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UPMC On Topic Thyroid Cancer: Effective Treatments through Early Diagnosis

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Steven P. Hodak, MD
Co-director, UPMC Multidisciplinary Thyroid Center

It’s very anxiety-producing for a lot of patients to hear the word cancer.  And oftentimes they really shut down and they have a hard time  listening to anything that comes after.

Part of the job that we need to do is giving  patients space to breath, to relax, and to become receptive again to the information they need so they know what comes next. It’s very important that thyroid cancer is found early and that appropriate treatment and follow-up are given.

In the Multidisciplinary Thyroid Center, we have medical endocrinologists, endocrine surgeons, head and neck surgeons, radiologists, nuclear medicine physicians, pathologists, and access to advanced chemotherapy protocols that all can be useful in managing patients with various stages of thyroid cancer or other thyroid diseases.

What’s useful about our clinic is that a patient with a thyroid nodule can walk in, get a diagnostic ultrasound by an expert radiologist. If a fine needle biopsy is needed, we can do that on the spot. And, when cancer is obvious on the cytology, we can often find that on the microscope, make the diagnosis right away, have the pathologist confirm the diagnosis, and if thyroid surgery is necessary, the thyroid surgeon in the clinic can see the patient and book the surgery the same day the patient is seen.

What’s amazing about that is we can take a visit that would normally take weeks or usually months and compress that into several hours. That’s truly an extraordinary patient experience.

We often collaborate during the course of the multidisciplinary clinic.

  • The surgeon will ask me a question or I’ll ask the surgeon a question. 
  • We frequently discuss the imaging tests with the radiologists and we put our heads together practically for every case that we see in the clinic individually.
  • We also meet together to discuss difficult cases where a true multidisciplinary approach can have great advantages. 

So, the most important thing to emphasize is that, most of the time, fine needle biopsy is conclusive and tells us very definitely that a thyroid nodule is not cancer, or — in the rare case where a malignancy is present — that cancer is there. In about 20 percent of cases we have what’s called an indeterminate diagnosis and that means the diagnosis can’t be made just with a needle biopsy.

Molecular diagnostics is a very important thing we offer at UPMC and it’s not something widely available.  What we’re able to do is to use a panel of genetic tests to determine if mutations are present in the DNA of nodules that make those nodules more likely to be cancer. There’s a range of mutations that we test and they all have a very, very high predictive value for malignancy for cancer.

Most patients, with the rare exception of the most advanced thyroid cancer patients, have an extraordinarily normal lifestyle.  Even after thyroidectomy, even if they require thyroid hormone replacement, even if they needed radioactive iodine therapy, and — quite often — even if they have advanced disease, patients can live very normal lives.