December 11, 2017—Dr. Megan R. Haymart, Associate Professor of Medicine at the University of Michigan, Ann Arbor was awarded the prestigious Van Meter Distinguished Lectureship Award at the American Thyroid Association® Annual Meeting. In her address at the meeting in Victoria, British Columbia, titled “Implications of Diagnosing Low-Risk Thyroid Cancer,” Dr. Haymart discussed the controversies in the treatment of low-risk differentiated thyroid cancer and the implications for clinicians and patients alike.
The incidence of thyroid cancer has increased significantly in the past 30 years, primarily due to improved and increased use of diagnostic tools. Approximately 90% of all patients with differentiated thyroid cancer have low-risk disease, if the definition is based on disease-specific survival. As low-risk cancers are increasingly diagnosed, several effects on patients have become apparent. Dr. Haymart discussed each of these in turn, presenting details from a variety of hospital studies in the U.S.
- Variations in care
ATA® standard thyroid cancer treatments include surgery, sometimes followed by radioactive iodine (RAI) and thyroid hormone suppression. The pendulum has swung and in recent years less intensive treatment has been advocated. However, as the incidence of small, low-risk cancers has increased and continues to increase, variation in care has been noted. Specifically, in the use of RAI, significant between-hospital variation suggests clinical uncertainty over its role in thyroid cancer management. Where and by whom the patient is treated may have more influence than does the severity of the disease on whether RAI is used.
Low-risk cancers are being overtreated in all aspects of care: surgery, use of RAI, use of thyroid hormone suppression, and long-term management. In many scenarios, treatment is more aggressive than recommended by the ATA guidelines. In some cases, fear of the patient’s death may drive overtreatment—fear on the part of the patient but also on the part of the physician.
- Patient harm
Dr. Haymart concluded that thyroid surgery complications are underreported and that patients may be at risk for greater harm than previously realized. Risks of thyroid surgery include low calcium secondary to hypoparathyroidism and voice changes secondary to vocal fold paralysis. Complications of RAI include lacrimal duct and salivary gland damage, increased risk of cavities, second primary malignancy (especially leukemia), bladder irritation and abdominal pain, and earlier onset menopause, among others. Complications of thyroid hormone replacement include osteoporosis/fracture, arrhythmia, and possibly cognitive defects in the elderly.
- Excess imaging and surveillance
Insurance claims for imaging for localized differentiated thyroid cancers more than doubled between 1993 and 2009. Use of RAI scans in presumed iodine avid disease has shown improvement in disease-specific survival, but otherwise additional imaging after initial treatment has not been associated with improved survival.
Dr. Haymart received her MD from the Johns Hopkins University School of Medicine. She completed an internship and residency in Internal Medicine at Johns Hopkins Hospital and a fellowship in Endocrinology, Diabetes, and Metabolism at the University of Wisconsin.
In the eight years since she began her independent career at the University of Michigan, Dr. Haymart has earned a reputation as one of the national leaders in thyroid clinical research. She has recently secured two major research grants, one to study the role of patient and physician perceptions in treatment decision-making in thyroid cancer care, and the other to study incidental thyroid cancer discovery and strategies to minimize over-diagnosis and over-treatment. Both are critical issues for the field.
She has published many important papers in high-profile journals. She served on the editorial boards of Thyroid® and Journal of Clinical Endocrinology and Metabolism (JCEM) and is an associate editor of VideoEndocrinology™. She has donated a great deal of time and enthusiasm to the ATA®, serving on the Public Health Committee (2010−12) and the Finance and Audit Committee (2012−17), which she chaired from 2016−17. She was recently elected to the ATA® Board of Directors (2017−21). In addition, she is a member of the Endocrine Society’s Annual Meeting Steering Committee.
Dr. Haymart’s expertise also is recognized by frequent invitations to speak at national conferences—including the 2009, 2013, and 2016 ATA® annual meetings and the 2011 and 2016 Endocrine Society annual meetings—and to give presentations, such as those at the University of Wisconsin (2012, 2014), the Washington Hospital Center (2014), and Johns Hopkins (2016).
The American Thyroid Association® (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA® is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 94th anniversary, the ATA® continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health. These efforts are carried out via several key endeavors:
- The publication of the highly regarded professional journals Thyroid®, Clinical Thyroidology®, and VideoEndocrinology™
- Annual scientific meetings
- Biennial clinical and research symposia
- Research grant programs for young investigators
- Support of online professional, public, and patient educational programs
- Development of guidelines for clinical management of thyroid disease and thyroid cancer
The ATA promotes thyroid awareness and information online through Clinical Thyroidology® for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA® website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association® joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).