Thyroid No Surgery 101: What to Do with Your Small Thyroid Cancer? Three Options.
Dr.Guttler’s opinion on article in Thyroid 28(10)2018 p. 1325
Brito JP et al Thyroid Cancer Treatment choice for Microcancers
This article does not mention the third option on minimally invasive ablation, though studies throughout the world have used with good results.
Ultrasound on a small thyroid microcancer for consideration of these options.
Background information before you decide on treatment if any.
- Small cancers are common. Most are harmless. 100/1000 people 10% have small thyroid cancers.
- Most will remain undiagnosed throughout their life because they will have no symptoms unless some primary physician orders a dangerous “screening” ultrasound.
- Death is very very rare at 1/1000 patients with small thyroid cancers.
- It can be scary to find out you have even mostly harmless small thyroid cancer.
- The word cancer itself is scary.
What are the options
- There are no wrong answers to any of these choices.
- Your micro-nodule can be easily followed and successfully treated by any of these three.
- There is no rush to treatment with these 3 options.
- This is the old standard treatment for thyroid cancer which includes removing half or all of the gland.
Active Surveillance Monitoring with Ultrasounds.
1. This is a wait and see approach which may result in you never having thyroid surgery in your lifetime.
2. Rescue surgery is an option in the rare case the cancer grows 3-5 mm during the followup period. This late surgery has the same or better results than if it was done originally.
Minimally Invasive Ablation Methods:
Radiofrequency ablation on microcancer
Ethanol ablation for microcancers successful in this Mayo clinic by Dr.Ian Hay.
Removes the small cancer by chemical or heat treatment. These are ethanol PEI and radiofrequency ablation RFA. Both have been used successfully on patients who do not want major surgery for a relatively harmless cancer, but do not like having it in their neck for 40 years!
What are the effects on your body of these Three treatment Options?
1. Surgery: Thyroid hormone treatment for life. Most feel good on thyroid replacement but not all patients are happy. Some have persistent symptoms and need frequent dose changes.
1-2 inch Surgical Scar
Some have problems with the scar. Pain in the area and some have big scar formation called Keloid.
Permanent vocal cord paralysis in 1-5/100.
Temporary needing treatment in 20/100 surgeries.
Permanent in 1-5 /100 needing lifetime monitoring and treatment for surgical induced deficiency of the parathyroid glands called surgical hypoparathyroidism.
Active Surveillance Monitoring with ultrasounds
- No physical effects noted
- However, Emotional toll in many knowing they harbor a cancer that someday may need surgery and maybe it will be a worse prognosis later. This fear of the unknown makes the third opinion viable for some.
Chemical or Heat Ablation in situ by Ethanol PEI or radiofrequency RFA.
- Minimally invasive procedures proven to ablate these small cancer inside the thyroid and prevent recurrence.
- To emotionally effected patients it gives peace of mind to those who don’t want major surgery and fear having the cancer in the neck for the rest of their life if they did not need rescue surgery.
- There is no need for thyroid hormone after PEI or RFA for such small tumors.
- Out patient procedure taking 15-30 minutes under local only.
- Follow up is needed to be sure the tumor is truly ablated. Follow up with a repeat USG biopsy of the cancer area.