Case Studies in Thyroid Cancer - Episode 13

TC Patient Considerations: Thyroidectomy

Lori Wirth, MD, and Andrew Gianoukakis, MD, discuss patient and clinical characteristics necessitating thyroidectomy in patients with thyroid cancer.

Andrew Gianoukakis, MD: I have a quick question for you guys because this came up recently. If you have a patient with a medullary [thyroid cancer], very high calcitonin, it’s out of the neck, very likely to have distant disease, and you look for distant disease and it’s all over. It’s in the lungs, it’s in the liver, it’s widely metastatic; what is the advantage of still sending for a thyroidectomy?

Lori Wirth, MD: That’s a good question Andrew, and it can be a difficult decision, I agree. I think that’s an uncommon presentation, but it can happen. One reason to consider doing the neck surgery is so that you get rid of bulky disease in the neck that’s going to impact breathing and swallowing. If you can achieve that without harming the patient from a surgical complication point of view, then you may be averting a difficult death for a patient in the future. On the other hand, if their burden of disease in the neck is not as bad and isn’t going to get them into trouble as much as their metastatic disease is going to be, and you know that they have a RET mutation, since we have very effective RET-specific therapies now, I think it could very well make sense to just start with the systemic disease and turn back to doing surgery in the neck if the time comes where you may be starting to see some progression in the neck that you’re going to start to worry about.

Andrew Gianoukakis, MD: I agree. It came up recently, and there isn’t really straightforward guidance in the ATA [American Thyroid Association] guidelines, etc. That’s why I was interested in your opinions.

This transcript has been edited for clarity.