Thyroid Cancer Risk Assessment and Diagnosis

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The rapid rise in new thyroid cancer diagnoses could be associated with newer diagnostic tools that can identify smaller tumors than previous methods. While also beneficial, this precision may be problematic, because there is no way to determine which small tumors will rapidly increase in size and which will remain small for many years, suggests R. Michael Tuttle, MD. To help guide next steps after identifying these smaller tumors, the American Thyroid Association Guidelines recommend not biopsying tumors less than a centimeter in diameter.

In the past 10 years, there has been a dramatic change in how thyroid cancer is managed, Tuttle notes. In the past, it was treated with a one-size-fits-all approach with a total thyroidectomy and radioactive iodine, and risk stratification was simply whether a patient would die or not. Today, stratification is based on a patient’s risk of recurrence, with many factors contributing to the assessment process, including the pathology report, the size of the tumor, lymph node involvement, blood markers, and surgical findings.

Level of risk is more on a continuum, Tuttles states, and so treatment must be individualized, which increasingly complicates decision-making. Most patients assume that more treatment is better; perform more surgery, administer more radioactive iodine, and the outcome will be superior. However, this is not the case, Tuttle explains, as some patients achieve excellent outcomes with a minimal surgery. In some cases, certain patients will need more, warranting a thorough risk assessment of every patient.