Thyroid Micro-Papillary Cancer Road Map: 2018 An Update

Thyroid Micro-Papillary Cancer Road Map: 2018 An Update

Thyroid Micro-Papillary Cancer Road Map: 2018 An Update

Thyroid Micro-Papillary Cancer Road Map: 2018 An Update

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  1. No “Screening”thyroid Ultrasound without an indication. Just Day No! Just having a thyroid gland is not a reason to have an ultrasound.
  2. thyromegaly
  3. No Needle biopsy if less than 1.5 cm and without any suspicious features. Just Say No.
  4. This nodule is 100% benign at any size but if <1.5 cm it should not be biopsied.
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  6. Any doubt about 1, and 2 get any outside expert opinion from a thyroid cancer expert.
  7. If a biopsy is done and it is suspicious, get thyroid cancer molecular markers  before thinking about surgery from needle washout from biopsy or scratch off of slides. ThyGenX and ThyraMIR from Interpace Diagnostics.
  8. If it is positive for papillary thyroid cancer, and <1.5 cm you have other options that the classic knee jerk surgery.
  9. Active Surveillance AS is an alternative to surgery and has proven safe. No surgery unless the nodule grows a few millimeters.
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  11. Most never grow, but if they grow 3 mm a rescue surgery can be done which is just as good as an original surgery at first discovery.
  12. For those who commonly quit AS after a few years,or decide at first not to have either, because they do not like having a cancer in the neck for 40 years, there is a third alternative.
  13. Ethanol ablation PEI, and radiofrequency ablation RFA can ablate the small cancer in the thyroid gland.
  14. PEI is available in the USA now, but RFA is a referral option to Korea or Italy.
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  17. Ethanol ablation PEI is another possible alternative for those who don’t want surgery or observation. Study by Dr.Ian Hay shows promise for PEI.
  18. If surgery is your choice up front, lobectomy is the best surgery, not total, radioiodine, or thyroid hormone suppression.
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  20. Remember, most local surgeons do a few thyroid surgeries a year with high complication rates compared to high volume surgeons.
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  22. High volume is >25 totals a year.
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  24. However, before surgery have a complete endocrine neck thyroid ultrasound looking for suspicious cancer lymph nodes.
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  26.  A positive node biopsy with needle washout for thyroglobulin TG can change the surgery to total and modified neck dissection.
  27. Do not have any RAI/131 post surgery ablation without an outside consultation from an endocrinologist but not a surgeon or nuclear medicine physician.
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  29. Whatever you choice yearly follow up neck ultrasound and thyroglobulin TG is needed for several years.
  30. Good luck on your journey
  31. Call Matt for details and consultation at 3110-393-8860 or email thyroid.manager@protonmail.com.
  32. Richard Guttler MD, FACE,ECNU
  33. thyroid.com
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