The bad news: By the time you turn age 60, you have a 50% chance of having a mass or nodule in your thyroid gland in the neck.
The good news: Only 5% of these masses are cancerous.
The problem: How do you and your doctor determine which nodules are cancerous without unnecessary surgery?
Most thyroid masses do not cause symptoms, but some cause a bump you can see or feel or the sensation of tightness in your neck. Many are found by ultrasound of the neck after an exam by a physician.
High risk groups for thyroid cancer include:
● Adults less than 30 or over 60 years old
● Patients with a history of head and neck irradiation
● Patients with a family history of thyroid cancer
The evaluation of thyroid masses is very straight forward and noninvasive:
● History and physical examination
● Measurement of serum TSH
● Ultrasound to confirm the presence of nodularity, assess sonographic features, and
● assess for the presence of additional nodules and lymphadenopathy
● Fine Needle Aspiration (FNA)
A blood test called a thyroid stimulating hormone (TSH) will be performed and if it is elevated, this increases the likelihood of cancer.
An ultrasound will be performed to determine the characteristics of the nodule. For solid or semi-solid nodules over 1 cm, taller than wide, calcified lesions or in patients with high risk, the next step is the fine needle aspiration or FNA.
An FNA is performed in the office with ultrasound guidance using local anesthesia. The accuracy of FNA is 97%. About 5 % of these biopsies will show cancer. About 70% will show no cancer. About 25% will be described as “indeterminate.” In the past, this group required either multiple repeat ultrasounds and biopsies or surgery to remove the lesion. The problem is, about 70% of the time, the mass that was removed was not cancerous. So, how can patients and surgeons avoid unnecessary surgery?
Recent advances in molecular genetic analysis provides the answer. Surgeons can now use genetic testing for this “indeterminate” group to help determine who needs surgery and who does not.
By taking microscopic samples of the material obtained from the FNA, DNA and RNA from the thyroid material can be used to classify which thyroid masses show changes of cancer. This additional molecular genetic information adds specificity to the microscopic information from the FNA and moves the needle from “indeterminate” to benign or malignant. This technology now allows the classification of benign or malignant in the “indeterminate” group with up to 95% accuracy.
This is essential in helping surgeons and patients decide who should undergo thyroid surgery for thyroid cancer and who can avoid surgery and follow with noninvasive ultrasound. This is an important technology for directing patients and physicians to the least invasive and most cost-effective therapy.
So, if you have a thyroid mass:
1. Find an experienced thyroid surgeon
2. Get a TSH, ultrasound and FNA
3. If the FNA is indeterminate, ask for genetic testing
It could be the solution to avoiding thyroid surgery.
For more information:
Ellis A. Tinsley, Jr., MD, FACS is board certified in Vascular and General Surgery. He has been performing vein procedures for over 25 years. He attended Davidson College and the University of North Carolina School of Medicine. He is a Clinical Professor of Surgery at the University of North Carolina School of Medicine. He has been listed on the Best Doctors in North Carolina list in the North Carolina Business Journal since 2003.