Risks of Surgery For Thyroid Cancer Higher Than Expected

MedicalResearch.com Interview with:

Megan Rist Haymart MD Assistant Professor University of Michigan

Dr. Haymart

Megan Rist Haymart MD
Assistant Professor
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Thyroid cancer is typically treated with thyroid surgery. It is common practice for physicians to inform patients that the risk of vocal cord paralysis or hypoparathyroidism with thyroid surgery is 1-3%.

However, most of these estimates are based on single institution studies with high volume surgeons. In our study we evaluated surgical risks in a population-based cohort. Using the Surveillance, Epidemiology, and End Results-Medicare database, we found that 6.5% of thyroid cancer patients developed general post-operative complications (fever, infection, hematoma, cardiopulmonary and thromboembolic events) and 12.3% developed thyroid surgery specific complications (hypoparathyroidism/hypocalcemia, vocal cord/fold paralysis).

Older patient age, presence of comorbidities, and advanced stage disease were associated with the greatest risks of surgical complications.

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Widespread Thyroid Cancer Screening Likely Leads To Overdiagnosis and Overtreatment

MedicalResearch.com Interview with:

Dr. C. Seth Landefeld MD U.S. Preventive Services Task Force and  Chairman of the department of Medicine and Spencer Chair in Medical Science Leadership University of Alabama at Birmingham (UAB) School of Medicine

Dr. Landefeld

Dr. C. Seth Landefeld MD
U.S. Preventive Services Task Force and
Chairman of the department of Medicine and
Spencer Chair in Medical Science Leadership
University of Alabama at Birmingham (UAB) School of Medicine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Thyroid cancer is rare in the United States, and the evidence shows that screening for it leads to an increase in new diagnoses without affecting the number of people who die from it. This is because screening people without signs or symptoms for thyroid cancer often identifies small or slow-growing tumors that might never affect a person during their lifetime.

After reviewing the evidence, the Task Force found little evidence on the benefits of screening for thyroid cancer and considerable evidence that treatment, which is often unnecessary, can cause significant harms. Additionally, in places where universal screening has been implemented, it hasn’t helped people live longer, healthier lives.

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Affordable Care Act Linked To Marked Increase in Surgery for Thyroid Cancer

MedicalResearch.com Interview with:

Benjamin James, MD MS Assistant Professor of Surgery Adjunct Assistant Professor of Otolaryngology Section of Endocrine Surgery IU Division of General Surgery Indiana University Hospital Indianapolis, IN 46202

Dr. Benjamin James

Benjamin James, MD MS
Assistant Professor of Surgery
Adjunct Assistant Professor of Otolaryngology
Section of Endocrine Surgery
IU Division of General Surgery
Indiana University Hospital
Indianapolis, IN 46202

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Over the few decades, there has been a substantial increase in the incidence of thyroid cancer. It is the fastest growing cancer and a recent study in JAMA found that the mortality rate has been rising.

In 2006, Massachusetts passed healthcare reform, which expanded Medicaid, created new subsidized insurance programs for those ineligible for Medicaid and extended young adults eligibility on parental plans until the age of 26.

The aim of our study was to evaluate the impact this has had on the treatment of thyroid cancer. To address this question, we used the Hospital Cost and Utilization Project State Inpatient Databases for Massachusetts, New Jersey, New York, and Florida, which included a cohort of 56,581 inpatient admissions from 2001 to 2011. We then compared these states before and after the healthcare reform in Massachusetts to evaluate the effect the healthcare reform had on the treatment of thyroid cancer.

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Flame Retardant Chemicals In Homes May Be Raising Risk of Thyroid Cancer

MedicalResearch.com Interview with:

Julie Sosa, MD MA FACS Professor of Surgery and Medicine Chief, Section of Endocrine Surgery Director, Surgical Center for Outcomes Research (SCORES) Leader, Endocrine Neoplasia Diseases Group Duke Cancer Institute and Duke Clinical Research Institute Durham, NC 2771

Dr. Sosa

Julie Sosa, MD MA FACS
Professor of Surgery and Medicine
Chief, Section of Endocrine Surgery
Director, Surgical Center for Outcomes Research
Leader, Endocrine Neoplasia Diseases Group
Duke Cancer Institute and Duke Clinical Research Institute
Durham, NC 2771

MedicalResearch.com: What is the background for this study?

Response: The incidence of thyroid cancer has dramatically increased world-wide over the last several decades. In the United States, thyroid cancer is the fastest increasing cancer among women and men. This observation has been almost exclusively the result of an epidemic of papillary thyroid cancer, or PTC, which now comprises approximately 90% of new cases.

The use of flame retardant chemicals, or Flame Retardant Chemicals, also increased over the last several decades due to the implementation of mandatory and voluntary flammability standards for furniture, electronics, and construction materials. Over time, FRs come out of these products and accumulate in indoor environments where humans are exposed. Animal studies suggest that FRs can disrupt thyroid function, and many contribute to cancer risk. But many human health endpoints have not been investigated.

Our work was aimed at investigating whether exposure to Flame Retardant Chemicals could be associated with PTC. To address our research question, we recruited 140 adults, 70 with PTC and 70 who were healthy volunteers without evidence for thyroid cancer or thyroid disease. Then we visited participants’ homes and collected dust samples, a metric that we have previously shown is an indicator of long-term exposure to Flame Retardant Chemicals in the home.

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Thyroid Care Collaborative Improves Adoption of Thyroid Cancer Clinical Guidelines

MedicalResearch.com Interview with:

Ilya Likhterov, MD Assistant Professor, Otolaryngology Icahn School of Medicine at Mount Sinai

Dr. Ilya Likhterov

Ilya Likhterov, MD
Assistant Professor, Otolaryngology
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As our understanding of thyroid cancer improves, the way these patients are diagnosed and treated is changing. It is difficult for clinicians to incorporate every individual scientific study into their practice. These studies are numerous and the results can be conflicting.

To address this difficulty, organizations such as the American Thyroid Association (ATA) create summary recommendations that account for the latest research and translate it into a format that is easily usable for physicians. Such clinical practice guidelines are available not just for thyroid cancer care, but in many other fields. The difficulty however, is how to ensure that clinicians have access to the guidelines and incorporate the recommendations into their practice.

There are a number of barriers to actually using the guidelines in practice, and we attempt to identify strategies on how to overcome these.

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Number of Newly Reported Thyroid Cancers Stops Rising

MedicalResearch.com Interview with:

Dr. Luc G. T. Morris, MD, MSc Head and Neck Service, Department of Surgery Memorial Sloan Kettering Cancer Center New York, New York

Dr. Luc G.T. Morris

Dr. Luc G. T. Morris, MD, MSc
Head and Neck Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York

Medical Research: What is the background for this study? What are the main findings?
Dr. Morris:  Over the past 30 years, the incidence of thyroid cancer in the US has tripled. It used to be a mystery why this was happening. But recently, many researchers have shown that this is mainly happening because of improvements in medical technology that allow us to better identify and biopsy small nodules in the thyroid gland. Many of these small nodules turn out to be thyroid cancers. In fact, up to 30% of healthy persons have small cancers in their thyroid glands, and nearly all of these would not go on to cause any problems for the person if the cancer were never discovered. In other words, a large reservoir of small thyroid cancers has always been present, like a huge submerged iceberg, but we are just getting better at finding them. Therefore, the dramatically rising incidence of thyroid cancer is best characterized as an “epidemic of diagnosis,” not an epidemic of disease. This is highly relevant to patients found to have these small thyroid cancers, because it means that many of these cancers would not have caused problems for the patient, and that there would be no benefit (only potential harm) to diagnosing and surgically removing them.

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Excessive Diagnosis of Small Thyroid Cancers May Bring More Harm and Than Good

Juan P. Brito Campana, MBBS Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine Mayo Clinic , Rochester, MinnesotaMedicalResearch.com Interview with:
Juan P. Brito Campana, MBBS
Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine
Mayo Clinic , Rochester, Minnesota

Medical Research: What is the background for this study?

Dr. Brito: The occurrence of thyroid cancer is increasing faster than any other cancer in the United States. If this trend continues, thyroid cancer will become the third most frequent cancer in women in the next five years. Despite this increase, death related to thyroid cancer has not increased.  The reason is that the majority of the new cases of thyroid cancer are small papillary thyroid cancers. These cancers are the most benign variant of thyroid cancer and most patients diagnosed with this type of cancer never experience any symptoms or other negative effects. To better understand how these new cases of thyroid cancer are diagnosed we studied every case of thyroid cancer diagnosed in Olmsted, County, MN from 1935-2012.

Medical Research: What are the main findings?

Dr. Brito: We found that almost half the new cases of thyroid cancer were found among people who did not have any symptoms related to thyroid cancer. The most frequent reasons for identifying these patients presenting were review of thyroid tissue removed for benign conditions; incidental discovery during an imaging test ; and investigations of patients with symptoms or palpable nodules that were clearly not associated with thyroid cancer, but triggered the use of imaging tests of the neck.

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Non-Adherence to Guidelines May Lead To Inappropriate Radioactive Iodine Treatment for Thyroid Cancer

Sanziana Roman MD FACS Professor of Surgery Duke University  Section of Endocrine Surgery Director of the Endocrine Surgery Fellows and Scholars Program Duke University School of Medicine Chief, General Surgery and Associate Chief of Surgery for Clinical Affairs, DVAMCMedicalResearch.com Interview with:
Sanziana Roman MD FACS

Professor of Surgery Duke University
Section of Endocrine Surgery
Director of the Endocrine Surgery Fellows and Scholars Program
Duke University School of Medicine
Chief, General Surgery and Associate Chief of Surgery for Clinical Affairs, DVAMC

Medical Research: What is the background for this study?

Dr. Roman: Adjuvant radioactive iodine (RAI) is commonly used in the management of differentiated thyroid cancer. The main goals of adjuvant RAI therapy are to ablate remnant thyroid tissue in order to facilitate long-term follow-up of patients, decrease the risk of recurrence, or treat persistent and metastatic lesions.

On the other hand, Adjuvant radioactive iodine ( therapy is expensive, with an average cost per patient ranging between $5,429.58 and $9,105.67. It also carries the burden of several potential complications, including loss of taste, nausea, stomatitis with ulcers, acute and/or chronic sialoadenitis, salivary duct obstruction, dental caries, tooth loss, epiphora, anemia, neutropenia, thrombocytopenia, acute radiation pneumonitis, pulmonary fibrosis, male infertility, and radiation-induced malignancies. Therefore, Adjuvant radioactive iodine ( should be used only for appropriately selected patients, for whom the benefits would outweigh the risks.

Based on current guidelines, adjuvant RAI is not recommended for patients with papillary thyroid cancers confined to the thyroid gland when all foci are ≤1 cm (papillary thyroid microcarcinoma, or PTMC). Similarly, Adjuvant radioactive iodine ( does not have a role in the treatment of medullary and anaplastic thyroid cancer. Given the fact that variation in treatments exist, our goal was to analyze patterns of inappropriate adjuvant RAI use in the U.S. in order to identify potential misuses leading to an increase of costs for the healthcare system and unnecessary patients’ exposure to risks of complications.
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Tyrosine Kinase Inhibitor Effective in Advanced Refractory Thyroid Cancer

Dr. Martin S. Schlumberger MD Department of Nuclear Medicine and Endocrine Oncology Centre de Référence Tumeurs Réfractaires de la Thyroïde Institut Gustave Roussy and University Paris-Sud Villejuif, FranceMedicalResearch.com Interview with:
Dr. Martin S. Schlumberger MD
Department of Nuclear Medicine and Endocrine Oncology
Centre de Référence Tumeurs Réfractaires de la Thyroïde
Institut Gustave Roussy and University Paris-Sud
Villejuif, France

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Schlumberger: Patients with advanced refractory thyroid cancer is rare (4-5 patients/million population) but portends a poor prognosis with a median overall survival of 3-5 years from the diagnosis of metastases.

Before the availability of kinase inhibitors there was no effective treatment, and for this reason placebo was used as control in SELECT trial. This trial showed an improvement of PFS lenvatinib vs placebo (hazard ratio: 0.21; 99% CI: 0.14–0.31, P<0.001; median PFS: 18.3 vs 3.6 months, respectively) and objective response rate of 65% with some complete responses. Time to response was short (2 months).

Similar benefits were observed in naive patients and in patients who had been treated with another tyrosine kinase inhibitor, demonstrating the absence of cross resistance.

Toxicity was significant and could be controlled with dose reduction and symptomatic treatment.

Medical Research: What should clinicians and patients take away from your report?

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Primary vs Secondary Thyroid Cancer Survival in Adolescents and Young Adults

Melanie Goldfarb MD Assistant Professor of Surgery, Endocrine Surgery University of Southern California Keck School of Medicine, Los Angeles, CaliforniaMedicalResearch.com Interview with
Melanie Goldfarb MD
Assistant Professor of Surgery, Endocrine Surgery
University of Southern California
Keck School of Medicine, Los Angeles, California


MedicalResearch.com: What are the main findings of the study?

Dr. Goldfarb: Adolescents and young adults (AYAs) who develop thyroid cancer as a secondary cancer are six times more likely to die than AYAs with primary thyroid cancer, though survival with treatment is excellent for both primary and secondary cancers at greater than 95 percent. Additionally, Hispanics, Males, and those of lower socioeconomic status have worse overall survival.

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Thyroid Cancer: Increase in BRAF, RAS Mutations

Yuri E. Nikiforov, M.D., Ph.D. Professor of Pathology Vice Chair for Molecular Pathology Director, Division of Molecular & Genomic Pathology Department of Pathology University of Pittsburgh Pittsburgh, PA 15213MedicalResearch.com Interview
Yuri E. Nikiforov, M.D., Ph.D.
Professor of Pathology, Vice Chair for Molecular Pathology
Director, Division of Molecular & Genomic Pathology
Department of Pathology, University of Pittsburgh Pittsburgh, PA

MedicalResearch.com: What are the main findings of the study?

Dr. Nikiforov: This is examined temporal changes in mutational profiles and standardized histopathologic features of thyroid cancer in the U.S. over the last four decades. It showed a significant change in molecular profiles of thyroid cancer during the past 40 years as it determined two major trends in changing the mutational make-up of thyroid cancer: a rapid increase in the prevalence of RAS mutations, particularly for the last 10 years, and continuous decrease in frequency of RET/PTC rearrangement. The rising incidence of RAS mutations points to new and more recent etiologic factors, probably of a chemical or dietary nature. The decreasing incidence of RET/PTC rearrangements, a known marker of high-dose environmental and medical radiation, suggest that the impact of ionizing radiation, at least as related to high-dose environmental exposures and historical patterns of radiation treatment for benign conditions, is diminishing.
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Thyroid Cancer: Incidence on the Rise, Cause Unknown

David Goldenberg MD, FACS Professor of Surgery and Oncology Director of Head and Neck Surgery Associate Director of Surgical Services- Penn State Hershey Cancer Institute Division of Otolaryngology-Head and Neck Surgery The Pennsylvania State UniversityThe Milton S. Hershey Medical Center 500 University Drive, P.O. Box 850 H091 Hershey, PA  17033MedicalResearch.com Interview with:
David Goldenberg MD, FACS

Professor of Surgery and Oncology
Director of Head and Neck Surgery
Associate Director of Surgical Services- Penn State Hershey Cancer Institute
Division of Otolaryngology-Head and Neck Surgery
The Pennsylvania State UniversityThe Milton S. Hershey Medical Center, Hershey, PA  17033

MedicalResearch.com: What are the main findings of this study?

Dr. Goldenberg: The incidence of thyroid cancer is on the rise and has nearly tripled in the last thirty years.

Some authors have attributed this increase in incidence to improved sensitivity of diagnostic techniques and imaging allowing for diagnosis of small insignificant thyroid cancers. Others do not agree and state that is a real rise in this disease.
Many patients have their cancer discovered by accident when they undergo a diagnostic study for some other reason- such as trauma, neck pain, or carotid artery studies (for clogged arteries).

We aimed to compare incidentally discovered versus non incidentally discovered thyroid cancers to determine whether the thyroid cancers in both groups harbor different characteristics.
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