Micro-papillary Thyroid Cancer: What Should the Patient Do with This Diagnosis?

Micro-papillary Thyroid Cancer: What Should the Patient Do with This Diagnosis?

Micro-papillary Thyroid Cancer: What Should the Patient Do with This Diagnosis?

Micropapillary Thyroid Cancer: What Should the Patient Do with This Diagnosis?

Comments by Dr.Guttler.

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  1. Dr.Guttler presentation on ethanol Ablation at national endocrine meeting.
  2. You have three choices.
  3. Surgeryfile:///var/folders/t0/8fx0yxz91_j8333c0by7ff040000gn/T/thyroidologistslogo.jpg
  4. Active surveillance AS ( Keep the cancer in your neck forever or if it grows then Surgery,PEI or RFA
  5. Ethanol PEI or Radiofrequency ablation RFA of the micro-cancer leaving the thyroid gland intact. The last option is relatively new since Mayo Clinic and and Korean studies show it can completely ablate micro thyroid cancers.
  6. 60 members of the Korean Society of Thyroid-Head and Neck Surgery participated in a study in September 2016.
  7. Active surveillance was preferred for tumors <5 mm. USA guidelines have <1.3 cm can be treated by AS.
  8. All the surgeons preferred ultrasound-guided FNA and surgery for nodules with extrathyroidal extension (ETE).
  9. Posterolateral ExtraThyroidal Extension increased the respondents’ preference for total thyroidectomy (61.7%).
  10. Korean surgeons favored total thyroidectomy and CLND in cases wherein ETE, central lymph node metastasis, or critical organ involvement was suspected.
  11. Some surgeons reportedly favor active surveillance for MPTC without ETEs
  12. The number of surgeons favoring active surveillance for proven MPTC has substantially increased after the new guideline was published.
  13. Active surveillance was introduced in the 2015 ATA and 2016 KTA guidelines because of the slow growth of MPTC.
  14. Prerequisite for active MPTC surveillance was an intraparenchymal lesion without lymph node metastasis.
  15. The diagnosis and treatment of patients with MPTC are more conservative than previous ones.
  16. These findings suggest that while the conservative approach for MPTC treatment is expanding the surgeon still prefer surgery over everything else.
  17. What a surprise.
  18. Dr.Guttler’s Summary from this article by Dr.Se.
  19. Recent studies offer hope of a non-surgical and non-active surveillance pathway for patients who don’t want surgery and also do not like the long term follow up associated with active surveillance. Many start AS and in 1-2 years opt for surgery. Now if they pull out they can be considered for Ethanol or radio frequency ablation of the micro papillary while still in the intact thyroid gland.
  20. If you are interested please call Matt at 1310-393-8860 or email to thyroid.manager@protonmail.com. We do ethanol ablation here and also at Mayo Clinic.
  21. Dr.Ian Hay heads the program at Mayo Clinic.( i.hay@mayo.edu).

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  1. Professor JH Back heads the program for RFA ablation at Asan MC in Seoul Korea.
  2. baek

Current trends of practical issues concerning micropapillary thyroid carcinoma: The Korean Society of Thyroid-Head and Neck Surgery

Lee, Yoon Se et al

Medicine: November 2017 – Volume 96 – Issue 45 – p e8596

[1]. Perros P, Boelaert K, Colley S, et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014;81:1–22.
[2]. Pitoia F, Miyauchi A. 2015 American Thyroid Association Guidelines for thyroid nodules and differentiated thyroid cancer and their implementation in various care settings. Thyroid 2016;26:319–21.
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