Questions to Ask Before Thyroid Cancer Surgery

A thyroid cancer diagnosis often begins with something small — a lump that wasn't there before, a change in the voice, a lymph node that feels off. From there, the pace can pick up quickly: biopsy, cell typing, staging and a decision about surgery.

That surgical decision is where Dr. Robert S. Alter sees people get caught off guard. Some go into the operating room expecting one lobe of the thyroid to be removed and learn afterward that both were taken. It's a choice with long-term consequences, including whether a person will need thyroid hormone replacement for the rest of their life.

In an interview with CURE, Alter, co-division chief of genitourinary oncology and head and neck oncology at Hackensack Meridian John Theurer Cancer Center in Hackensack, New Jersey, discussed what should happen in that first conversation after a thyroid cancer diagnosis — from defining the cell type to asking about family history — and why coming in with a written list of questions matters more than people realize.

Transcript

The first part of the conversation should be all about the initial symptoms and presentation. What led them to the doctor? Sometimes it's something as subtle as a suspicious lymph node, a swelling, a voice change. Once a concern is there, the referral to a biopsy, which can be done ultrasound-guided — it doesn't have to be surgical.

But once you have that information, it's confirming the diagnosis. It's important to define the cell type. There are three different categories of thyroid cancer, and each treatment plan is based upon the cell structure. Then there's the initial staging, the extent of disease.

Through the doctor's eyes, we have to formulate what the first plan is in regard to the type of surgery. Is it going to be one lobe, what's called a lobectomy, or is it going to be a total thyroidectomy? A very common scenario is they take out one lobe, they analyze it, and when they get that result they formulate a plan: do they stop there for surveillance, or does one proceed forward doing surgery for the other side? Some doctors like to just jump in and take out both lobes based upon suspicion.

There are times when one truly wants to maintain what the body has to offer. If you still have one lobe of a thyroid in, it's very functional. One can easily stay off medications. So the conservative approach is really based upon the fact that one lobe of the thyroid can suffice for the rest of life, and there are guidelines for when you consider doing the total thyroidectomy initially or based upon the result of the first lobectomy. A lot of times people walk in and they assume they'll have one lobe taken out, and they're blindsided by the second procedure. Physicians should offer that information, and if not, patients should ask about it.

Other things you have to ask: Is this genetic? Is there a family history that one should ascertain, both in regard to a genetic risk assessment, counseling and testing? Most of these patients are in their 20s and 30s, sometimes a little bit older. They have to ask whether this is something they received from family members, and therefore they should ask about siblings as well, or is it something they can carry on to their offspring? The fear of the disease itself overwhelms you, and you tend to forget anything but yourself. But it's always important to inquire about the rest of the family.

It's always hard to be composed when you get a diagnosis. Coming with a list of questions and asking the surgeon for time is quite important.

Transcript has been edited for clarity and conciseness.

For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.