Tumors of the thyroid gland are very common. Most tumors of the thyroid gland are benign. When a patient presents with thyroid nodules, most are asymptomatic. Occasionally, people do have some symptoms of pressure, hoarseness, trouble swallowing or breathing. These symptoms are unusual. If a patient has any of these symptoms or a history of radiation therapy, family history of thyroid cancer or growth of the thyroid mass into the trachea or adjacent structures then surgery is often recommended. In most patients, we proceed if the nodule is large enough with a needle biopsy done under ultrasound guidance for maximal accuracy. If the pathology is consistent with a benign nature, then often we recommend follow-up with serial ultrasounds to make sure there is no change in size over time. If the pathology is consistent with a carcinoma, then the patient needs surgery. If it is an indeterminate category such as Hurthle cell or follicular neoplasm, then surgery is also recommended due to increased risk of carcinoma. It’s important to remember that fine-needle aspiration (FNA) is not the same as an open biopsy. So, it is important to take the information as being important but not perfect, even with the genetic testing that is available in some places and significantly increases the accuracy of the results.
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There is a type of thyroid cancer that is extremely aggressive called anaplastic cancer. Prior to Dr. Ducic’s landmark research paper on it, it was almost universally quickly fatal. Now, a significant number of patients have a chance at cure albeit with aggressive surgery. Medullary carcinoma may be part of the hereditary condition (MEN syndromes, multiple endocrine neoplasia) or arise simply from bad luck. They are treated with surgery and do well long term especially if the disease is confined to the thyroid gland. Most commonly, we see well-differentiated thyroid cancers (papillary and follicular). These are best treated with surgery and then often iodine 131 treatment after surgery. Long term cure rates are high but often these may recur in lymph nodes in the neck and require long term monitoring. We work closely with endocrinology and radiation oncology with all these tumors.