By Sara Bondell - September 25, 2020
More than 52,000 Americans will be diagnosed with thyroid cancer this year. While most cases are curable, thyroid cancer is the rise in the United States. Moffitt Cancer Center’s Head and Neck Oncology and Endocrinology Oncology Programs offer a multidisciplinary approach to collaboratively attack the disease and give patients the best chance of survival.
Moffitt’s experts are answering some of the most-asked questions about thyroid cancer:
Who is at risk for thyroid cancer?
Dr. Julie Hallanger-Johnson, chair, Endocrinology Oncology Program: “People are at risk for thyroid cancer if they have had radiation exposure to the head and neck, especially in youth. We know that being exposed to radiation in the neck is a risk. In the ‘olden days,’ they used to radiate tonsils and the thymus gland to prevent sudden infant death syndrome. We wouldn’t do that now because we have better evidence. But those patients are at a higher risk because of that radiation exposure. Treatment for childhood cancers that included radiation of the head and neck, such as certain lymphomas, can increase the risk. Family history can be important, but it is not as likely in differentiated thyroid cancer. Medullary thyroid cancer can be inherited. It is rare, probably less than 5 to 10% of patients with papillary thyroid cancer have a genetic predisposition to it.”
What questions should you ask your thyroid surgeon?
Dr. Caitlin McMullen, head and neck surgeon: “A patient should primarily ask how many thyroid surgeries the surgeon does per year. We know that surgical volume correlates with outcomes, including complications. They should ask the surgeon what their complication rate is, specifically that surgeon’s rate of vocal cord nerve injury. It is also important to ask what the expected recovery is so the patient can plan their time and plan time off from work.”
How do surgeons minimize complications from surgery?
Dr. Kristen Otto, head and neck surgeon: “As part of the compliment of potential complications after surgery, one of the most important and troublesome things in addition to injury to the vocal cord nerve can be injury to the parathyroid glands during surgery or sometimes inadvertent removal of the parathyroid gland. When we do an operation to remove thyroid cancer, we never intend to remove the parathyroid glands and sometimes they do get damaged or removed with the specimen. This can lead to problematic issues with calcium management after surgery, so patients will need to be on a big dose of calcium tablets and sometimes vitamin D tablets as well. Fortunately, most often this is a temporary issue, but sometimes can be permanent and sometimes be a nuisance for patients after surgery. We also know seeing a surgeon who does a lot of thyroid surgeries each year can cut down on the incident of parathyroid issues after a thyroidectomy.”
What role does gender play in thyroid cancer?
Hallanger-Johnson: “Thyroid disease in general is more common in women. Part of that has to do with autoimmune disorders because thyroid dysfunction, whether it be hyperthyroidism or hypothyroidism, is often related to an autoimmune cause. Autoimmune diseases are more common in women and thyroid disease as a result is more common in women. Part of the other potential issue has been discussed, which is are we over diagnosing people because women seek more medical care? That is a concern. For example, women see their OBGYN who palpates a nodule and then leads them on the path of a workup and that sort of thing. So, I think there has been a question about that even though you can argue both sides of that issue. People like me with an ultrasound machine in their hand are going to find thyroid nodules in more than 50% of patients so we have to be careful. When we are doing those ultrasounds, we have to have a good reason. The second point is, thyroid cancer has been a rapidly growing diagnosis in women. Why is that? Is it related to diagnosis or is it related to a true increase in prevalence? I think the answer is a lot of different reasons and there are probably things we don’t fully understand. There have been environmental chemicals that have been correlated with thyroid cancer such as flame retardant chemicals. If you put all of these together you might get the answer.
How important is multidisciplinary care for thyroid cancer patients?
Hallanger-Johnson: "Our patients who come to Moffitt don’t get the view of just one person. Our patients get the entire Endocrine Tumor Board input. This includes our surgeons, our radiologists, our pathologists, our endocrinologists and medical oncologists in a room and we are trying to make the best treatment decisions."