César Fuquen Leal
Latin Agency for News of Medicine and Public Health
Most thyroid cancers can be cured with treatment. However, for a patient to undergo any of the therapeutic options that exist, it is essential to have an early diagnosis to avoid metastases and adverse alterations.
The Journal of Medicine and Public Health (MSP) consulted with Dr. José García Mateo, endocrinologist and president of the Puerto Rican Society of Endocrinology and Diabetology, who explained the therapeutic targets that exist for the different stages of thyroid cancer.
Low-risk cancer treatments
Very small thyroid cancers that have a low risk of spreading in the body may not need treatment right away.
“Treatments for these thyroid cancers can be treated with surgery. The vast majority are treated with surgery, either a total tracheostomy, but many of the patients who are low or intermediate risk are treated with a lobectomy. I am using lobectomy to remove only half of the thyroid where thyroid cancer is found, which is the one with practically the same risk of recurrence as if you had removed the entire thyroid. If it is a low-risk cancer, you have total surgery; if it is high intermediate, it has to be total; if it is low intermediate, you do a lobectomy to the vast majority ”, explained the endocrinologist.
High-intermediate-risk cancer treatments
A significant percentage of thyroid cancer patients undergo surgery to remove the thyroid. The procedure the patient undergoes will depend on the type of thyroid cancer, the size of the cancer, whether the cancer has spread beyond the thyroid, and the results of an ultrasound examination of the entire thyroid gland.
“If the risk is intermediate high or medium high for recurrence or mortality, it is done with a total thyroidectomy. The high risk is that it already has an incidence of metastasis, either from the lymph node or distant metastasis, often to the lung. There one has to deal with radioiodine where lower doses have been used lately. ANDhe patient who has an intermediate risk of recurrence will be a dose of 30 milligrams, but patients with more aggressive metastases, who present with metastases or develop metastases later, can be treated with doses higher than 100. After that, if the thyroid is removed, many times they may need a total tracheostomy. You will need thyroid hormone therapy where at first we try to give a higher dose so that the levels of TSH, which is the thyroid stimulating hormone that comes from the pituitary, stays low and does not stimulate any tissue that is left there from cancer . Later, over time, we see if it is necessary to continue like this with the high levels or to lower them ”, the doctor deepened.
Other therapeutic methods
In some people, the cancer may never grow and require no treatment. However, there are patients in which growth can finally be detected and treatment can be started. Dr. Garcia explained some methods that exist.
“Not all thyroid cancer patients are given iodine therapy, lately they are given less iodine. There are many patients that I do not give iodine treatment because they are low risk because we detect them earlier. There are patients who have more aggressive cancers that do not respond to iodine over time so we have targeted chemotherapy or thyroid kinase inhibitors, which are drugs that go directly to the replication of this type of cancer. They are oral medications and they help a lot. It is very rare that we need another type of radiation therapy for oncology, but there are patients who have metastases at the bone level and other sites that we can use radiation therapy other than radioiodine ”, determined the president of SPED.
Timely detection vital
The early diagnosis of thyroid cancer “could prevent the appearance of a more aggressive presentation such as metastatic lesions and a poor prognosis of the disease.” This is how Dr. García recommends his patients make a timely diagnosis and avoid future manifestations.
“If the patient has a family history of thyroid cancer, or if he notices any injury or mass on his neck on his self-exam, he should seek help from his doctor. The specialist to determine if these nodules need further evaluation is the endocrinologist. The endocrinologist will determine through a clinical examination and sonography how at risk this nodule is of being cancer and the need to perform a biopsy. Not all thyroid nodules need a biopsy, but if necessary, we determine from the result if it is necessary to carry out an operation or give a more aggressive treatment, ”stated Dr. José García Mateo in dialogue with MSP.