Thyroid Disease

Clinical Services: Endocrine and Minimally Invasive Surgery
Upper East Side
520 East 70th Street, Starr 8
New York, NY 10021
Fax
(212) 746-8771
Call
(212) 746-5130
Lower Manhattan
156 William Street, 12th Floor
New York, NY 10038
Fax
(646) 962-0157
Call
(646) 962-5213
Northwest Brooklyn
263 7th Avenue, Suite 5A
Brooklyn, NY 11215
Fax
(718) 780-3154
Call
(718) 780-3288

Thyroid Nodules

Although thyroid nodules are very common, fewer than one in 100 are cancerous. Most nodules are identified during a physical exam or imaging of the neck. Rarely do they cause symptoms but some very large nodules are associated with difficulty breathing or swallowing. This is unlikely with small nodules.

Once there is a suspicion for a thyroid nodule, a formal neck ultrasound is warranted. This is a non-invasive test without any radiation exposure and is performed quickly by expert radiologists. At Weill Cornell Radiology through joint efforts, a comprehensive neck ultrasound is used to evaluate the thyroid gland itself, as well as surrounding lymph nodes and anatomical structures for appropriate patient management. This ultrasound exam will allow endocrine surgeons at our institution to appropriately assess each thyroid nodule and decide if a fine needle aspiration (FNA) biopsy is warranted.

Not all nodules in your thyroid need to be biopsied, therefore, selecting the appropriate nodules is important. Your surgeon will discuss with you whether or not you require a biopsy.  To optimize convenience, we offer these biopsies in our office at the time of consultation. They are performed by our endocrine surgeons, with a pathologist in the room, who makes a real-time assessment to ensure that an adequate sample has been obtained. At this time, we may also elect to submit your biopsy for genetic testing, when appropriate, to aid in determining the best treatment for your nodule going forward. The biopsy procedure itself takes about 5 minutes, and is similar to having blood drawn. Patients go home immediately and can resume all daily activities.

The results of the FNA biopsy may indicate that surgery is required to treat your thyroid nodules.  Your surgeon will discuss your biopsy results with you and determine whether surgery or close observation is appropriate.  Typically, benign nodules can be observed unless they are symptomatic, while nodules that are found to be cancer or are highly suspicious for cancer will be recommended to be removed.  Approximately 25% percent of the time, nodules are deemed “indeterminate” and these are sent out for molecular testing to help decide the best course of action – continued observation or excision.  Surgery may also be recommended to you if the nodules are causing symptoms, such as pressure, difficulty breathing, or trouble swallowing.  Lastly, surgery may also be offered to select patients with Graves’ disease (hyperthyroidism).  These procedures are performed typically as same day surgery using minimally invasive techniques to improve recovery.

Thyroid Cancer

At the Weill-Cornell Endocrine Oncology center, we provide a patient-centered approach to rapidly and definitively diagnose your thyroid cancer. If a nodule does prove to be suspicious or is clearly a cancer, we design a rational approach to treatment based on risks of recurrence or metastasis, including coordination of care.  All cancer cases are presented at our weekly multidisciplinary conference to develop the best treatment plan for each tumor and patient.

For tumors that appear worrisome or aggressive, your treatment will include surgery to remove either part of or the whole thyroid gland, and potentially surrounding lymph nodes as well. Surgery is performed with a minimally invasive approach and targeted to remove the tumor and any regional spread. Our approach is tailored to the type of tumor and its characteristics, with each patient’s treatment being based upon optimizing outcomes. After surgery, a recommendation regarding radioactive iodine or other additional treatments is made after your case is presented to the multidisciplinary conference, a group that includes endocrinologists, surgeons, nuclear medicine physicians, radiologists, endocrine oncologists, pathologists, and radiation oncologists.

For small tumors that are clearly confined to the thyroid gland and have an indolent appearance on ultrasound, we can enroll you in our longitudinal cancer surveillance program instead of performing surgery. This program’s enrollment includes repeat imaging and bloodwork at specified intervals to monitor for tumor growth or changes. If your tumor appears concerning during follow-up, then further treatment options will be discussed at that time.

Your treatment options will be based on the specific type of thyroid cancer diagnosed on pathology, which include:

·      Papillary thyroid cancer

·      Follicular thyroid cancer

·      Anaplastic thyroid cancer

·      Medullary thyroid cancer

Each of these cancers is treated differently with a patient-centered approach. It is important to understand that some thyroid cancers are non-inherited (arise sporadically) or inherited (passed along the family tree). Some of the most common genetically inherited conditions involving thyroid cancer include:

·      Familial Non-Medullary Thyroid Cancer:  these patients have a strong family history of papillary thyroid cancer

·      Familial Medullary Thyroid Cancer:  occurs in ~25% of patients diagnosed with medullary thyroid cancer

·      Multiple Endocrine Neoplasia Types IIA & IIB:  these patients are risk for medullary thyroid cancer, and may have other tumors such as pheochromocytomas and hyperparathyroidism

·      Familial adenomatosis polyposis (FAP) & Gardner’s Syndrome:  these patients are at risk for papillary thyroid cancer, as well as colon cancer

·      Cowden’s Disease:  these patients are at risk for papillary & follicular thyroid cancer, as well as breast cancer, uterine cancer, and benign tumors called hamartomas.

·      Carney Complex, Type I:  these patients are at risk for papillary thyroid cancer, as well as pigmented skin lesions and myxomas.

At WCM, patients with inherited disorders, or suspicion for inherited disorders, are evaluated by our geneticists for thorough evaluation and counseling.

More aggressive thyroid cancers require multiple different therapies that may include surgery, radioactive iodine, radiation, and immunotherapy. Using a multidisciplinary approach, we strive to provide our patients with the most up-to-date medical treatments while ensuring the highest quality of life after any intervention.

Thyroid Surgery

This involves removing part of or your whole thyroid gland. In the hands of our expert surgeons, this procedure typically can take between 45 minutes to 2 hours. Most patients will go home the same day after a 4-6-hour observation period. After a night of rest at home, patients typically will be able to resume most normal activities, including eating, the next day. Some patients may require more extensive surgery depending on their diagnosis, and if this happens, your surgeon will thoroughly discuss your recovery and expectations with you.

The risks of thyroid surgery include bleeding, nerve injury that could affect your vocal cords and thus the quality of your voice, and damage to the parathyroid glands that control your calcium levels. Our surgeons, due to their expertise and large experience, have minimized these risks to some of the lowest in the country. Your preoperative evaluation will include a voice assessment and direct examination of the vocal cords before and after surgery is done if there is suspicion for laryngeal dysfunction using flexible laryngoscopy.  Additionally, during the operation itself, our surgeons may use nerve-monitoring technology, which helps assess the integrity of your vocal cord nerves in real-time.

 

Follow-Up and Additional Treatments

If you require thyroid hormone replacement post-operatively, this is typically one pill taken daily, and dosages are adjusted based on close follow-up with your surgeon, endocrinologist, and internal medicine doctors. Thyroid hormone has virtually no side effects, as it is identical to the hormone your thyroid produces naturally.

After surgery, all patients with thyroid cancer are placed in a registry and followed long term. This will entail blood work and ultrasound imaging that our staff will monitor. Typically, patients with a history of thyroid cancer should have annual comprehensive neck ultrasound scans, as well as blood tests to look for hormones and other biochemical markers that might suggest the return of the cancer.

In specific cases, novel therapies provided by our physicians and scientists at our program will be used to optimize your outcome. Furthermore, several research protocols have been developed at our institution with the intention to advance future diagnostic testing and treatments. Your doctor will discuss if you are a candidate to participate in these protocols.

At the Weill Cornell Endocrine Oncology program, we are dedicated to a patient-centered multidisciplinary approach to provide you with the most up-to-date treatment options and access to clinical trials for thyroid tumors.

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