Thyroid Cancer: The Diagnosis

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Thyroid Cancer: The Diagnosis




Guest:  Dr. Denise Carneiro-Pla – Surgery

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Denise Carneiro-Pla who is Assistant Professor of Endocrine Surgery at the medical university.  Dr. Carneiro-Pla, I know you have a strong interest in thyroid cancer and in the surgical resection of thyroid cancer.  First of all, how do you diagnose that?  When you go into an operation where there’s an enlarged thyroid nodule, how do you know beforehand that it might be cancer?


Dr. Denise Carneiro-Pla:  Usually you come to the surgeon because you have a thyroid nodule.  The thyroid nodule could be increasing in size or your voice can be changing.  There are things that you could find during the physical examination that could be suspicious for thyroid cancer.  So, when you have a thyroid nodule, what you need to do is have a biopsy done, which is done in the office with a fine needle aspiration.  With a really thin needle, we suction a couple of cells and send them to the pathologist, and they give the diagnosis.


If the diagnosis is cancer, you need to have a thyroidectomy.  So, at that point, the great majority of the time, we offer a thorough thyroidectomy.  It means that we take both sides of the thyroid and the isthmus, which is right in the middle, connecting the two lobes.  So, usually, we do a thorough thyroidectomy. 


Dr. Linda Austin:  How long does that procedure take?


Dr. Denise Carneiro-Pla:  It’s two and half, three, hours.


Dr. Linda Austin:  So it must be fairly delicate surgery, I would imagine?


Dr. Denise Carneiro-Pla:  The problem with the thyroid and parathyroid is that you have the nerves, the recurrent laryngeal nerves, right next to the thyroid and parathyroid, so those two procedures are very delicate because you need to find a nerve and preserve it.  If you don’t, you could have a voice change postoperatively.  It’s usually temporary, but it could be permanent, in less than one percent of the time.


Dr. Linda Austin:  How long does the patient have to stay in the hospital after the surgery?


Dr. Denise Carneiro-Pla:  Usually, patients having a thyroidectomy stay overnight and, in the morning, if everything goes fine, they’re discharged.


Dr. Linda Austin:  Now, I would imagine that it would depend on the stage of the cancer whether the patient has chemotherapy or radiation afterwards.  What happens after discharge?


Dr. Denise Carneiro-Pla:  Depending on the type of cancer you have, if you have papillary cancer or follicular cancer, you could have radioactive iodine, which is not really chemotherapy or radiotherapy.  You inject an isotope in the blood at a certain time after surgery and this iodine that is radioactive will kill the thyroid cells left behind after surgery.  This is usually the treatment that you would get as a postoperative treatment following thyroidectomy surgery.  There are different types of thyroid cancer, like medullary carcinoma, for which this treatment would not work, so your best option is a thyroidectomy with no dissection.


When you do radioactive iodine, you have to have your thyroid completely removed.  Sometimes when you have a thyroid cancer, you may only have one side of the thyroid removed, a lobectomy.  This is a controversial.  I tend to perform thyroidectomies in patients when I know they have thyroid cancer.  But there are surgeons that perform lobectomies for thyroid cancer and that’s not wrong.  It just depends on what school of thought you follow for thyroid management, peri-cancer management.


Dr. Linda Austin:  Dr. Carneiro-Pla, thank you so much for talking with us today.


Dr. Carneiro-Pla:  Thank you.


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