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In the last 30 years, the incidence of thyroid cancer has been increasing at a rate faster than any other cancer type. In fact, it is the 5th leading cancer diagnosis in women. At Sparkle, we often will be part of the team with a surgeon or thyroid cancer specialist and oncologist. We often will be part of surveillance, and order screening tests when indicated for thyroid cancer.
The concern has been raised that the increase is thyroid cancer is more of an over-diagnosis rather than solely a true increase in the disease. It turns out that there is an increase in detection often of the type of thyroid cancer that is low risk and non-lethal. There may also be an increase in true incidence which is felt to be related to environmental factors affecting the thyroid. The diagnosis of thyroid cancer is a controversial issue sometimes because of this and management and treatment can vary widely amongst thyroid cancer specialists. Some thyroid cancers depending on biopsy pathology results are felt to be low risk and do not require aggressive intervention.
In 2017 the USPSTF (United States Preventative Services Task Force) came out with a recommendation against routine cancer screening in patients without symptoms. The reasoning behind this is that most cancer growths identified would be the low risk type and those with aggressive types would present with symptoms. That being said, we often will palpate the thyroid gland as part of our exam in the office. If screening is indicated based on the history and physical exam, we typically will order a thyroid ultrasound. If a biopsy is needed for nodules greater than 1 cm in size we refer to a surgeon or endocrine specialist who can perform this type of procedure.
We follow the 2015 American Thyroid Association guidelines and avoid over diagnosis and over treatment of thyroid cancer. In these guidelines, sometimes active surveillance is a management strategy for patients with low risk thyroid cancer. It depends on how the cancer appears under the microscope and the classification of the cells based on these guidelines. If surveillance is appropriate (in collaboration with a thyroid cancer specialist) we will work with you to treat the biological terrain that allowed for a nodule or a cancer to grow. If thyroidectomy is needed, we will support your recovery from surgery and work to help balance your thyroid levels. If you have had thyroid surgery for cancer in the past, we will work with you to balance your hormone levels and again think about the imbalances in your biology that allowed for cancer to grow. In all cases of thyroid nodules and cancer, we will look at nutrition, the immune system balance and toxic burden. We often also use osteopathic manipulation as part of the treatment plan as well.
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