After 10 years of Treatment for Thyroid Cancer Patient Requested a Review to See if it was Benign
50 Y/O patient was diagnosed 10 years ago with papillary thyroid cancer after an evaluation for goiter. He was mildly hypothyroid and had TPO and TG antibodies for Hashimoto’s thyroiditis. The initial endocrine neck ultrasound found a goiter with changes of Hashimotos, and a <1 cm nodule which was central on the lobe away from the capsule and recurrent nerve. It was taller than wide and had a incomplete halo capsule and was mixed echo pattern or hypo and isoechoic. FNA was consistent with a papillary carcinoma. A total removal of the thyroid comfirmed a papillary thyroid cancer, but it was a follicular variant of papillary thyroid cancer with no capsule extention and 7 negative lymph nodes.The cancer follow up protocol was thyroid suppression,endocrine neck cancer lymph node mapping. No radioiodine was needed over 10 years. The thyroglobulin and TG antibody were very low consistent with non-ablated thyroid and Hashimoto’s. Pre-surgery TG /TGab 10/51 10 year 0.5/0.9.
The review revealed he had criteria for non-invasive follicular tumor with papillary like cells. NIFT-P, rather than follicular variant of papillary carcinoma based on new criteria for the diagnosis of papillary thyroid cancer.
The cancer protocol in this case does not need modification as the main treatment 10 years ago and the follow up studies show no new activity.The patient had been switched off suppression as per the new guidelines and just needs replacement thyroid therapy. If needed a letter to insurance will update the diagnosis if needed.
Comment: The reclassification of thyroid cancer can occur BEFORE the Surgery. Defer any treatment until you are evaluated for this variant now called benign or a micro- classic papillary that could be followed safely without surgery by Active Surveillane.
Call Matthew at 310-393-8860 for details on how to down grade a cancer diagnosis or safely save your thyroid from surgery by a longterm Active surveillance program at Santa Monica Thyroid Center.