Clinical Thyroidology® for the Public

Summaries for the Public from recent articles in Clinical Thyroidology
Table of Contents | PDF File for Saving and Printing

THYROID CANCER
Influence of emotions during treatment conversations for lowrisk thyroid cancer

Clinical Thyroidology for the Public

Instagram Youtube LinkedIn Facebook Twitter

 

BACKGROUND
The majority of thyroid cancers have an excellent prognosis; they are curable by surgery and not associated with cancer recurrence and death. These are called low-risk thyroid cancers. In the past several years, medical guidelines changed their position regarding the extent of treatment for these cancers. Total thyroidectomy (removing thyroid gland completely) and radioactive iodine therapy are not recommended any more for management of thyroid nodules exhibiting characteristics of a low-risk cancer. Instead, the adopted recommendation is now lobectomy (removing one lobe of thyroid gland). Despite the changes in guidelines, many low-risk thyroid cancers in the United States are still managed by total thyroidectomy. This is considered over-treatment and may be associated with unnecessary complications.

Patient’s anxiety is one of the known factors affecting the decisions regarding management of their medical problems. The goal of this study was to describe the emotional content of patient-surgeon conversation prior to surgery in patients thought to have low-risk thyroid cancer.

THE FULL ARTICLE TITLE
Pitt SC et al 2021 The influence of emotions on treatment decisions about low risk thyroid cancer: A qualitative study. Thyroid. Epub 2021 Oct 12. PMID: 34641715.

SUMMARY OF THE STUDY
This study was done in 2 university hospitals. Thyroid surgeons and their patients were invited to participate and their conversation prior to surgery was recorded and then transcribed. A total of 9 surgeons joined the study; they were in practice for 5-50 years, 67% of them were male and 67% were white. Overall, 30 patients participated in this study. They were all English-speaking, with thyroid nodules with evidence of low-risk cancer prior to surgery. The average age of patients was 48.5 and the range was 20-71 years. Of these patients, 87% were white and 80% were women.

Low risk cancer was defined as a thyroid nodule smaller than 4 cm which was proven to be papillary thyroid cancer or highly suspicious for papillary thyroid cancer by biopsy. In addition, there was no evidence of spread of the cancer to the lymph nodes in the neck or extension of cancer beyond the thyroid gland by imaging studies done prior to surgery.

Patients completed a validated Cancer Worry Scale and 80% expressed worry and anxiety. The source of anxiety for patients were cancer diagnosis (the C word), the possibility of recurrence and advancement of the cancer, potential complications from treatment (for example, change of voice, scar) and taking thyroid hormone for life. In response, most surgeons tried to provide re-assuring information backed by research. However, at times, they missed the opportunity to respond with empathy. When responding with empathy they reminded patients that they would not be abandoned and provided resources and empathic gestures. At the time of preparation of this article, 11 patients had total thyroidectomy, 2 had partial thyroidectomy, 10 were not able to decide and 7 decided to have active surveillance (monitoring the cancer by thyroid ultrasound and deferring surgery).

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
The authors concluded that most patients express negative emotions and anxiety when discussing the treatment options with their surgeons. In response, education regarding the low probability of harm by a low-risk thyroid cancer is provided by surgeons, but some miss the opportunity to offer empathy in addition to teaching. Both patients and surgeons agreed that patient anxiety is one of the reasons total thyroidectomies is chosen over lobectomy.

— Shirin Haddady, MD MPH

ABBREVIATIONS & DEFINITIONS

Cancer recurrence: this occurs when the cancer comes back after an initial treatment that was successful in destroying all detectable cancer at some point.

Total thyroidectomy: surgery to remove the entire thyroid gland.

Partial thyroidectomy: surgery that removes only part of the thyroid gland (usually one lobe with or without the isthmus).

Radioactive iodine (RAI): this plays a valuable role in diagnosing and treating thyroid problems since it is taken up only by the thyroid gland. I-131 is the destructive form used to destroy thyroid tissue in the treatment of thyroid cancer and with an overactive thyroid. I-123 is the non-destructive form that does not damage the thyroid and is used in scans to take pictures of the thyroid (Thyroid Scan) or to take pictures of the whole body to look for thyroid cancer (Whole Body Scan).

Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous.

Papillary thyroid cancer: the most common type of thyroid cancer. There are 4 variants of papillary thyroid cancer: classic, follicular, tall-cell and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).

Lymph node: bean-shaped organ that plays a role in removing what the body considers harmful, such as infections and cancer cells.

Thyroid Ultrasound: a common imaging test used to evaluate the structure of the thyroid gland. Ultrasound uses soundwaves to create a picture of the structure of the thyroid gland and accurately identify and characterize nodules within the thyroid. Ultrasound is also frequently used to guide the needle into a nodule during a thyroid nodule biopsy.