Doctors are seeing more patients with thyroid cancer in the last 30 years, as data from the American Cancer Society show. Thyroid cancer is the fastest-growing cancer diagnosis in the United States. The vast majority of these cases are papillary thyroid cancers, which are more common in adults between the ages of 30 and 50 and more common in women than men.
For many years, we’ve handled these cases the same way:
- A growth, or nodule, appears on a patient’s thyroid
- We perform a biopsy, which involves taking a sample of the nodule’s tissue
- If the biopsy confirms that the nodule is cancerous, we recommend surgery, which can involve removing either part or all of the thyroid
But in the last five to 10 years, we’ve found that patients whose thyroid nodules aren’t considered aggressive both clinically and cytologically tend to have a low risk of symptoms or death over long periods of time. As we find more of these small, slow-growing thyroid nodules, researchers have begun to study whether it’s better in these cases to practice active surveillance, also known as watchful waiting.
As of August 2017, there are several clinical studies measuring outcomes for patients with low-risk thyroid cancer who decide to closely monitor their cancer instead of having surgery. But prospective, controlled trials will take years or decades to show their full results. In the meantime, I recommend surgery for the majority of my patients who have low-risk thyroid cancer.
Active surveillance involves regular monitoring of thyroid nodules. Patients with small nodules can come back every three to six months for a thyroid ultrasound, and the doctor can track that nodule’s growth over time. If the nodule has grown at least 20 or 30 percent in six months, the surgeon and patient can re-evaluate whether surgery is a good option. A thyroid fine needle aspiration (FNA) is recommended for thyroid nodules at least about 1-1.5 cm or larger.
A potential reason to wait on surgery is if the patient has other health conditions that could make surgery and recovery more challenging. For example, a patient in their 80s who has heart disease is likely to have more trouble recuperating after thyroid surgery than an otherwise healthy patient in their 30s.
These are valid considerations, and doctors should discuss them with their patients. Though I tend to recommend surgery for my patients with low-risk thyroid cancer (e.g., thyroid nodules larger than 1-1.5 cm and/or that have an FNA suspicious or diagnostic of thyroid cancer it’s a decision both the patient and their doctor should weigh carefully. Make sure to discuss the advantages and disadvantages of surgery, as well as your risks if you decide to wait. Ask about the surgeon’s experience performing this kind of procedure. And don’t be afraid to ask for a second opinion.
Request an appointment with one of our endocrinologists if you think you may have a thyroid nodule or if you need a second opinion.
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