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

Thyroid nodules are very common (about 50%-70% of the population have them). 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). 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 is follicular tumors. Unfortunately, often we cannot tell if a follicular tumor is malignant or benign on 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 a potential avenue.

What is Afirma© "gene expression" testing?

When you have a thyroid nodule with an indeterminate FNA, then the most common recommendation is for surgical removal to a facilitate 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.

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 corner stone of treatment for differentiated thyroid cancer is surgery with removal of the entire thyroid. In addition to surgery, some patients will require radioactive iodine following surgery to lower the chance of the thyroid cancer returning. Finally, after surgery you must take 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.

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. It is important that if you have a thyroid cancer that you get regular follow up with your physicians to monitor for a recurrence which usually includes a neck ultrasound and blood tests.

What is robotic thyroid surgery?

Robot assisted thyroid surgery is a branch of remote access surgery which allows the surgeon to move the incision out of the neck to the arm pit or hair line. Although this improves cosmesis, often there are increased risks due to the amount of dissection necessary to reach the thyroid. Because of these risks, the FDA suspended approval of robotic thyroid surgery in 2011.