Thyroid Nodules
Thyroid nodules are extremely common.
Most people will have them in their lifetime and, fortunately, the overwhelming majority will be benign (a.k.a. non-cancerous). Usually following nodules with ultrasound is sufficient however sometimes they warrant a biopsy. Biopsy is most often performed by fine needle aspiration (FNA) but can occasionally be performed by core needle or diagnostic lobectomy with a minimally invasive approach.
Types of Thyroid Cancer
By far, this is the most common form of thyroid cancer.
This is fortunate because it carries an excellent prognosis with long term survival near 100% for most patients. Treatment is often centered around surgery although in select cases it can be reasonable to watch it closely. If surgery is the best choice for you, we will plan to remove half of the thyroid, the whole thyroid and occasionally the lymph nodes of the neck if involved.
Diagnosis of papillary thyroid cancer is most often made in one of two ways, either fine needle aspiration (FNA) or found by accident. When the diagnosis is made by FNA we then have the luxury of tailoring your surgery accordingly. This gives us the best chances at a single surgery to provide a cure. The next most common scenario is that when we perform surgery on a goiter the pathologist finds a small accidental cancer next to the main mass. In those cases, no further treatment is needed because the cancer will have already been removed. A less common "accidental" diagnosis is when it is found in the lymph nodes of the neck before being identified in the thyroid itself.
In recent years we have scaled down our surgical aggression toward this biologically non-aggressive subtype of thyroid cancer allowing for less surgery which has led to less complications and improved quality of life. What was once a massive incision, excessive in-hospital stays with drains and high risk to the critical structures near the thyroid, has now transitioned to minimally invasive, outpatient surgery while often allowing the noncancerous half of the thyroid to remain in the body.
Sometimes after surgery we will recommend radioactive iodine to help eliminate microscopic thyroid tissue in higher risk cases. Generally, we reserve this conversation until after the final pathology report has been completed (usually 1-2 weeks after surgery).
Below is a link to the America Thyroid Association. There is an excellent PDF that can be printed for your reference.
Nearly 10% of all thyroid cancer will be follicular. Like papillary thyroid cancer, this type also has a favorable prognosis.
While treatment is often centered around surgery, observation is a potential option in select cases. The most common surgery is a hemithyroidectomy (removal of the diseased half of the thyroid gland).
Diagnosis of follicular thyroid cancer isn't usually made until after surgery. We often remove half of the thyroid gland because a thyroid nodule has a fine needle aspiration (FNA) biopsy suggesting a follicular lesion. On needle biopsy both benign and cancerous lesions of follicular nature appear similar. The final determination must be made by a pathologist using a whole specimen. Fortunately, once the thyroid tumor has been removed it is often the case that no further treatment will be needed.
Alike to the trends in the treatment of papillary thyroid cancer, we have begun to temper our surgical aggression toward this biologically non-aggressive thyroid cancer allowing for less surgery which has led to less complications and improved quality of life. What was once a massive incision, excessive in-hospital stays with drains and high risk to the critical structures near the thyroid, has now transitioned to minimally invasive, outpatient surgery while often allowing the noncancerous half of the thyroid to remain in the body.
Sometimes after surgery we will recommend radioactive iodine to help eliminate microscopic thyroid tissue in higher risk cases. Generally, we reserve this conversation until after the final pathology report has been filed (usually 1-2 weeks after surgery).
Below is a link to the America Thyroid Association. There is an excellent PDF that can be printed for your reference.
This is a less common form of thyroid cancer. It accounts for roughly 1-2% of cases.
It requires special knowledge of thyroid pathology and surgery in the head & neck. Unlike the most common forms of thyroid cancer (papillary and follicular) this has different biologic behavior. It mandates more thorough surgery and prophylactic management of the neck lymph nodes. You will also need additional blood tests and imaging prior to surgery.
Medullary thyroid cancer can occur spontaneously or be part of a specific gene mutation called RET and associated syndromes. If you have not been screened for this, we will help complete the evaluation before surgery.
Below is a link to the America Thyroid Association. There is an excellent PDF that can be printed for your reference.
This is a very serious diagnosis and should be addressed as such.
If you have been told that you have this diagnosis, please request an urgent appointment with Dr. David Temmermand by phone or email.
Below are links to the American Thyroid Association website with additional information on anaplastic thyroid cancer. We encourage you to become well educated about this condition.
At the Thyroid and Parathyroid Surgery Center of New Jersey, Dr. David Temmermand is one of the most highly skilled head and neck endocrine surgeons in America.
