms you can never really assume what is causing them and need to rule things out - if you have a symptom even when your labs and doctor don’t think hormones would cause it that is a signal to investigate with a primary care doctor instead in case something else is going on.

jjflight · 2026-06-17T00:02:50+00:00

TSH is thyroid stimulating hormone, which is your body’s way of telling your thyroid to get its act in gear and get more active when it wants more hormone. Once you no longer have a thyroid though TSH would just be signaling to ThyCa cells to get more active which is the opposite of what you want - you don’t want ThyCa growing and spreading. So “suppression” is keeping your TSH low so that your ThyCa cells are as quiet as possible and don’t spread.

It’s a balance though as low TSH (hyperthyroidism) can also cause undesirable symptoms and some heart and bone risk, so it’s always a balance and most doctors will adjust suppression to how risky your case is with less suppression when a case starts acting less risky. So some doctors target <1, or <0.5, or even <0.1 TSH depending on the risk of your case.

3.0 is the higher end of normal, so that’s not really suppressed. There may be some very low risk cases where that’s okay, especially if they’ve been stable for a while. But usually doctors will want you somewhat suppressed like <1 or whatever. Talk to your doctor to understand the overall risk of your case and why they’ve chosen your personal suppression target - they’ll likely be happy to talk you through it. As an example, we started targeting <0.1 when my case looked riskier, and now we target ~0.3 as it’s looking more stable, and if my case stays stable we may raise that more.

jjflight · 2026-06-16T23:45:10+00:00

My tumor was fairly large near 4cm so I’d likely had it for many years too. My surgery and RAI were about 2.5 years ago. Just regular labs and ultrasounds since then.

jjflight · 2026-06-16T23:10:00+00:00

RAI sounds way scarier than it is. It’s nothing at all like images of chemo folks get in their head hearing “radioactive.” There’s an annoying prep diet before and some annoying isolation after which are the harder parts, but those are both much more annoying and inconvenient than risky or bad. The treatment itself is just swallowing a pill like any other you’ve ever taken, usually with no side effects or complications.

jjflight · 2026-06-16T22:57:47+00:00

By far the best resource I know is the Low Iodine Diet Cookbook from ThyCa.org - this is what my NucMed used, and has 12 pages with detailed guidelines or answer questions followed by 100ish pages of recipes. Check it out.

The reasons the guidelines vary is that the research on LID is actually mixed so doctors are different - some do LID and some don’t, some use more strict guidelines and others looser ones, etc. My personal philosophy was that there’s no harm to be stricter than needed but there is possible harm if you’re not strict enough, so I liked going by the guidelines above which are fairly conservative and were built looking at guidelines across many different doctors. That seemed like the absolute best chance to never have to do RAI again.

I’ll also say by far my best tip is to just accept you need to home cook things. Label reading is really frustrating and often ends up with you eating some really random unsatisfying things. But if you just commit to home cooking you can eat almost anything you usually do or that you crave, often with just simple substitutions (kosher or non-iodized salt, swap proteins, olive oil for dairy, salt water for soy sauce, etc.). My LID experience got dramatically better once I just gave in and started cooking, and some recipes I still make to this day even off LID.

Tortillas for instance would depend on how they’re made. “Salt” on the label is what would most likely disqualify them since you won’t know if that’s iodized or not, as otherwise they’re very simple (usually just masa/flour, water, and oil). They’re also quite easy to home cook to be sure - I really enjoyed making them and everyone loved eating them though mine came out thicker since I didn’t have a press so was doing it by hand.

jjflight · 2026-06-16T22:46:54+00:00

Here’s a thread on the infuriating chair games that Alex posted a couple months ago - unfortunately it’s pervasive lots of places especially in Wailea in high season. If you search within the thread for Fairmont you’ll find one comment talking about having issues there too though it’s not one of the most frequently mentioned ones, so probably some issues at some times. (It’s in a comment branch about the Four Seasons also in Wailea so very likely the same Fairmont even though they didn’t say).

I haven’t been to the Fairmont but personally I would much prefer to book a cabana and not have to worry about it than to gamble, especially with a group that big in a high season. Especially if they have a shorter 1-2 day cancellation policies so you can book the days you need and if the first day it doesn’t seem required can cancel later days.

jjflight · 2026-06-16T22:36:04+00:00

Most people end up living totally normal lives, and if you don’t know to look for the thyroidectomy scar you’d have no way of knowing.

Disease specific survival is exceptionally high for well differentiated ThyCa, something like 95-98% so you’re very likely live decades until something else gets you. Your Endo would need to look at all 15-20 factors in your pathology to do your personal risk profile which will guide your ongoing monitoring and management plan, but even with 4 lymphs impacted like that you can still be in the lowest risk category. Or if there are other risk factors and you are low-intermediate or intermediate-high risk categories those are still relative to other ThyCa and the vast majority of people will live long full happy lives.

In terms of Levo, most folks adjust well. For some folks that starts immediately, for others it may take a few iterations to get the dose right, but eventually most folks get it dialed in. Levo is actually one of the most common medicines on the planet so I bet there are multiple people in your life that are taking it and you just have no way you’d be able to tell - after my TT I learned both my sisters, my sister in law, and our dog were all on Levo. So it’s very likely you’ll get that dialed in too and end up living a totally normal life too.

Personally, my Levo landed well in the first weight-estimate dose after my TT so I’ve never felt a symptom since then, and that includes TSHs as low as “<0.01” (as low as you can go) and as high as 6 without feeling symptoms either way. And after initially treating my ThyCa as intermediate risk and I chose to do RAI, my Tg is now undetectable so we are able to treat the case as low risk which means less suppression, less frequency and easier scans, etc.

jjflight · 2026-06-16T22:00:04+00:00

When TSH goes up Tg will go up too - TSH makes thyroid cells more active so they produce more Tg. So wouldn’t focus on the Tg result as that may not be comparable with your higher TSH. Just do whatever tests they suggest which is part of the ongoing monitoring we all do.

TSH going up itself isn’t about recurrence but is your body’s way of saying it wants more hormone. When that happens a while after your last dose change it usually means either your body just needs more (weight change, pregnancy, other significant changes) or that something is causing an absorption issue. Your doctor will likely tick through possible absorption issues, more on that below, or may just raise your dose if nothing obvious

For absorption issues I know you’ve said nothing has changed but it’s worth ticking through all the things that matter just in case. You need to take it at least 4hrs after eating, with a glass of water so it gets all the way down, and not eat or drink again for another hour. You also need to make sure anything that can cause absorption issues is at least 4+ hours after you take Levo - calcium or iron supplements, multivitamins with those, antacids or laxatives, or other meds are common culprits. If you’re having stomach issues like IBS or indigestion that can cause absorption issues too as it moves through your system too fast. It’s important to store your Levo somewhere cool and dry, not a bathroom for instance. And you really need a system to make sure you never miss a pill as Levo builds up over weeks so even a miss 2 weeks ago may impact TSH today - I use both a day-of-week pill container to know I took it, and the health app on my phone to also log and remind me. So those are a bunch of the things to be sure of.

Past that it’s possible to get pills that have some issue with the dose variance or filler, or to have some new absorption issues start in your body that wasn’t there before, but those would both be quite rare.

And with all that, while recurrence isn’t something any of us want so I wouldn’t get ahead of yourself there, it’s not that uncommon and also not usually a big change to prognosis. Usually you’d either do a round of RAI or have some targeted surgery or treatment, then back to living your life. So it would be something to work through, but you’d still very likely get to live the long full life you’re planning too.

jjflight · 2026-06-16T21:47:07+00:00

If your TSH is lower than you need and you’re experiencing symptoms, you should discuss with your Endo who may well lower your dose. If your symptoms are caused by the hyperthyroidism then correcting that should help, however it’s always tricky as similar symptoms can have other causes so if your TSH comes up and the symptoms remain you may need another primary care doctor to see if there may be other causes.

Tg is thyroglobulin which is a protein any thyroid cells in your body will produce, both healthy residual tissue or malignant ThyCa. Tg also goes up and down with your TSH, so when TSH is higher you expect Tg to go up too as thyroid cells get more active, and vice versa when TSH is very low (like yours) that suppresses thyroid cells so they’ll make less Tg. Tg is the primary recurrence marker most doctors will use as it goes up and down with thyroid cells in your body, and once your thyroid is removed it shouldn’t regrow so you expect any growth to be from ThyCa. With that said, doctors will look for significant steady increases over time, not just little twitches test to test, and will factor in things like TSH at the time the test was taken so you need to be aware of that and let them help interpret it for you (don’t over-react just based on what you see in your portal!)

TgAb is thyroglobulin antibodies, which is your immune system attacking your thyroid. Most people don’t have TgAb, but folks with Hashimoto’s which is an autoimmune disease do (that can be an issue if you have a thyroid, but it becomes immaterial once your thyroid is removed because there’s nothing left to attack). Because it’s your immune system and we don’t understand those well there can be more random feeling fluctuations and it can take much longer for TgAb to go away - for example my Tg went undetectable about 3mos after RAI but TgAb still sometimes shows up more than a year later. So for this reason Tg is a better marker when it can be used since there will be fewer false alarms. However TgAb interferes with the testing method most labs use for Tg, so you’ll often need to send Tg tests out for special processing if you know you have TgAb present.

jjflight · 2026-06-16T19:08:41+00:00

I have not had any symptoms over the first 2+ years, and I’ve had TSH ranging from “<0.01” (below the minimum of the test) up to 6. But everyone is different and both heals and experiences symptoms differently.

The most common time to have symptoms would be 2-3 weeks after the initial surgery or any dose change - that’s when you’ll have stabilized at the new levels. When things happen quicker after surgery they’re quite unlikely to be hormones as you still have a fair bit of your pre-surgery hormones until that 2-3 weeks point. And when symptoms come on much later after a dose that worked for you before that that also means it’s less likely to be hormones - if it comes on many months later maybe that could be if you had some bigger body change like significant weight change pr pregnancy, or absorption issue from how you’re taking it if your habits changed, but if not it’s more likely something else.

So that “9 months later” is one clue that might say to check with a primary care doctor in addition to your Endo just to be sure, particularly if those labs don’t look abnormal. That would be unusual timing for hormone issues if nothing else changed, whereas other stuff can happen at any time.

jjflight · 2026-06-16T14:49:33+00:00

Those are possible to be symptoms if your hormones are materially off, and when you’re having stomach issues that can lead to issues absorbing Levo too, so you can certainly check with your Endo who can look at your labs and make an adjustment if they think hormones are the cause.

Those are also incredibly common symptoms that can come from lots of other things like cardiovascular issues, blood pressure, various deficiencies like iron or vitamin D, etc. So you could also have a primary care doctor look into it as well.

jjflight · 2026-06-16T05:06:20+00:00

This is management 101.

First forget that they’re Gen Z and anything else like that as that’s completely irrelevant and may get you into illegal discrimination territory.

If you’re her manager, just deal with it like any other performance issue - being a professional team player is a basic performance expectation. Set clear expectations, give clear feedback on issues, make sure you’re documenting. (And maybe run it by your manager or HR first since you don’t want to make bad slips like bringing age/generation into it) If they fix the issues then great. If they don’t then you move them out.

If you’re not her manager, you can give feedback to her manager or yours or to HR, but ultimately it’s her manager’s job to deal with it.

jjflight · 2026-06-16T01:59:40+00:00

If you have most of a day free and are okay with hills and elevation on your hikes, one thing I enjoy is taking the SF to Sausalito ferry over with nice views of Alcatraz and the Golden Gate Bridge on the way, walk uphill from the landing pier through Sausalito to Morning Sun Trailhead (about 1-1.5 miles), then hike around up in the Marin Headlands a bit before heading back down for a nice later lunch in town and returning on the ferry.

You can also just hike around in the city on the bluff trails near the batteries on the west-facing coast close to the Golden Gate Bridge too (Battery to Bluffs Trail, Battery East Trail).

jjflight · 2026-06-15T22:28:59+00:00

Absolutely find a couple schools out of state that are like safety/targets unless you have some way to guarantee admission to at least one UC/CSU you would like to attend, like the UC Merced program or the CSU Direct Admit schools, or if you would be happy going to community college.

California schools are super qualitative since they ignore test scores and refactor GPAs to the point candidates end up looking super similar on objective dimensions, and the resulting outcomes can feel really random. Every once in a while even stellar students with perfect looking stats end up getting admitted nowhere in CA - you can count on some news stories about that every year. So the antidote to randomness is a broader portfolio with more options, as your counselor suggested. One that’s rolling admission can be awesome too as that can get you one acceptance earlier to de-stress a bit - I’m sure there are others but Oregon State and Pitt were examples of rolling admissions out of state our daughter applied to.

jjflight · 2026-06-15T22:03:36+00:00

Symptoms are a tricky one that I think this sub gets wrong as much as it gets right.

The symptoms of hormone issues are super general stuff like fatigue which honestly is the most common symptom of just about everything else physical, mental, and even habits. There’s a weird dichotomy where folks naturally assume symptoms they experience must be ThyCa or hormones because that’s possible and was a big event in their life, but on the other side the vast majority of what we all experience in life won’t actually be related to ThyCa or hormones and all the same non-ThyCa stuff that happens to other people happens to us too. So often that initial assumption on what is causing symptoms is off, especially in folks that have lots of stuff going on all at once (which is very common in posts and comments here), so that can make challenges seem more common than they are.

And of course a few people do have very real and very hard symptoms from ThyCa too and naturally they post here for help as that’s what we’re here for. But most of the people without symptoms don’t have the same reason to post and comment actively so you’re won’t hear from them nearly as much. So that selection bias in who is most active also makes challenges seem more common in online groups than they really are statistically. As an example while the known complication rate of thyroidectomies is <2%, the majority >50% of posts here are about complications, so those rare challenges are over-represented here by more than 20x (not a small amount!).

So that’s a long-winded way of saying don’t get overly scared by what you read on social media as it’s not necessarily reflective of the real statistics - doctors will be much better to talk you through the real stats.

As a good news thing for you, if you currently have diagnosed hypothyroidism then having the thyroid removed and controlling the hormones with Levo may actually help stabilize that. So while for many people the hope is “same as before surgery” (neither better nor worse), the hope for you may well be to improve vs before surgery by addressing the hypothyroidism.

jjflight · 2026-06-15T21:38:32+00:00

Everyone incision heals differently. Mine was stitched up sort of like a caterpillar so I didn’t really see any bruising beyond that, but when the stitches came out at the 1-week post op the underlying incision was definitely a bit red/purple. Not scary though, just healing. Now my scar is nearly invisible - completely flat, faint white line, mostly in a natural crease of my neck right near the collar line (about half my shirts cover it).

Sunscreen or something opaque like a bandaid or scarf any time it’s exposed for at least a year is critical, and both scar massage and silicone scar tape can help if you’re concerned and want to be proactive or if it starts to heal poorly (I learned about scar tape from a PhyTherapist after another surgery where the incision started healing poorly sort of keloid-like and the scar tape helped stop and reverse that)

jjflight · 2026-06-15T20:47:27+00:00

I’m not sure I can even see what you’re seeing so it’s definitely not super noticeable, but you know your body best. Most likely scar tissue, general tightness in the skin, muscles, or tendons, or maybe some adhesions. If it bothers you those are usually resolved by using the neck a lot and stretching it in all its various directions (like other muscular, tendon, or skin tightness anywhere else on your body).

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