Quality of Life Innovations from the Columbia University Department of Surgery

The Thyroid Surgery Experts

Advances in the treatment of thyroid cancer are improving the quality of life of patients at the New York Thyroid/Parathyroid Center at Columbia University Medical Center,
which is co-directed by endocrine surgeon James A. Lee, MD, and endocrinologist Robert McConnell, MD.

Thyroid cancer is the most common endocrine malignancy, and typically affects young and middle-aged women. If the disease is diagnosed early and treated properly,
most patients have a very good prognosis, so early diagnosis is key, according to
Dr. McConnell.

TREATMENT UNDER LOCAL OR LOCO-REGIONAL ANESTHESIA

Surgery to remove cancerous nodules of the thyroid traditionally has been performed under general anesthesia. Since the late 1990s, patients at Columbia have received
treatment under local or loco-regional anesthesia, and can return home the same day (instead of staying at the hospital three to five days). This inpatient procedure was
pioneered at Columbia by the late Paul LoGerfo, MD, in order to provide patients with a less traumatic procedure and faster recovery. According to Dr. McConnell, "Patients feel far better after this type
of surgery than after general anesthesia." Although this approach has been standard of care at Columbia for many years, only now is it becoming widely adopted across the country.

THYROGEN THERAPY

Following surgery for thyroid cancer, many patients are treated with radioactive iodine in order to eliminate any residual cancer cells. Traditionally, patients have had to avoid taking any thyroid medication
for several weeks in order to undergo this treatment (called remnant ablation), and during the withdrawal period, they have had to endure the uncomfortable, sometimes debilitating symptoms of
hypothyroidism (fatigue, muscle aches, pains, memory impairment, depression, weight gain, and more).

At Columbia, patients need not go through weeks of feeling poorly. Instead of withdrawal from thyroid hormone prior to radioiodine therapy, they can receive thyrotropin alpha, or Thyrogen® , an
injectable thyroid stimulating hormone. Thyrogen was first approved by the FDA in 1998 as a diagnostic tool (because it increases the sensitivity of the thyroid during testing), and then in 2007 for use
during remnant ablation. According to Dr. McConnell, "Post-Thyrogen remnant ablation is as effective as withdrawal therapy, but patients feel well."

THYROGLOBULIN IN FOLLOW-UP CARE


After treatment for thyroid cancer, patients must continue to receive regular monitoring for signs of recurrence, which may occur in up to 30% of patients. For patients at low risk, the standard method
is to measure levels of thyroglobulin, a protein produced by the thyroid gland (and thyroid cancer cells). Studies have found that the presence of thyroglobulin preceded tumor recurrences by three to five
years in 80% of patients. After removal of the thyroid, there should be no thyroglobulin present. If thyroglobulin is detected, this may signify the presence of tumors. Measurement of thyroglobulin
through a simple blood test, also pioneered by Dr. LoGerfo in the 1970s, is now considered a standard of care today.

Low-risk patients may undergo neck ultrasound as well as thyroglobulin assays as part of their follow-up care. Both thyroglobulin and radioiodine scans, as well as PET/CT scans, are used in high-risk
patients, mainly those with advanced, highly aggressive thyroid cancers. Although the use of thyroglobulin assays is standard throughout the world, the New York Thyroid Center is unique in that its
surgeons, endocrinologists, and radiologists collaborate very closely in the care of each patient. "This collaboration not only makes for a better patient experience, but improves patient care,"
says Dr. McConnell.
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Quality of Life Interventions from the Columbia University Department of Surgery
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