1. Virtually everyone will develop small thyroid nodules (less than 1 cm in size) that can be detected by ultrasound by the time they reach age 65.
2.Most of these nodules do not require any investigation.
3. Refuse any thyroid ultrasound if you have no indications.
4. Nodules that are less than 5-6 mm virtually never need further attention.
5.Nodules that are 7-10 mm occasionally will exhibit suspicious features that do prompt a needle biopsy (fine needle aspiration).
6. Microcancers are thyroid cancers < 1 cm in size.
7.These are the papillary,the most common type of thyroid cancer.
8. Microcancers (less than 1cm) are very common and may occur in up to 1 in 10 adults in the United States.
9. The majority of patients are unaware of their existence since they do not cause any symptoms.
10.Most are discovered accidentally, typically during an imaging study.
11. The prognosis of these small cancers is excellent, but no matter how small the cancer may be, the word “cancer” can be scary.
12. There is a 10% risk of the micro cancer growing about 3mm in size in 10 years.
13. 90% of small thyroid cancers do not grow.
14. There is a 4% risk of the tumor spreading to lymph nodes around the thyroid at 10 years.
15. 96% of the microcancers do not spread.
16.Thyroid microcarcinomas will usually not cause any health risks during the patient’s life.\
17. Therefore there are 3 alternatives to treating microcancers.
20 Ethanol PEI or radiofrequency ablation RFA of the microcancer with preservation of the intact thyroid gland.
21.The risk of dying from a small thyroid cancer is extremely small (less than 1 in 1,000 people).
22. Surgery for papillary thyroid microcarcinomas usually consists of removing the lobe of the thyroid gland containing the microcarcinoma.
23.Lymph nodes around the thyroid gland are typically not removed unless they appear enlarged or suspicious on a neck ultrasound or at the time of surgery.
24Microcancers have no need for radioactive iodine after surgery.
25.Survival after surgery for papillary thyroid microcarcinoma is greater than 99%.
26.The chances of a recurrence of thyroid cancer after surgery are between 2-4%.
27.If there is a recurrence, it typically occurs in the other lobe of the thyroid or in lymph nodes in the central neck area (around the thyroid).
28.These lymph nodes would have been too small for the surgeon to notice and remove at the time of the initial operation.
29.These lymph nodes may or may not grow over time and if they do, they grow very slowly.
30. Less than 1% chance of dying from microcancer.
31. There are complications that have to be taken into consideration.
32.As with any surgery, thyroid surgery is subject to the typical risks of any operation including bleeding, infection, and problems with anesthesia.
34.Both can be temporary or permanent, but permanent changes are very uncommon in the hands of an experienced thyroid surgeon.
35. The typical recovery time after thyroid surgery is between 5 and 7 days.
36. Some patients do not feel quite right until 8 weeks post-surgery.
37. Approximately half of patients undergoing removal of half of the thyroid will need thyroid hormone for life.
38. All will need thyroid hormone if they take the whole gland.
39. A small continue to complain of weight gain, energy and emotional problems, as well as cognitive decline, even if their thyroid hormones are in the normal range.
40. Following thyroid surgery, life-long follow-up is required.
41.ACTIVE SURVEILLANCE: Just follow the size of the cancer for slight enlargement by ultrasound.
42.Not all microcarcinomas of the thyroid need to be removed at the time of diagnosis.
43.Recent data has shown that 5 to 10% of thyroid microcarcinomas may grow or spread to the nearby lymph nodes over the course of 10 years.
44.No deaths have been reported so far in the surveillance of microcarcinomas of the thyroid, and no patient has reported that their thyroid cancer spread to other areas of their body outside of their neck.
45. Many patients feel that avoiding surgery when the odds of progression are so small is a significant benefit.
46 The 5-10% of carcinomas that grow or spread during active surveillance, a delayed surgery can cure the thyroid cancer with the same excellent prognosis as if the surgery had been done immediately after diagnosis.
47.The chances of progression of thyroid microcarcinomas differ with age.
48.In elderly patients (older than 70 years of age), the chances of thyroid cancer growth or spread probably approximate 1-2%, whereas the chances of progression in 20-year old patients likely approaches 10-15%.
49. Younger patients will require longer follow up and some may elect to have their thyroid removed initially.
50. Others may choose to postpone their surgery to a convenient time that does not interfere with important life events like graduations, weddings, etc.
51. Just like real estate it location,location,location.
52.Critical locations in the thyroid – very close to the recurrent laryngeal nerves for instance – may be better managed by surgical excision since any growth could lead to compromise of the voice.
53 Thyroid ultrasound performed by an expert thyroid sonologist will be required every 6 months for the first 2 years and then yearly for up to 5 years.
54.After 5 years of no documented growth or spread, thyroid ultrasounds can be done much less frequently.
55.There is no physical harm to an active surveillance monitoring program.
56.There could be emotional effects from the knowledge that the patient has a thyroid cancer in his/her body that is being monitored.
57. For certain patients, this emotional burden can be a good reason to choose immediate surgery or alternative in situ ablation of the small cancer in the thyroid gland by ethanol PEI or radiofrequency ablation RFA out patient minimally invasive procedures.
Call me for a consultation if you have a microcancer and are trying to decide between surgery, active surveillance or if you do not want surgery and also do not like the idea of a cancer in your neck for many years consider ablation of the cancer with preservation of your normal thyroid gland and function.
310-393-8860 or [email protected]