Should Further Testing Be Done for Thyroid Cancer Diagnosis?

Q: Should Further Testing Be Done for Thyroid Cancer Diagnosis?

Elaine / 33 years old / Female<br>Hello：<br>1. <br>The attending physician only informed my mother that the examination results indicated "malignant tumor or suspected malignant tumor, specifically papillary thyroid carcinoma." As you mentioned, it has already been confirmed as c

Is further examination or diagnosis necessary?

Dear Dr.
Chen,
My mother is 57 years old and has been experiencing coughing symptoms regardless of whether she has a cold.
In December 2014, she underwent ultrasound, fine needle aspiration, and MRI at a major hospital due to left-sided thyroid enlargement.
The results of the first two tests indicated "nodules present in both lobes of the thyroid, but normal," so she did not return to the hospital to review the MRI results.
A few days ago, my mother went back to the hospital to check the follow-up results from her blood tests, fine needle aspiration, and ultrasound from last December.
However, the attending physician only informed her that the results indicated "malignant tumor or suspected malignant tumor, consistent with papillary thyroid carcinoma," and recommended that we consult surgery or otolaryngology for surgery, without mentioning details such as the size, number, and location of the tumor.
Seeing many online inquiries where individuals were clearly informed about the size, number, and location of tumors before surgery, my family and I realized that we might not fully understand my mother's condition.
We are very concerned about making a decision regarding surgery without complete information about her condition.
Therefore, I would like to ask the physician whether further examinations or confirmations are necessary.
Could my mother's persistent cough be caused by the thyroid tumor, and is there a way to confirm this? Lastly, should we choose surgery from the general surgery department or the otolaryngology department?
I appreciate your assistance in answering these questions.
Thank you.

elaine, 30~39 year old female. Ask Date: 2016/01/08

Dr. Chen Sirong reply Oncology

Elaine / 33 years old / Female
Hello:
1.
The attending physician only informed my mother that the examination results indicated "malignant tumor or suspected malignant tumor, specifically papillary thyroid carcinoma." As you mentioned, it has already been confirmed as cancer, specifically papillary thyroid carcinoma.
2.
I noticed that many individuals asking questions online were well-informed about the size, number, and location of the tumors before surgery.
My family and I realized that we do not fully understand my mother's condition, and we are very concerned about making a decision regarding surgery without complete knowledge of her illness.
Therefore, I would like to ask the physician if further examinations or confirmations are necessary.
Different cancers are managed differently; for this type of cancer, if surgery is performed and it has not spread, the success rate is very high.
The five-year survival rate for patients in stages I, II, and III is over 95%, and even in stage IV, the five-year survival rate is still 57%.
It is advisable to proceed with surgery quickly.
After the surgery, the physician will also conduct iodine-131 scans to determine whether additional iodine-131 treatment is necessary.
It is not that we do not conduct examinations; for this type of cancer, we typically proceed with surgery first and then conduct further evaluations.
3.
Is my mother's persistent cough caused by the thyroid tumor, and is there a way to confirm this? A: No.
4.
Lastly, should we choose surgery from a general surgeon or an otolaryngologist? A: Both options are viable.
Thank you for your letter.
Taoyuan Hospital
Chen Sih-Rong

Reply Date: 2016/01/08

More Info

When it comes to the diagnosis and treatment of thyroid cancer, particularly in cases where there is a suspicion of malignancy, it is crucial to ensure that all necessary evaluations and tests are conducted to confirm the diagnosis and determine the appropriate course of action. In your mother's case, given her history of thyroid nodules and the recent diagnosis of suspected papillary thyroid carcinoma, further testing may indeed be warranted to provide a clearer picture of her condition.

Firstly, it is important to understand that the initial evaluations, such as ultrasound and fine needle aspiration (FNA), are standard procedures for assessing thyroid nodules. While these tests can provide valuable information, they may not always give a complete picture, especially regarding the size, number, and exact location of the tumors. If the results indicate a malignancy or suspicion of malignancy, additional imaging studies may be beneficial. A neck ultrasound can help assess the size and characteristics of the nodules, and it can also evaluate the surrounding lymph nodes for any signs of metastasis.
In some cases, a CT scan or MRI may be recommended to provide more detailed images of the thyroid and surrounding structures. These imaging modalities can help determine if the cancer has spread beyond the thyroid gland, which is critical for staging the cancer and planning treatment. If your mother has persistent cough symptoms, it is essential to investigate whether they are related to the thyroid condition or if they stem from another underlying issue, such as a respiratory condition. A thorough evaluation by a pulmonologist may be necessary if her cough persists despite the thyroid diagnosis.

Regarding the surgical options, both general surgeons and otolaryngologists (ENT specialists) are qualified to perform thyroid surgeries. The choice between the two may depend on the complexity of the case and the surgeon's experience with thyroid procedures. It is advisable to consult with both types of specialists to understand their approaches and recommendations. A multidisciplinary team approach can often provide the best outcomes, as it allows for a comprehensive evaluation of the patient's condition.

In summary, further testing, including additional imaging studies and possibly a second opinion from another specialist, may be beneficial to ensure that your mother receives the most accurate diagnosis and appropriate treatment plan. It is essential to have a clear understanding of the tumor's characteristics, including size, number, and location, before making decisions about surgery. Open communication with the healthcare team is vital, and do not hesitate to ask for clarification on any aspects of her diagnosis and treatment options. Your mother's health and well-being are paramount, and ensuring that all necessary evaluations are completed will help in making informed decisions moving forward.

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