Thyroid No Surgery 101: How to Avoid Unnecessary Testing, Biopsies and Surgery
- Refuse a thyroid ultrasound if requested by your physician if he or she can not give you an indication that it is really needed. Indications are a palpable nodule, goiter, family history of thyroid cancer or autoimmune thyroid diseases ( Hashimoto’s or Graves’ ).
- If did not follow #1 and had the ultrasound and a small nodule was found do not have a biopsy until you are sure it is needed. Many small nodules can be followed with repeat ultrasounds rather than a biopsy. Also many bigger nodules have an ultrasound pattern that is 99% benign and also does not need a biopsy. ( thyroid cysts, and spongiform nodules). Now is the time to get an outside opinion rather than wait until you have a biopsy you do not need.
- You did not follow #1,2 and had the biopsy. Before you consent to have surgery for even a benign biopsy, or suspicious, or even thyroid cancer, time for a outside opinion.
- Many physicians and surgeons send people to surgery even if the biopsy is benign telling them that the biopsy could be wrong, or it will need to remove someday.
- Suspicious biopsy results are really benign and lead you to the surgeon. Outside opinions here can save you a surgery.
- Molecular marker testing on the slides from the biopsy or a new biopsy can confirm a suspicious result is really benign.
- Expert molecular marker researchers have ThyGenX and ThyrSeq2 available for thyroid cancer testing.
- What if the biopsy confirms papillary thyroid cancer?
- There is a new non-cancer that previously was considered to be a papillary thyroid cancer but has been declassified to benign. Call non-invasive follicular tumor with papillary looking cells or NIFT-P.
- Confirm you do not have NIFT-P before you allow the surgery for thyroid cancer.This is not cancer and you do not need surgery.
- Again, postpone surgery until you get an outside opinion. Some thyroid cancers need only a lobe removed to confirm the tumor is not invasive.
- Small less that 15 mm non-invasive papillary thyroid microcancers can be treated by active surveillance with yearly ultrasound checks for growth instead of surgery. Surgery is only needed for a small group who show 3 mm increase over the first ultrasound. Most do not grow and the small number that do are still treated by surgery without the delay effecting survival.
- For those patients with micro-papillary cancers who refuse initial surgery, but do not like having a cancer in their neck for 40 years, or start active surveillance but quit due to fears related to having cancer in their neck can have a third option.
- There are two minimally invasive methods to ablate the small cancer inside the thyroid. This has the best situation for those with fear of both surgery and long term surveillance. It aso keeps the thyroid gland intact and no thyroid hormone replacement is needed.
- Ethanol ablation or PEI is available in the USA for micro-papillary cancers. Pioneered at Mayo Clinic, and available in other private centers ( Dr.Guttler’sSanta Monica Thyroid Center).
- Thyroid tumor Radiofrequency Ablation or RFA is not available in the US but is coming in 2018.
- Both methods have shown good results in studies from Mayo Clinic’s Ian Hay and from Korea’s Asan MC under Professor Baek.
- Finally, remember it is wise to start your research right away when they want you have the unnecessary screening ultrasound.
- If you arrive at the end of the line, and your choices are surgery, active surveillance, consider either Thyroid tumor PEI or RFA.
- Thyroid PEI is available at Mayo clinic or my thyroid center. Request a consultation with Dr.Hay at Mayo, and call Matt at my center to see if you are a candidate for Thyroid PEI. 310-393-8860 or email firstname.lastname@example.org.
- Also at my center we have a referral arrangement with Asan MC and Dr.Baek to accept my patients for thyroid tumor ablation with RFA in Seoul Korea.Call Matt at my center to see if you are a candidate for either Thyroid PEI or RFA. 310-393-8860 or email email@example.com.
Do your homework before you have any thyroid imaging.
Richard Guttler MD,FACE,ECNU