Early detection and treatment of cancer is usually a good thing. In the case of thyroid cancer, however, some physicians worry that treatments for patients may be too aggressive, particularly when small tumors have been detected in only part of the thyroid.
The thyroid is a small butterfly shaped gland straddling the front of the neck, just below the “adam’s apple.” When a thyroid tumor is detected on one side, or lobe, doctors and patients must decide how much of the thyroid to remove in order to arrest the cancer.
Up to 90% of surgeries for thyroid cancer involve total thyroidectomies where the entire gland is removed. More conservative options involve a “lumpectomy” or “lobectomy” where only part or half of the thyroid is excised. The debate among physicians is over which surgical approach provides the best outcome for patient survival and quality of life.
One study in 2006 from Northwestern University in Chicago, Illinois looked at the results from more than 50,000 thyroid cancer patients who had surgery in 1985 to 1998. The researchers found that tumor size was critical in determining the best surgical choice.
For thyroid tumors less than one centimeter the extent of surgery—total or partial removal of the thyroid--did not affect patient long-term survival or tumor recurrence. But “total thyroidectomy results in lower recurrence rates and improved survival for papillary thyroid cancers greater or equal to one centimeter compared to lobectomy,” the authors concluded.
When small tumors are confined to one lobe, "there is no rationale for taking out the whole thyroid. You are punishing the patient, more or less, for their whole life," argues Dr. Ashok R. Shaha, a professor of surgery at Memorial Sloan-Kettering Cancer Center, quoted in the National Cancer Institute Bulletin.
The punishment, Dr. Shaha explains, is that patients who undergo total thyroidectomy require life long thyroid hormone replacement in addition to regular doctor visits to ensure the proper dosage.