Courtney Gibson, MD, MS, FACS, in honor of Thyroid Cancer Awareness Month

What advances have made the biggest impact in the treatment of patients with thyroid cancer over the last five years, and what is the outlook for thyroid cancer in the next five years?

Molecular testing (MT) to examine somatic changes has become an important adjunct in the diagnosis and treatment of many cancers, and is primarily utilized in thyroid disease as a preoperative method to refine the cancer risk of indeterminate thyroid nodules found with fine needle aspiration cytologic evaluation. For example, indeterminate nodules typically carry a 15-30% risk of malignancy; in the absence of any further genetic information on such nodules, patients were recommended to undergo routine diagnostic thyroid lobectomy. With the advent of MT, a patient’s risk for cancer within this subgroup of thyroid nodules is more clearly defined, and is often downgraded (~5% risk). In such cases, patients are able to avoid unnecessary surgery for a benign nodule.

What are some of the biggest challenges you face in caring for patients with thyroid cancer?

Active surveillance (AS) of small, indolent well-differentiated thyroid cancers can be challenging for several reasons. To date, AS is not a widely adopted option. It requires informed surgical discussion, patient motivation and compliance, potentially more cost, an experienced multidisciplinary management team, and high-quality neck ultrasound (US). Clinical protocols propose US every six months for two years to document nodule stability and then every one to two years with annual thyroid function testing. Because of the labor-intensive nature of such surveillance, it is an option that is not often chosen, either by patients or providers in the United States.

What inspires you as an oncologist/surgeon?

The patient population inspires me most. I entered into medicine because I greatly enjoy helping others; I committed my training to surgery because I like to see tangible evidence of such help. Endocrine surgical oncology greatly satisfies both of these needs—patients are looking for a “cure” when they receive a diagnosis of thyroid cancer, and surgery often definitively provides that cure. Thyroidectomy is usually a definitive and often curative procedure, with a low risk of morbidity.