2017 Thyroid New Years Resolutions: How to Avoid Biopsies and Surgery
Too many thyroid ultrasounds on people with no clinical indication. Too many biopsies on small harmless nodules, and too many surgeries on small harmless thyroid cancers, and on benign nodules that were called cancer until they were downgraded to benign nodules. Learn to be pro-active and just say no.
Ultrasound and 3D imaging is the main way all these harmless nodules and cancer are found. Resolve to refuse any imaging study especially thyroid ultrasound that is called routine with your physical examination or is offered as a screen for thyroid cancer.You must have a clinically important indication to have these studies. Refuse a relative or friend sonographer who wants to give you a free thyroid ultrasound, or if offered at a health fair.
Resolve if you did allow an ultrasound and a small nodule was found that you would refuse a knee jerk reflex thyroid biopsy. Defer the biopsy to determine if a biopsy was really needed. A second opinion to determine if the small nodule common in 30-50% of the population has worrisome features suggestive of thyroid cancer. If there is none, you can defer any biopsy and elect to have the nodule checked yearly for growth. The biopsy is not essential and is the gateway to a surgery you did not need. Active surveillance of the nodule will allow your endocrinologists to see if there is growth and if so will do the biopsy then. You may never have to have a biopsy, and if you do later it would not effect your survival.
Resolve if you have gone as far as approving a biopsy for your small harmless micro-nodule, and you are told to have surgery immediately because it was suspicious or definitely thyroid cancer, defer the surgery until you obtain an expert opinion on the results. These small cancers found by biopsy may never grow and for sure may never kill you.If the cancer is located in the middle of the gland away from the recurrent nerve they can be watched without surgery. These micro-nodular classic papillary thyroid cancers are found at autopsy and never caused any problems in the lifetime of the patient who never knew they had it inside their thyroid gland their whole life. If you can trust expert thyroid cancer specialists and endocrine societies, you DO NOT NEED TO HAVE IT REMOVED. Active Surveillance with a registry holding your records of yearly ultrasounds of your neck and thyroid will be stored for 50 years and available to all your new doctors. Criteria for surgery would be a minimal growth of the nodule of 3 mm or the finding of abnormal lymph node.Most patients never have surgery, and the ones that do have as good a prognosis as if they had the original surgery at first. JUST SAY NO TO A QUICK SURGERY. GET HELP.
Resolve to evaluate the results of a diagnosis of follicular variant of papillary cancer FVPTC either before the surgery or before any thyroid cancer protocol is begun. Recent evidence found that small non-invasive FVPTC have no potential to effect your life, and therefore are not cancers at all. 11,000 cases a year that were call FVPTC are now downgraded to a benign look a like tumor called Non-invasive follicular tumor with papillary like cells, or NIFT-P. If it is diagnossssssed before surgery, or after a lobectomy you are done. You do not need any cancer protocol such as completion thyroidectomy, thyroid hormone suppression, or radioiodine radiation therapy. YOU DO NOT HAVE CANCER,YOU MAY NOT NEED ANY THYROID HORMONE, AND YOUR HEALTH RECORDS WITH NOT CARRY A CANCER DIAGNOSIS FOREVER.
It is your neck,nodule and cancer so be pro-active before you act impulsively and do a John Wayne and just rip it out.
Happy Thyroid New Year
Richard Guttler MD,FACE,ECNU