How thyroid cancer diagnosis and treatment are changing
September is Thyroid Cancer Awareness Month, making this a perfect time to review some important changes in the evaluation and management of thyroid nodules and cancers that have occurred in the last several years.
The thyroid gland is a butterfly-shaped organ that lives in the front of the neck and produces hormones that regulate the body’s metabolism. Sometimes the tissue of the thyroid gland will develop lumps, called nodules. Thyroid nodules are very common, and rarely may contain cancer.
Even though most thyroid nodules do not contain cancer, the overall number of nodules being detected every year has made thyroid cancer the fastest growing cancer diagnosis in the United States.
In the past, most patients were treated the same way, regardless of the unique attributes of the patient or their cancer; almost everyone had the entire thyroid gland removed, then received radioactive iodine and high doses of thyroid hormone replacement.
Recently, however, there have been significant changes to the way thyroid nodules and cancers are managed, with an emphasis on minimizing the side effects of treatment without compromising the patient’s long-term survival.
As the number of thyroid nodules being detected has increased, a more selective use of biopsy (tissue sampling with a small needle) of these nodules have been recommended. The focus is no longer solely on the size of the nodule to determine when a biopsy should be performed, but also on the appearance of the nodule on ultrasound.
In cases where the biopsy results are uncertain, new molecular (genetic) testing can be performed on the tissue. This allows patients to better understand their risk of cancer and aids in management decisions.
MultiCare is unique in that it is the only health care system in the South Sound region that has standardized this testing throughout the entire system, meaning that all MultiCare patients can receive the same level of diagnostic testing regardless of where they have their biopsy performed.
The treatment of well-differentiated thyroid cancer is also becoming more personalized. Whereas all thyroid cancer patients in the past had their entire thyroid glands removed, new guidelines published by the American Thyroid Association in 2016 outline situations in which less extensive surgery may be considered. Additionally, more selective use of radiation therapy after surgery is also advocated.
For the most up-to-date recommendations on managing thyroid nodules and cancers, schedule an appointment with a MultiCare thyroid expert to discuss your specific health care needs. Thyroid experts can be endocrinologists, ENT doctors and/or surgeons. You can also start with your primary care doctor for a referral. Find a doctor near you.
William S. Duke, MD, FACS, is Director, Thyroid and Parathyroid Surgery of the Otolaryngology Department at MultiCare Health System. He specializes in the minimally invasive surgical treatment of thyroid conditions such as nodules, goiters, cancers, and hyperthyroidism, as well as parathyroid disorders such as hyperparathyroidism and parathyroid tumors and cancer.