Thyroid No Surgery for Small Thyroid Cancers

Thyroid No Surgery for Small Thyroid Cancers

Thyroid No Surgery for Small Thyroid Cancers

Thyroid No Surgery for Small Thyroid Cancers

The Art of Refusing a Surgery for a Small Micro-Papillary Thyroid Cancer

It a  patient is told they have cancer it can be nervous time for sure. However, not all cancers are the same.

One type called classic papillary cancer may be so slow growing that it may never grow at all. What should the patient do when confronted with a thyroid cancer diagnosis?

  1. Determine what type of thyroid cancer.
  2. If it is a papillary thyroid cancer you need to determine the size of the tumor and it’s location within the thyroid gland.
  3. If it is a micro-papillary cancer and it is <1.5 cm and located within the lobe away from the capsule and recurrent nerve you have a cancer that may never grow.
  4. What do you do and how do you get this needed information to make an informed opinion on the need for surgery?
  5. Your primary gatekeeper and his surgeon will push you to have surgery ASAP. There is no hurry to have surgery with this indolent cancer.
  6. Get your records including the ultrasounds and actual pathology slides from the needle biopsy for review by a thyroidologist or endocrinologist with an interest in thyroid cancer.
  7. If your expert second opinion agrees it is a micro-papillary classic thyroid cancer but it is small and safely inside the thyroid gland, and there are no abnormal lymph nodes to biopsy then you have all the information you need to explore the potential that you may not need SURGERY.
  8. The program to treat these “safe” cancers is called Active Surveillance.
  9. The patient returns for yearly endocrine neck ultrasound studies to determine if the micro-cancer has grown.
  10. The size increase is very small (3 mm). That means if it increases 3 mm you are a candidate for “rescue” surgery. However, studies have shown that few ever increase in size over 22 years.
  11. The late surgery if needed is as safe or safer that if the surgery was done at the beginning.
  12. The value to Active Surveillance is that you may never need surgery at all.It will change the cancer followup testing and treatment.It could also save you from unnecessary radioiodine therapy as well.
  13. This is available to patients who have told their family about the choice and had received support from them for not having surgery at the beginning.
  14. There are patients who are nervous about a cancer even if harmless to be in their neck for a lifetime, but do not want the standard removal of the thyroid gland.
  15. The available alternative to total removal or lobe removal is ethanol PEI.
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  17. Dr Ian Hay has shown PEI can ablate micro-papillary cancers inside the thyroid gland without any change in thyroid function. He states it could be an alternative to surgery or active surveillance for some who do not want surgery and also do not want the cancer in their neck for years with active surveillance.
  18. or radiofrequency ablation (RFA) of the micro-cancer while leaving the gland intact.
  19. If the surgery is your choice it can be a lobectomy instead of a more serious total thyroidectomy.
  20. If you want to keep your thyroid gland even though it has a small harmless micro cancer, then ACTIVE SURVEILLANCE (AS) is an excellent alternative to surgery.
  21. Call the administrator Alicia at 310-393-8860 or email thyroid.manager@protonmail.comfor details and a second opinion BEFORE you have the surgery for your <1.3 cm micro-papillary classic thyroid cancer.
  22. Richard Guttler MD,FACE,ECNU
  23. Ethanol ablation PEI done by Dr.Guttler in his center.
  24. Referral to Korea for thyroid RFA available after evaluation by Dr.Guttler to see if they are candidates.

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