520 East 70th Street, Starr 8
New York, NY 10021
156 William Street, 12th Floor
New York, NY 10038
263 7th Avenue, Suite 5A
Brooklyn, NY 11215
Thyroid Nodules and Cancer
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 very small nodules.
Once there is suspicion of thyroid nodules a formal neck ultrasound is warranted. This is a non-invasive test that does not cause any radiation exposure and is performed quickly by expert radiologists. At Weill Cornell Radiology (hyperlink our to radiology and US) through joint efforts the thyroid ultrasound includes a formal neck ultrasound looking at all the surrounding lymph nodes and structures for appropriate patient management. This ultrasound exam will allow endocrine surgeons at our institution appropriately assess each thyroid nodule and make a determination if a biopsy is warranted.
Not all nodules in your thyroid need to be biopsied therefore selecting the appropriate nodules is important. Mindful of patient's convenience, we offer these biopsies in our office. When these are performed they are performed by our endocrine surgeons with the pathologist making real-time assessment of the tissue. We also perform genetic testing on nodules when appropriate to allow for appropriate surgical or non-surgical management.
When we perform these in the office at the time of your consultation we attempt to make you very comfortable and the entire procedure takes less than 5 minutes. Patients go home immediately and can resume their daily activities.
Since our pathologists are on-site they make rapid determinations of the diagnosis and when needed send samples for genetic testing.
Some nodules require surgery for determination if they are cancerous. Others are removed because of characteristics specific to the nodule and you. These procedures are performed typically as same day surgery using minimally invasive techniques to improve recovery.
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.
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. After surgery, we will have a multidisciplinary discussion to determine whether you are a candidate for radioactive iodine therapy, which destroys any residual microscopic cancer cells in your body.
For small tumors that are well-confined to the thyroid gland and have an indolent appearance, we can enroll you in our longitudinal cancer surveillance program – this 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.
Surgical approaches are performed in a minimally invasive approach and targeted to remove the tumor and any effected regional spread. Our approach is tailored to the type of tumor and its characteristics. Each patients’ treatment is based upon optimizing outcomes.
Additionally, we provide genetic testing for patients and their families when necessary.
More aggressive therapies require multiple different therapies that may include surgery, radiation and immunotherapy (connect to immunotherapy article). 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.
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 1 1/2 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 discuss your recovery and expectations with you closely.
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 risk to some of the lowest in the country. In fact, we typically will evaluate your vocal cords before and after surgery to assess for any laryngeal dysfunction using fiberoptic laryngoscopy. During this quick bedside procedure, your surgeon will use a narrow flexible telescope to look in the back of your throat to evaluate your vocal cords.
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. It has few side effects as it is similar to the hormone your thyroid used to produce.
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.