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Rethinking Thyroid Cancer Treatment: Knowing When Less Is More

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Rethinking Thyroid Cancer Treatment: Knowing When Less Is More

Oct 04, 2023

Recent advancements have certainly improved thyroid cancer outcomes, but are all treatments and surgeries essential? Jason Hunt, MD, the clinical director of neck and throat surgical oncology at Huntsman Cancer Institute and University of Utah Health, breaks down the risks of overdiagnosis and overtreatment. Learn the pivotal questions to ask your doctor and understand when the contemporary "wait and see" strategy might be your best path forward.

Episode Transcript

Interviewer: Advancements in recent years have changed how doctors diagnose and treat thyroid cancer. However, overtreatment is still a major concern. So how can you as a patient make sure that you get an accurate diagnosis and then the thyroid cancer treatment that you actually need?

Dr. Jason Hunt is the clinical director of head and neck surgical oncology at University of Utah Health and the Huntsman Cancer Institute.

Ensuring Accurate Diagnoses of Thyroid Cancer

Dr. Hunt, now I understand the first part of ensuring proper treatment is getting an accurate diagnosis. How can a patient be confident that their thyroid cancer diagnosis is accurate?

Dr. Hunt: This is the first step. There is oftentimes some confusion. Most patients don't show up with something that is causing a lot of difficulties with their quality of life. They show up with a lump in the neck. Sometimes they don't even show up with a lump in the neck. They get a CT scan for something totally different. Maybe they fell and hit their head, went and got a scan in the emergency room, and said, "You have a nodule on your thyroid gland." And that kind of leads this series of events.

They go and see someone to get an ultrasound. Ultrasound says, "Well, we need to stick a needle in it." The interesting thing about the biopsies for these nodules is that oftentimes they are indeterminate. So oftentimes they'll come back and it'll say something such as, "Atypia of undetermined significance," kind of leaving the patient like, "Well, what is this, and what do I do next?"

Over the past five to 10 years, we've actually changed a little bit on how we manage these situations. Previously, if you had that type of diagnosis that was inconclusive, we would tell you, "You have a 10% risk of cancer, but the only way we're going to know for sure is by doing surgery, by taking out half of your thyroid gland." And we don't have to do that anymore. We've now kind of honed in more.

The world has moved a lot more towards the genetics of it, so looking at the mutations, looking at specific markers. And a marker is something . . . oftentimes it's a protein or something that's produced by the tumor that may give you a hint or a sign that it's cancer.

And so now instead of going straight to surgery to take out half your thyroid gland, we actually talk to you about, "Let's do some more tests." We may be able to actually downgrade this to a completely benign nodule that you do not need any surgery, you don't need anything for.

Overtreatment of Thyroid Cancer

Interviewer: So, from what I understand, overtreatment of thyroid cancer was pretty common. I mean, is it still pretty common? Is that still going on?

Dr. Hunt: Yeah, I would say, unfortunately, it is. I think a lot of people are still treating it like we did 10, 15 years ago. And so more aggressive surgeries are being done. More radioactive iodine than really needs to be performed is still ongoing.

There are usually two people that are involved in your care. So there's a surgeon and then there's an endocrinologist. And you really want to make sure that both of those individuals have . . . I don't even want to say expertise because if you're living somewhere and you're not near a major city, maybe you're going to see someone that does a little bit more general. But you still want to make sure that they're kind of up to date, that they, on a regular basis, are treating patients with thyroid cancer.

And that's important for the endocrinologist and the surgeon. That's what's going to help you to make sure that you're actually getting kind of more up-to-date treatment.

And there are also resources out there that you can follow. Maybe it helps to give you those questions.

At Huntsman Cancer Institute, we're an NCI-designated cancer center. And so I sit on the NCCN thyroid cancer panel, and we actually help to create guidelines. And that's readily available to everyone out there. There's also an American Thyroid Association that also helps to publish guidelines, and these are your friends. I think if you're being offered treatment that does not show up in these guidelines, it's important to ask the question.

Interviewer: So let's say that there's a situation where a patient is working with an endocrinologist who maybe isn't up to date on the latest stuff because it's hard to keep up on that stuff.

Dr. Hunt: Sure. It is.

Choosing the Best Surgeon and Endocrinologist for Your Thyroid Cancer Treatment

Interviewer: What would be the best approach? What kind of questions could they ask? What kind of information could they bring?

Dr. Hunt: The American Thyroid Association and the NCCN, are really great resources. There are good questions on those websites, especially the American Thyroid Association, that can kind of help prompt you on the questions you should be asking.

If you're seeing a surgeon, there are a lot of good surgeons that are out there. And certainly, for most thyroid cancers, you don't have to be in a university setting. There are a lot of good doctors out there.

But you should be able to ask the question "How often do you do this?" of a surgeon. You really want your surgeon who does probably at least 20 or 30 thyroidectomies a year, to stay up to date.

And the endocrinologist, you just want to make sure that they're kind of also seeing, on a regular basis, thyroid cancer patients.

Interviewer: Dr. Hunt, thank you for clarifying that for us. If you or a loved one has received a thyroid cancer diagnosis and you want to further educate yourself about the condition and how it should be treated, we have two additional interviews that could be helpful.

First, a deep dive into the diagnosis and treatment of thyroid cancer and why a wait-and-see approach could be the best strategy.

If you and your doctor decide to pursue treatment, our second piece is all about what you can expect before, during, and after a thyroid cancer treatment.