thyroid cancer

[deborah212]

Been in primary care less than year (previously hospitalist medicine), and I feel like I'm diagnosing a lot of thyroid CA in young women in their 20s that are picked up on physicals.

--1 papillary thyroid CA who's already undergone complete a thyroidectomy

--1 with atypical cells on path who is getting a partial thyroidectomy

--1 who's getting biopsied shortly with very ominous U/S

 

Anyone else having this experience? Talking to other PAs/MDs in my practice, seems like some providers see similar vs. none. I am more aggressive in getting U/S if I think the thyroid feels abnormal so perhaps this accounts for it. Practicing in a major urban city.

[zepoPA]

I've worked Primary Care >17 yrs. (FP/IM), Women's care and Urgent Care. Diagnosed and treated numerous cases of hypo/hyper thyroid, Graves, Thyrotoxicosis. Also hypo/hyper parathyroidism. Ordered hundreds of thyroid ultrasounds, with nodules or benign calcifications. Cancer only ONE single case: 13y.o. female. Referred her out to Ped Onc and she is doing very well. She is still my patient at the age of 26 :;)):

[kittykatufl]

I work in endocrinology and see thyroid nodules every day, very very common. This doesn't necessarily make the cancer. We usually don't biopsy anything smaller than a centimeter. Many people proceed with surgery based on inconclusive path instead of waiting and watching. If it's less than a centimeter it's not cancer (usually).

[rcdavis]

I work in endocrinology and see thyroid nodules every day, very very common. This doesn't necessarily make the cancer. We usually don't biopsy anything smaller than a centimeter. Many people proceed with surgery based on inconclusive path instead of waiting and watching. If it's less than a centimeter it's not cancer (usually).

 

You wait and watch only?

No RAIU to discern "hot" or "cold"? Or is sub centimeter nodule too small to discern on scan?

Any exceptions to the rule: ( fm hx follicular ca, previous radiation)?

[NeoTrion]

You wait and watch only?

No RAIU to discern "hot" or "cold"? Or is sub centimeter nodule too small to discern on scan?

Any exceptions to the rule: ( fm hx follicular ca, previous radiation)?

 

We always did I 123 uptake for hot and cold nodules followed by an ultrasound guided FNA if any cold nodules were seen. Then usually surgery followed up by I 131 uci/mCi dose uptake/whole body scan for residual tissue. I131 mCi treatment depending on the uptake of residual tissue after surgery and the presence of migratory tissue.

 

Of course thyroid panel is also used to guide Tx dose. Tx is just hard because they have to be off any thyroid medication for about a month to get the full effect of the I 131.

[rcdavis]

We always did I 123 uptake for hot and cold nodules followed by an ultrasound guided FNA if any cold nodules were seen. Then usually surgery followed up by I 131 uci/mCi dose uptake/whole body scan for residual tissue. I131 mCi treatment depending on the uptake of residual tissue after surgery and the presence of migratory tissue.

 

Of course thyroid panel is also used to guide Tx dose. Tx is just hard because they have to be off any thyroid medication for about a month to get the full effect of the I 131.

 

I agree with this approach... Pathology is important

[NeoTrion]

There were a couple of times they would come back for the re-scan in six months because thyroglobulin levels were still high. Not unusual to see 0-1% uptake due to tracer accumulation in salivary glands, but we looked mainly at the labs. It wasn't unusual to have to do treatment on someone twice after surgery to get all of the residual tissue. We always did a re-scan after 6-8 months just to be sure we got everything with the ablation. You have to wait mainly because of the half life of 131 is around 8 days and you will still detect your treatment dose. So you have to wait at least 10 half lives before you can even think about sending them through the process again - of course minus the FNA. with 150 mCi that runs about 6 months since the uptake probes are so sensitive.

[deborah212]

I work in endocrinology and see thyroid nodules every day, very very common. This doesn't necessarily make the cancer.

 

The above cases were all from thyroid nodules I detected on physical exam and subsequently U/S for size and characteristics, and needed and FNA based on the above: 1 papillary thyroid CA, 1 atypia, 1 awaiting FNA that is suspicious for CA.

 

You wait and watch only?

No RAIU to discern "hot" or "cold"? Or is sub centimeter nodule too small to discern on scan?

Any exceptions to the rule: ( fm hx follicular ca, previous radiation)?

If I feel a nodule and the size is less than 1 cm on U/S, then I watch it.. don't do RAIU. Seems to be standard from uptodate.

[NeoTrion]

The above cases were all from thyroid nodules I detected on physical exam and subsequently U/S for size and characteristics, and needed and FNA based on the above: 1 papillary thyroid CA, 1 atypia, 1 awaiting FNA that is suspicious for CA.

 

 

If I feel a nodule and the size is less than 1 cm on U/S, then I watch it.. don't do RAIU. Seems to be standard from uptodate.

 

Just goes to show that some people have a more aggressive stance than others. Always interesting to see what other providers prefer to do.

[rcdavis]

Thyroid cancer is an uncommon type of cancer and starts in the thyroid gland. There are many types of thyroid cancer like papillary,medullary, follicular as well as many options for treatment thyroid cancer like surgery, external radiation therapy, thyroid hormone treatment.

 

Thank you for the info.