I have a thyroid nodule. Does that mean I have cancer?

Thyroid nodules are very common. In fact, they are found in about 50%-70% of the population. Fortunately, the vast majority are benign (95%) and non-bothersome. To evaluate whether your nodule is cancer, we frequently perform a Fine-Needle Aspiration (FNA) biopsy. In general, FNA's are well tolerated and very accurate.

My FNA came back as a follicular lesion or indeterminate. What does that mean?

When we FNA a nodule there are essentially three results we can get. The nodule may be 1) benign, 2) malignant (cancer) or 3) indeterminate. Indeterminate findings can occur for a variety of reasons, but the most common reason is that follicular tumors can be difficult to diagnose with FNA biopsy. The overall risk of cancer is usually around 20% in these cases. Historically, the recommended treatment for these findings is surgical removal to allow for diagnosis; however, recently the option of gene expression profiling has emerged as an option to give additional information about the risk of malignancy.

What is "gene expression" testing?

When you have a thyroid nodule with an indeterminate FNA, the most common recommendation is for surgical removal to facilitate a diagnosis. Gene expression testing is a new technology that provides additional information on the nodule based on its DNA and RNA fingerprint. This allows us to better quantitate the risk that the nodule is cancer, and can help us weigh the risks vs. benefits of surgery.

I have a multinodular goiter. What does that mean?

“Goiter” simply means that you have a big thyroid. Multinodular means that your goiter is composed of many thyroid nodules. Most multinodular goiters are benign, but when they get big enough, they may cause symptoms. The most frequent symptoms are problems breathing (especially when lying flat), difficulty swallowing, or hoarseness.

What is minimally invasive surgery?

Minimally invasive surgery for the thyroid strives to minimize the size of the incision to facilitate faster healing and improved cosmesis. Some thyroid surgeries can be performed through an incision that is approximately 3 cm (1-inch).

I have Graves' disease. Is surgery right for me?

Graves' disease is an autoimmune disease where the body makes antibodies that stimulate production of thyroid hormone. There are three treatment options for patients with Graves' disease, including taking a medication (such as methimazole), radioactive iodine or surgery. All these treatments have benefits and drawbacks, but surgery is an option for patients with Graves' disease.

I have a newly diagnosed thyroid cancer. What are my treatment options?

There are four types of thyroid cancer, but in general most people diagnosed with thyroid cancer have papillary thyroid cancer or follicular thyroid cancer. These are called differentiated thyroid cancer. The treatment of differentiated thyroid cancer involves three parts.

The cornerstone of treatment for differentiated thyroid cancer is surgery. Depending on your tumor, either half of the thyroid will be removed (also called a “lobectomy”) or the whole thyroid will be removed.  In addition to surgery, some patients will require radioactive iodine treatment to lower the chance of the thyroid cancer returning. Finally, after surgery, many patients will need a thyroid supplement (ie synthetic thyroid hormone) to keep your brain from stimulating growth of any thyroid cancer cells. This is called thyroid suppression therapy. All patients who have had their whole thyroid removed, and some patients who have had half of their thyroid removed will require thyroid suppression therapy.

I have a newly diagnosed papillary thyroid cancer. What is my prognosis?

Overall, patients with papillary thyroid cancer have a very good prognosis. Thyroid cancer can recur in the neck lymph nodes even years after your operation. These lymph node recurrences may require an additional surgery to remove them. This is called a neck dissection. Regular follow-up with your physicians is important for patients with thyroid cancer, in order to monitor for a recurrence. This is monitored with regular blood tests and neck ultrasound.

Can I have my thyroid removed without having a scar on my neck?

Yes! There are multiple new techniques that have emerged to allow surgeons to remove all or part of your thyroid gland. Our surgeons have special training in one of the newest and most popular techniques, which involves removing the thyroid through the inside of your lip and/or through an incision hidden just under your chin. At your consultation, you and your surgeon will discuss whether you may be a candidate for this procedure.

Next Steps

Our team at UC Davis Endocrine Surgery is here to help if you are dealing with a thyroid issue. Please call (916) 734-5959 to set up an appointment with one of our thyroid specialists.