ultrasound on everybody in their 60s and 70s, at least half of them would have nodules.” The determination at that point is how best to proceed, particularly in light of the fact that fully 90 percent of thyroid nodules are benign. “We’ll do a biopsy to determine whether there is cancer,” Dr. Lieb says, “and do another ultrasound at six months to see if it’s changing. And we’ll check thyroid labs to see if it’s overactive, and treat accordingly.” Thyroid cancer is one of the fastest rising cancers, especially in women, but mortality from thyroid cancer has not increased; the rate of death is actually very low. Of the four types of thyroid cancer – papillary, medullary, anaplastic and follicular – papillary is the most common, Dr. Wheaton explains. “The majority of patients with papillary cancer have their thyroid removed, maybe radioactive ablation afterward, and they do well,” she says, emphasizing that it always depends on the patient. Medullary thyroid cancer is a more aggressive disease, with a higher mortality rate, tending to be a genetic cancer that has often metastasized before it’s found. Similarly, anaplastic thyroid cancer, which claimed the life of Supreme Court Justice William Rehnquist, is very aggressive and almost always fatal. When Surgery is Indicated. With a diagnosis of cancer, removal of the entire thyroid is indicated, as well as some of the surrounding lymph nodes, says Rebecca Britt, MD, a fellowship trained general and laparoscopic surgeon and associate professor at Eastern Virginia Medical School. “From a recovery standpoint, most patients do extremely well with
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thyroid surgery,” Dr. Britt says. “Our most common complications are low calcium after surgery. In about three percent of surgeries, patients experience recurrent laryngeal nerve injury, or hoarseness, which is permanent less than one percent of the time.” “It’s a very delicate operation,” explains Doris Quintana, MD, a general and endocrine surgeon with Riverside Surgical Specialists, who did additional training in thyroid and parathyroid. “Keen attention to the finest details really makes a difference in how the patient does, particularly because of the presence of the four small parathyroids that are crucial to survival.” The surgery is traditionally done through a transverse incision across the front of the neck. Today, surgeons like Dr. Britt and Dr. Quintana can perform the operation with much smaller scarring than in previous years, but for some female patients, they both agree, there is a concern about any scar on the neck. In some cultures, for instance, where any imperfection is considered to render a woman unmarriageable, some surgeons are doing the procedure endoscopically, with tiny incisions in the axilla or underarms, or even around Rebecca Britt, MD the areola of the nipple. “A