Thyroid Nodules and Cancer Treatment

Skilled and Compassionate Treatment for All Thyroid Conditions

Our highly skilled endocrine specialists are dedicated to providing compassionate patient care for thyroid nodules or thyroid cancer.

Thyroid Nodules

Thyroid nodules are very common. Most are found during a physical or imaging exam of the neck. Thyroid nodules rarely cause symptoms. Very large nodules may cause difficulty breathing or swallowing. Less than 10 percent of thyroid nodules are cancerous.

If your doctor is concerned you might have a thyroid nodule, an ultrasound test of your neck will be done to evaluate the thyroid gland and surrounding area. The ultrasound is used to determine if a fine-needle biopsy of the thyroid is needed.

Biopsies are offered in the office during the consultation visit. The procedure takes about five minutes and is similar to having blood drawn. Patients can go home right away and resume all daily activities.

Results of the biopsy may show that surgery is needed to treat the thyroid nodule. If cancer is a concern or confirmed, then surgery is recommended to remove the nodule or nodules. Surgery may also be recommended if the nodules are causing symptoms.

Thyroid Cancer

At the Weill Cornell Medicine Endocrine Oncology Center, we use a patient-centered approach to quickly diagnose thyroid cancer. If a nodule seems like it may be cancerous or is clearly cancer, we design treatment based on risks that it may return or spread.

For aggressive tumors (meaning they are likely to spread) treatment will include surgery to remove part or all of the thyroid gland. After surgery, we may recommend additional treatment including radioactive iodine. Your doctor will explain all treatment options and discuss what to expect during your visit.

If the tumor (growth) is small and confined to the thyroid gland, patients may be monitored in a surveillance program instead of having surgery. Monitoring includes imaging and blood work tests to watch for tumor growth or changes. Treatment will be discussed as needed.

Aggressive cancers may require many types of treatment. We provide patients with the newest medical treatments to ensure the highest quality of life after any interventions.

At the Weill Cornell Endocrine Oncology Center, we provide a patient-centered approach to rapidly and definitively diagnose your thyroid cancer. We design a treatment approach based on risks of recurrence or metastasis (spreading to other parts of the body). All cancer cases are presented at our weekly multidisciplinary conference to develop the best treatment plan for each patient.

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

●      Papillary thyroid cancer

●      Follicular thyroid cancer

●      Anaplastic thyroid cancer

●      Medullary thyroid cancer

At Weill Cornell Medicine, patients with inherited disorders or potential inherited disorders, are evaluated by our geneticists for thorough evaluation and counseling. This information helps guide treatment.

Personalized Care

Each patient’s care is personalized based on the specific condition and long-term health goals. 

For tumors that appear to be fast growing, treatment will include surgery to remove either part of or the whole thyroid gland and, potentially, surrounding lymph nodes. Surgery is performed with a minimally invasive approach to remove the tumor and any regional spread.

After surgery, a multidisciplinary team of experts recommends the best follow-up treatment options, which may include radioactive iodine, radiation or immunotherapy. You will meet with experts frequently to monitor and improve your functional health and well-being.

For small tumors that are clearly confined to the thyroid gland and do not appear to be fast growing, we may recommend surveillance (careful monitoring) instead of surgery. This includes frequent 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.

For patients with malignant tumors less than one centimeter who are uncomfortable with surveillance, but prefer to avoid surgery, radiofrequency ablation may be an option. This non-surgical interventional procedure has been shown to have equivalent cancer-related outcomes and improved quality of life as compared to traditional thyroid surgery. Your surgeon will discuss if this procedure is appropriate for you.

Thyroid Surgery

Thyroid surgery involves removing part or all of the thyroid gland. This procedure typically takes between 45 minutes to two hours. Most patients go home the same day after a four- to six-hour observation period.

After resting at home overnight, patients typically will be able to resume most daily activities the next day. Your doctor will give you complete instructions and discuss your recovery and expectations with you.

Risks of thyroid surgery include bleeding, nerve injury that could affect your vocal cords and the quality of your voice, and damage to the parathyroid glands (tiny glands behind the thyroid) that control calcium levels in your blood. During surgery, our surgeons may use technology to monitor your nerves and check your vocal cords.

Our expert surgeons have minimized these risks. We will assess your voice and vocal cords before and after surgery.

Follow-Up After Thyroid Surgery

Patients may need thyroid hormone replacement after surgery. Hormone replacement is typically one pill taken daily. Thyroid hormones have no side effects. It is identical to the hormone produced naturally by your thyroid.

After surgery, all patients with thyroid cancer are placed in a registry and followed up with 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, new therapies provided by our physicians and scientists at our program can help optimize your outcome. Our team conducts research and has developed several research protocols to advance future diagnostic testing and treatments. If appropriate, your doctor will discuss this research with you.

Recurrent Thyroid Cancer

Even after treatment for thyroid cancer, it is possible for the cancer to return. This is called recurrent disease. Recurrent thyroid cancer may appear years after the initial treatment is completed. Treatment for recurrent thyroid cancer depends on many factors, including the type of prior treatment, the cell type that is now cancerous, whether the cells will respond to radioactive iodine treatment, site of recurrence and other individual considerations.

While surgery is commonly offered to treat recurrent thyroid cancer, there are several new innovative approaches as possible alternatives. Your doctor will explain your options and recommend a personalized treatment program specific to you.

At the Weill Cornell Medicine Endocrine Oncology Center, we are dedicated to providing the best possible experience to our patients using the newest treatment options and advanced technology.

Non-Surgical Thyroid Treatment Options 

The endocrine surgeons at Weill Cornell Medicine offer several non-surgical approaches to treat certain thyroid nodules and cancers. These procedures are performed with ultrasound imaging to guide a needle into the thyroid nodule to the appropriate area.

Ultrasound-Guided Radiofrequency Ablation 

Radiofrequency ablation uses a catheter (long, thin needle) containing an electrode at the tip to precisely heat and destroy tissue using ultrasound imaging guidance. This is a new approach and has been shown to be an effective alternative to surgery for benign (noncancerous) thyroid nodules.

This approach has also been shown as an effective treatment option for some small, low-risk thyroid cancers, as well as a subset of recurrent thyroid cancers in the neck. After ablation, you will continue active thyroid surveillance, which includes repeat imaging at specific times and repeat biopsy if new nodules develop at a later date.

Ultrasound-Guided Ethanol Ablation 

Ethanol ablation is a minimally invasive, non-surgical procedure typically used to treat benign thyroid cysts (growths) and recurrent thyroid cancer. The procedure is performed by injecting alcohol into the cyst or tumor through a small needle under ultrasound guidance.

Similar to after radiofrequency ablation, you will continue active thyroid surveillance, which includes repeat imaging at specific times and repeat biopsy if new nodules develop at a later date.

These non-surgical, minimally invasive procedures have been shown to be safe. However, similar to any type of interventional procedure, there are small risks. The overall complication rate is low (less than 3 percent), which can include voice changes, hypothyroidism, pain, skin burn and bleeding.

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