Tag Archive for: thyroidectomy

Advancing Thyroid Cancer Care: Tailored Treatment and Patient Involvement

Advancing Thyroid Cancer Care: Tailored Treatment and Patient Involvement from Patient Empowerment Network on Vimeo.

What are some ways that thyroid cancer care is being advanced? Expert Dr. Megan Haymart from the University of Michigan discusses updates in thyroid cancer guidelines, shared decision-making, and actionable patient advice for personalized treatment.

[ACT]IVATION TIP

“…patients should carefully ask the risks and benefits of each of the treatment options, so they can make a pro/con list for themself and really tailor it to what’s a priority to them.”

See More from [ACT]IVATED Thyroid Cancer

Related Resources:

Emerging Advancements in Thyroid Cancer Treatment

Emerging Advancements in Thyroid Cancer Treatment

Addressing Socioeconomic Disparities in Thyroid Cancer Care

Addressing Socioeconomic Disparities in Thyroid Cancer Care

Personalized Treatment Approaches in Advanced Thyroid Cancer Management

Personalized Treatment Approaches in Advanced Thyroid Cancer Management

Transcript:

Lisa Hatfield:

Dr. Haymart, with your involvement in creating thyroid carcinoma guidelines and your research on optimizing cancer care delivery, what recent advancements or changes in thyroid cancer management do you find most promising for improving patient outcomes?

Dr. Megan Haymart:

So I think there are a lot of exciting changes that are coming. But the one that I’m the most excited about with the guidelines is the guidelines are going to emphasize tailored care more and shared decision-making more. And so I think these are key. And so for a lot of thyroid cancer management, there is not one right or wrong treatment option. It depends a little bit on the patient and what their preferences are.

And so for preference sensitive decision-making, there’s going to be a lot more emphasis on including the patient in that decision-making. There’s no right or wrong choice. The patient can think about what concerns them the most and then prioritize things based on that.

So, for example, total thyroidectomy, which means removing all of the thyroid versus lobectomy, which removes half the thyroid. For some patients with low-risk disease, either option is okay. The benefit of doing a lobectomy is there’s less surgical risk, so less risk of voice problems, less risk of low calcium. The disadvantage is that sometimes there’s more follow-up needed, maybe more ultrasounds needed. You don’t know by blood work necessarily that all the cancer’s gone. So you get more information by doing the total thyroidectomy but the total thyroidectomy has more surgical risk.

So, for example, if someone is a singer and they really don’t want their voice to be damaged and they’re not that worried about cancer coming back, lobectomy might be the choice for them. If someone has a lot of anxiety about wanting to know that absolutely everything is gone and the idea that they might need more ultrasounds makes them anxious, maybe total thyroidectomy would be a better option for them.

And so moving forward, I think there’s going to be this emphasis on personalized care, shared decision making and sort of tailoring the care to the patient. And so my activation tip for this question is that patients should carefully ask the risks and benefits of each of the treatment options, so they can make a pro/con list for themself and really tailor it to what’s a priority to them.

Lisa Hatfield:

Okay. Thank you. And one follow-up question I have to that as a cancer patient myself is, whether a patient and their doctor chooses a more or less aggressive treatment with their thyroid cancer, what does the follow-up look like? Are labs and imaging done forever for that patient to make sure there’s not a recurrence or is it just for a certain period of time?

Dr. Megan Haymart:

So this is a great question. About, I don’t know, 10 years ago everybody was getting almost the same treatment, right? So we’ve started to tailor it more and there’s far more people getting lobectomy now than they were 10, 20 years ago. Which is great. The disadvantages, we don’t have as much long-term data on these individuals.

And so it’s a little hard to be conclusive about when is the right time to stop follow-up. The longer we get out, the more data we’ll have on how long we need to follow these patients who had lobectomy, but I think that’s an excellent question. It’s just the fact that there’s been a shift in management and we haven’t had time to catch up to like, how should surveillance or long-term survivorship care change.

Understanding Thyroid Cancer Treatment Options and Follow-Up Care

Understanding Thyroid Cancer Treatment Options and Follow-Up Care from Patient Empowerment Network on Vimeo.

What’s key for thyroid cancer patients to know about treatment options and follow-up care? Expert Dr. Megan Haymart from the University of Michigan shares her expert knowledge about various treatment paths and proactive patient advice to ensure optimal care.

[ACT]IVATION TIP

“…it would be important to ask how many surgeries have you done in the past year? Typically high volume is considered more than 25, very high volume, some of the physicians, some of the surgeons will do 100 a year. So that’s very important to ask this and ask them what is their complication rate? What are the complications that we might see?”

See More from [ACT]IVATED Thyroid Cancer

Related Resources:

Thyroid Cancer Explained: Types, Staging, and Patient Communication

Thyroid Cancer Explained: Types, Staging, and Patient Communication

Overcoming Thyroid Cancer Care Barriers

Overcoming Thyroid Cancer Care Barriers

Is There a Gender Disparity in Thyroid Cancer?

Is There a Gender Disparity in Thyroid Cancer?

Transcript:

Lisa Hatfield:

Dr. Haymart, can you explain the typical treatment journey for someone newly diagnosed with thyroid cancer and what can patients expect in terms of surgery, radioactive iodine therapy, and follow-up care?

Dr. Megan Haymart:

So patients typically have a biopsy and that’s how they find out they have thyroid cancer. Afterwards, they’re most often referred to surgery and so when they meet with the surgeon, the surgeon might talk about one, not doing the surgery, so just following it. But we don’t do that as often, but sometimes with small cancers and depending on what else is going on in a patient’s life at the time. Two, they might offer lobectomy. So the thyroid is a butterfly-shaped gland in the neck. So they might talk about taking out half the thyroid, not the whole thyroid. Or they’ll talk about a total thyroidectomy, taking out the whole thyroid. They should talk about the risk and benefits of both of those.

After the surgical pathology is back if someone had a total thyroidectomy for papillary or follicular thyroid cancer, radioactive iodine is a treatment option. And again, it’s not recommended for everybody, but for some patients, the things within the pathology look higher risk. There might be lymph nodes involved or signs of invasion. Radioactive iodine is a treatment option.

And then long-term, most patients are followed with neck ultrasounds, with laboratory work. Sometimes if there’s more suspicion, they may have additional, a suspicion of recurrence, they may have additional imaging, but for the most part, it requires lab work and periodic neck ultrasound during follow-up.

And so when patients are sort of along this pathway, I think a couple of things are important to know. One, sometimes it doesn’t move super fast. So it’s pretty typical, like between diagnosis and meeting with the surgeon, it might be a month, and then surgery might be a month or so after that. Radioactive iodine might be a couple months after that. And so that first six months to a year can be very stressful for a patient. So I think that’s important to know.

And then two, I think it’s important to make sure that when you go along this process, you have physicians that you trust and that you can rely upon. So you can still talk with your PCP who you know quite well. You may now have an endocrinologist that you see, and this might be new for you. You may have a surgeon that you see, and this might be new for you. And so you want to ask them the questions that you have.

And my activation tip would be that you want to make sure that you have high volume and experienced specialists. So, for example for surgery, it would be important to ask how many surgeries have you done in the past year? Typically high volume is considered more than 25, very high volume, some of the physicians, some of the surgeons will do 100 a year. So that’s very important to ask this and ask them what is their complication rate? What are the complications that we might see?

And then similarly for the endocrinologist, you want to ask what proportion of your patient population are thyroid cancer patients? How comfortable are you following thyroid cancer patients long-term? And you may get varying answers. And so I think it’s important just to ask these questions so that you feel comfortable that you have experienced providers taking care of you.

Deceived But Not Defeated

I never felt any symptoms. I mean, I was tired, but what young 20-something who had just started graduate school while maintaining a full time job wouldn’t be? It happened during a physical. A lump towards the top of my throat was felt by my doctor. “I would go and have that scanned,” he said. I wasn’t worried; he had never mentioned cancer. So I went and had the ultrasound. “Well, we see what your doctor was talking about, and it appears to just be a cyst,” the doctor said, “but there’s another spot on the right side of your thyroid. You have two options. You can wait to see if the spot grows or we can perform a biopsy to see if it’s cancer,” he explained. “Now, the chance of it being cancer is anywhere between 10-15%, a very very low chance,” he reassured me. “I want the biopsy,” I said, not wanting to take any chances. The biopsy was performed, and within minutes, the doctor returned saying he had bad news. “Unfortunately, it’s cancer, but the good news is that it’s very treatable. I recommend you having surgery.” And that was it; although, it hadn’t hit me, at least not as hard as I thought it should had – at least not immediately. I went to my car, called my mom, and asked her if she was sitting down. I told her the news, still shocked by the ordeal I was just handed. In an instant, my life had changed forever. I heard those three words no one ever wants to hear, “You have cancer.”

I wasn’t sure how to proceed. How advanced is my cancer? What doctor(s) do I go to? How quickly do I need surgery? I just started school – do I need to drop-out already? What about my job. All of these thoughts raced through my mind. However, the support of my family and, luckily, not having any symptoms kept me going. I was working in a hospital at the time, and I spoke with a few of the doctors I worked with. “Oh, the good type of cancer. You’ll be just fine,” one said. “‘Good type?’” I thought. What is good about having cancer? He gave me the name of a surgeon who specialized in thyroidectomies. It was a five month wait to get in.

When I eventually saw my surgeon, he gave me two options. The first, he explained, was a partial thyroidectomy. “We’ll only remove the lobe of the thyroid where your tumor is. The benefit of that is that the other lobe will continue producing enough of the hormones that your body needs so you don’t have to take a medication for the rest of your life. The second was a total thyroidectomy, rendering me to that medication, literally, for a lifetime. I went with the former, and had a successful surgery. Of course, it didn’t end there.

Two days after my surgery, my doctor called. “We performed pathology on some of the lymph nodes that we removed from your neck, and unfortunately, almost all of them had cancer. What this means is that we need to have you come back and perform another surgery to remove the rest of your thyroid. Then after, you’ll have to undergo radioactive iodine to rid your body of any residual thyroid tissue.” My heart sunk. My world was crushed yet again. Another surgery? What was radioactive iodine? I didn’t how to process the emotions that I was feeling as tears streamed down my face. “It never ends,” I thought.

After my second surgery, I was thyroid-free. Later, I went through the radioactive iodine procedure where I had to be a specific diet for approximately 3 weeks. I could consume very little to no iodine, or salt, which was essentially in every product. As I went up and down the grocery store aisles reading every nutrition label, I found myself frustrated finding almost nothing that I could eat. Don’t get me wrong, this was a very healthy diet, as I was essentially restricted to meats (without seasonings), fruits, and vegetables. But it wasn’t my favorite. I went to a nuclear medicine center where I consumed a pill that would make me radioactive. I was to stay physically away from people for approximately one week, slowly decreasing the amount of feet I could be within others as each day passed. I then had a whole body scan that showed that the cancer hadn’t spread, or metastasized, to any other place in my body, but there was still some residual thyroid tissue that the radioactivity would hopefully kill.

The journey continued. I would need to be on a medication for the rest of my life. I would need to see a specialist, an endocrinologist, for the rest of my life. They would decide the dosage of my medication based on a variety of factors, including how I was feeling emotionally and physically. It wasn’t until after I had my thyroid removed that I realized how much it does for our bodies. “It will take some time before we find the right dosage for you,” my endocrinologist explained. In other words, sometimes I would be hyperthyroid, other times, hypothyroid. My symptoms may be all over the place, including my metabolism rate, my body temperature, and even my mood. As a patient with chronic depression and anxiety, I could only hope that the “right” dosage would be found quickly.

Fast forward two years later from my diagnosis, and I have been deemed “cancer free,” no more thyroid tissue. While I am incredibly thankful for this result, I can’t help but feel survivor’s guilt. I often think, “Why me? Why did I get to survive and others don’t? How did I get by so easily?” Despite this guilt, I have used my cancer diagnosis and journey to become stronger both mentally and emotionally. I have unashamedly shared images on social media and written stories that have been published in the hopes to inspire others and to be an advocate for those who don’t feel like they have a voice. Yet, I don’t pretend to know everything. I still have questions that remain unanswered. How likely is my cancer to come back? Why do I keep losing so much hair? Why am I always so tired? Despite having the “good” type of cancer, there is nothing that great about it. Although I never had symptoms, I still went through two surgeries and a radioactive iodine procedure, which had its own side effects.

As a result of what I went through and my never-ending passion for helping others, I believe that my diagnosis happened for a reason – to lead me to a career in patient advocacy. I have a background in health administration, policy, and communication. I have worked at doctor’s offices and hospitals. I feel I had an advantage in having the knowledge that I did/do, and access to physicians. However, I still get confused when I ask my doctor a question, and I receive an answer that’s in medical jargon. I think, “I can’t be the only one who feels lost, who feels confused.” Plus, I know that there are patients who are going through worse situations than I did. There has to be a way to mend the physician-patient relationship that is currently suffering. There’s not enough time dedicated to each patient, to hear what they’re going through each day. Physicians also need to make sure that what they’re saying/explaining makes sense to the patient, especially when it comes to taking medication(s) (patients with chronic conditions usually have multiple, which can be hard to keep track). There are solutions coming to the forefront, such as pill packs, patient portals, and support groups. But I believe this is just the beginning. Every cancer is different. No two patients are the same – indifference is ignorance. It’s time to combine research, health literacy, and ultimately, compassion for a patient’s story, to provide the best care and create better health outcomes.