Thyroid Cancer in 2017: How to decide what you need to do about surgery now or deferred under Active Surveillance?

Thyroid Cancer in 2017: How to decide what you need to do about surgery now or deferred under Active Surveillance?

Thyroid Cancer in 2017: How to decide what you need to do about surgery now or deferred under Active Surveillance?

Thyroid Cancer in 2017: How to decide what you need to do about surgery now or deferred under Active Surveillance?

Main issues:

Size of the tumor, extra-nodal extension ( outside the lymph nodes), adverse histology, finding lymph nodes on on examination or ultrasound, multifocal disease,radiation exposure,first degree relative with thyroid cancer, other diseases, and patient’s preference.

Lobectomy is possible with cancers contained in only one lobe.

Smaller 1.5 cm cancers with no other finding have the option of deferred surgery and Active surveillance and only surgery if the cancer grows 3-5 mm during surveillance.

Total thyroidectomy for sure with extrathyroid extension,distant spread, aggressive tumor type on histology, and if the patient prefers a total.

Other criteria listed are in the gray zone and could go either way.

Radioiodine is used less now. Be sure you really need it before you allow nuclear medicine to treat you. Get opinions about will it really help in your cases.

Call Matt AT 310-393-8860 for an evaluation BEFORE you have the surgery. Less surgery is better for low risk cases, and no immediate surgery for small 1.5 cm papillary cancer is new and called Active surveillence, with a rescue surgery later if needed without increased risk. Most will never need surgery.

Richard Guttler MD,FACE,ECNU

image of micro cancer for no surgery and follow by Active surveillance.

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