Q&A: Researchers look for ‘sweet spot’ with low-risk thyroid cancer management
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Key takeaways:
- Treatment decisions for low-risk thyroid cancer have implications on long-term surveillance.
- Providers need to be aware of the psychosocial impact a thyroid cancer diagnosis may have on patients.
CHICAGO — There have been several changes in the management of low-risk thyroid cancer in recent years, but researchers are still trying to answer what level of surveillance is appropriate for patients.
Megan R. Haymart, MD, professor of medicine, metabolism, endocrinology and diabetes at the University of Michigan and a Healio | Endocrine Today Editorial Board Member, said treatment of low-risk thyroid cancer has de-escalated in recent years, with more patients receiving partial thyroidectomy instead of a total thyroidectomy and fewer people receiving radioactive iodine therapy. These changes have implications when it comes to follow-up. Haymart discussed considerations for managing low-risk thyroid cancer during a Meet the Professor session at ENDO 2023.
“As management has changed for thyroid cancer, it’s going to have implications for long-term surveillance,” Haymart told Healio. “We need to tailor the surveillance both to the individual as well as to the treatment that they received. In some instances, we can even consider when we can de-escalate ... for patients who are doing well.”
Healio spoke with Haymart about shifts in the long-term management of low-risk thyroid cancer, new research on disparities in thyroid health, and what new thyroid research experts should keep an eye on in the near future.
Healio: Has long-term management of low-risk thyroid cancer changed in recent years? If so, what are some of those changes?
Haymart: The main modalities that we use, thinking of differentiated thyroid cancer, have not changed a lot. It’s laboratory work: TSH, thyroglobulin, thyroglobulin antibody. Neck ultrasound is a mainstay of follow-up. But what has changed in recent years is that we’ve de-escalated the medical management and surgical management, meaning a lot more patients are having half the thyroid removed, instead of all of it. A lot more patients are not receiving radioactive iodine. That has implications for the follow-up period. For patients who have more done — like total thyroidectomy with radioactive iodine — the follow-up is actually easier because their tumor marker is really easy to follow, the neck ultrasound is usually unrevealing. For patients who have had less done, such as lobectomy, the follow-up is a little bit more complex, because there’s really more of a role for neck ultrasound. That’s the major thing, because we’ve had this change in management, it has implications for how we continue long-term surveillance.
Healio: How important is it to evaluate the psychosocial impact of a thyroid cancer diagnosis? What are some of the things providers can do to address this impact?
Haymart: Cancer-related worry is really common among our patients. We have a lot of younger patients that are diagnosed with it. It’s a big life event for them to get that cancer diagnosis, and studies have shown that it can impact their interactions with family and friends, it can impact their quality of life. It’s really important that we understand that this worry is common, and then figure out ways to address it.
Our team’s prior work has found that physicians are aware of the worry, they do try to make themselves more available, but there may be more that they can do. I think the physicians might take a lot on themselves. But there may be a role for support groups, there may be a role for counselors, for social workers, for psychology, for better online information being made available. We talk about that, too. What are the additional things that we can do to try to address patients’ worry?
Ultimately, we have to figure out a way to have tools that are tailored to the individual and also help with self-management of worry. It’s a major issue during the survivorship period and something that we need to figure out how to address better.
Healio: Where do you think the biggest focus is as far as thyroid research is concerned?
Haymart: There’s a lot of effort focusing on tailoring care, so avoiding overdiagnosis and overtreatment. That’s an area that our research group as well as others are interested in. It’s an exciting area that’s been understudied.
There’s more work looking at disparities in thyroid. If we’re trying to have optimal thyroid health for all, if we want to make sure that that everyone is receiving optimal care, we have to admit the disparities exist, and then we have to figure out how to address those. That’s something that there’s been a renewed interest in, and that’s really important.
Healio: What research is your team working on right now?
Haymart: Our team, including our work with Debbie Chen, MD, is very interested in access to care. Which patients are able to get in to see the physicians and what are the obstacles to access? We continue to work on studying overdiagnosis and overtreatment of thyroid cancer, and what we can do to sort of hit the “sweet spot” where we’re minimizing overdiagnosis and overtreatment. We don’t want undertreatment, especially when we do have some patients who have high-risk disease. That’s where there’s still work to be done, and the pendulum is moving. Obviously, we don’t want to move too far in the other direction [of undertreatment]. Better evidence will guide better care, and that’s why it’s important that we continue to research this.
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