Thyroid No Surgery # 5 How To Avoid Surgery With a Thyroid Follicular Variant of Papillary Thyroid Cancer now a benign tumor: NIFT-P
Thyroid No Surgery #5 How To Avoid Surgery With a Thyroid
Follicular Variant of Papillary Thyroid Cancer now called
Non-invasive follicular tumor with papillary like cells or NIFT-P
The recent surge of new thyroid cancers with 65,000 new cases in 2015 has a
special finding for about 11,00 of them. The recent downgrade
of their non-invasive follicular variant of papillary thyroid cancer to NIFT-P a
benign follicular tumor with “look a like” papillary cell changes means they
do not have cancer after all. This can change their treatment and can
change the cancer follow up protocol. No longer needing thyroid hormone
suppression, total thyroid removal or even lobe removal if the benign
condition is diagnosed early enough by needle biopsy.The ultrasound pattern and the needle
biopsy cytology and molecular markers can diagnose this without surgery in some cases.
What do I need to do If I am told I have thyroid cancer?
1. The term cancer is frightening. However thyroid cancer is usually slow
growing and gives you time in most cases to defer anything after the
needle biopsy until an expert has determined what kind of thyroid cancer
you have or that you just have the “look a like” benign follicular tumor.
2. Evaluating this by yourself is not a good idea. Take your records,imaging
including ultrasounds,and actual biopsy slides and report to a clinical
3. At the appointment they will examine you, draw necessary blood studies,
and do a detailed endocrine neck ultrasound (US). You can find an
ECNU certified endocrinologists at aace.com. This whole neck US is
needed to evaluate you for abnormal lymph nodes.If a biopsy of the
nodes are positive you do not have the benign “look a like”.
4. Next they will review the biopsy pathology reports, and will have a
special cytopathologist with expertise in diagnosis of thyroid cancer by
needle biopsy review the biopsies.
5. A new needle biopsy may be needed to obtain better quality material,
and get molecular markers and benign classifiers. The clinical
thyroidologist is an expert in obtaining good quality material for
6. The ‘look a like” benign tumor may be diagnosed by needle biopsy.
If not a lobe removal only instead of the knee jerk total thyroidectomy can make the diagnosis, and save you from needing thyroid hormone for life.
7. The marker result may be a RAS mutation not BRAF or RET/PTC. This is
typical of a follicular lesion and usually not papillary cancer. This “look a
like” acts like a follicular adenoma not papillary even though it has the
“look a like” papillary cells.
8. If it is determined you have the Non-invasive follicular tumor and not
papillary thyroid cancer you may not need a total removal surgery, radioiodine or long
term thyroid cancer follow up.You will not need thyroid hormone replacement either.
9. The decision to treat you with thyroid hormone is on a case by case
basis. The status of your underlying thyroid condition can determine if
you need treatment.
10. Finally, if you do elect to have surgery a simple less dangerous lobe
only removal will still usually not require thyroid hormone
11.Also, if you investigate this after the total thyroid removal and find you
have NIFT-P you do not need any further cancer treatment.
12.A warning about radioiodine treatment. If you were planning to get
radiation it is not necessary and is adds risk from radiation you did not
need if you have NIFT-P.
13.Help with this complex situation can be obtained by an ECNU certified
14.Santa Monica Thyroid Center’s Richard Guttler is an investigator for
Active Surveillance program of TCCC and can follow your benign nodule
and store your records in the registry for 50 years.
Call Matthew at 310-393-8860 for consult evaluation details.