Newly diagnosed with thyroid cancer and have 2 main concerns

@lise01 and others - do you know (especially if you are getting surgery at a teaching hospital) if the surgeon indeed does the entire operation or if students, residents are also doing some part of the surgery and how closely are they observed?

@cocha It was a more detailed ultrasound that looked more at the lymph nodes and he marked on a paper the suspicious ones for me to give the surgeon. No biopsy they do those during surgery if they are going to not just take them all. A pathologist will look at them and do what’s called a frozen section and then call into the operating room and tell the surgeon what the results are. (I work in the OR)

@cocha I specifically asked my surgeon that question and said I only wanted him to do the surgery. He said he would, but that others in the room would be assisting.

I have been looking at the "Save Your Thyroid" Facebook group and Youtube channel and it is quite interesting to see how many patients are now pushing for RFA and how there are RFA clinical trials happening at Columbia, Johns Hopkins and other places for cancerous nodules up to 1.5cm. Outside of the US, cancerous nodules up to 2cm (and more) are being ablated using RFA. Some have even commented that RFA will be the first line of treatment in the US in a couple of years. So thyroidectomies and lobectomies will not be done as readily as they are being done now, and we could get to keep our thyroids.
Apparently the more conservative clinics and medical schools are still doing thyroidectomies while others are moving to more "modern" treatments such as RFAs, transoral surgeries and so on. FYI.

Hey @cocha and @hopeful23 and @koh -- just catching up on your posts. Trying to play catch up after two weeks off has me scrambling!

Re: cancer spread from FNA -- it's called needle track dissemination, I believe, and it is quite rare. The first endo I saw, who did mine, did something not quite right -- it was extremely painful compared to one I had before and my neck started swelling up . He was actually surprised /alarmed and I dont think took as many samples as he had intended. So, I worried about consequences of improperly executed FNA and brought it up with my doctor -- he assured me that it is extremely uncommon.

@cocha I would be very surprised if they let a student or resident actually perform the surgery. We go through this process of vetting surgeons, so they should absolutely be the ones actually doing it. I would ask them if you want to grant yourself some peace of mind about that -- I don't think there are any wrong questions to ask when it comes to your well-being. I had my surgery done at UCSD Moores Cancer Center, and while I suspect they might have UCSD medical students training there and potentially present/assisting, I know my surgeon was the only one who actually operated on me.

Hope you are all doing well!

@lise01 and @hopeful23 hope you are both steadily getting better.

One surgeon who I consulted with recently said I could get RFA instead of surgery and that has put a new twist in my treatment story. I am getting a few more opinions on this and will know more by next week.

Oh wow, that's a big deal. Is this a surgeon that you already had consulted with? I didn't even ask mine because of all the people I spoke to, no one even suggested the idea. It was always surgical approach. Please do update once you know more.

Do you know if it works only on the thyroid nodule or is it also used when lymph nodes are involved?

I got 2 other opinions and was told that because of the location, size and the extra-thyroidal nature of the cancerous tumor I should opt for a lobectomy instead. (which is still better than a total thyroidectomy) I could still take the risk and go ahead with RFA but am opting for surgery at the moment.

Having said that, RFA is DEFINITELY a better option for non-cancerous nodules, and even smaller cancerous nodules that are fully encapsulated. Columbia University, for example, is running a clinical trial right now for treating cancerous nodules up to 1.5cm with RFA. Outside the US, this has already been attempted for over 5 years. Lymph nodes with carcinoma can also be ablated with RFA.

It is very easy to get an appointment (even tele visit for some states outside NY) with Dr. Jennifer Kuo at Columbia to discuss your options about RFA (over surgery). It is also important to talk to a surgeon who not only does the conventional total thyroidectomy and lobectomy but is also trained in RFA. That is when you will get a balanced opinion. Otherwise a surgeon is only going to recommend what s/he has been doing all along, i.e surgery.

It was helpful to watch Dr Keith Forwith on Save Your Thyroid channel on YouTube to understand the different options, including RFA, for treating thyroid nodules/tumors. Prof. Korkusuz in Germany will also give honest answers to your questions on a tele visit about your options. Asan Medical Center in South Korea will offer you a remote consultation about RFA for your case. Dr. Jung Kwan Baek from this center is the world leader in RFA and trains international physicians in RFA.

The bottomline is - you can indeed avoid surgery in some cases for thyroid nodules/tumors. Ask multiple doctors about RFA for your case before accepting the surgical option.

Another promising article on RFA for the treatment of benign and malignant thyroid nodules authored by prominent surgeons.
https://www.frontiersin.org/articles/10.3389/fendo.2021.698689/full

Hi, just joined. I will be having thyroidectomy and removing lymph nodes. In 3 weeks. I have read on hear about some have radioactive iodine treatment after this surgery. Why is that. My doctor never mentioned that.