The Thyroid Nodule Epidemic by Jeffrey Dach MD

Excellent article- follow link for complete text. This reminds me of the over-treatment women routinely get for various breast cancers- some of which are so slow-growing that they will never cause a problem, or threaten life.

I can think of two forum-folk for whom this article is personally significant.

http://jeffreydach.com/2009/08/16/the-thyroid-nodule-epidemic-by-jeffrey-dach...



"...For twenty years as an interventional radiologist, my job was to perform ultrasound needle biopsies of small thyroid nodules sent into the hospital by primary care doctors. The vast majority of thyroid cancers found with ultrasound scanning and needle biopsy are the small papillary carcinoma, a relatively benign tumor with excellent prognosis (30 year survival rate 95% )...

...A Frustrated Radiologist Says : Turn Off the Ultrasound Machines

An exasperated radiologist, John J. Cronan, MD says in the June 2008 issue of Radiology we should "turn off the ultrasound machines". Cronan questions this entire medical enterprise of detecting thyroid nodules, and small cancers with ultrasound guided biopsy. "From the patient perspective, we have hung the psychologic stigma of cancer on these patients and the dependency for daily thyroid supplementation...We accept all these consequences to control a cancer with a 99% 10-year survival."

A Normal Finding

Dr Harach says occult papillary carcinoma of the thyroid is a "normal" finding in Finland, and does not cause biologically significant disease. Dr. Louise Davies agrees with Dr Harach, and says in JAMA, "papillary cancers smaller than 1 cm could be classified as a normal finding" ...

...Keith Heller, MD, a neck surgeon who operated on 1,000 cases of thyroid cancer over a 28 year career, addressed his colleagues in a medical meeting saying:

"I do not believe that this epidemic of (thyroid cancer) is real. It is due to ...the increasing use of ultrasound-guided needle biopsy of thyroid nodules. We may be diagnosing and treating cancers that have no clinical significance...We have embarked on a quixotic quest to rid our patients of microscopic and probably clinically unimportant thyroid cancer.... We are performing far too many unnecessary thyroidectomies. "

..."Our preliminary data suggest that papillary microcarcinomas do not frequently become clinically apparent, and that patients can choose observation while their tumors are not progressing, although they are pathologically multifocal and involve lymph nodes in high incidence."

This is astounding. Even though the papillary thyroid cancer may be multi-focal, or involve regional lymph nodes in the neck, Dr. Ito says the patient can opt for watchful waiting with serial ultrasound follow up studies.

In another study of 52 cases, Dr Ito found when the papillary thyroid cancer is resected as a benign nodule (by mistake), even this is sufficient treatment and no further immediate surgery is needed.

It's the Pathologist's Fault - Just Stop Calling It Cancer

Perhaps this whole problem is caused by incorrect terminology used by the pathologist who reviews the biopsy slide and uses the word "cancer", a word that strikes fear and creates undue stress. Once a pathology report with the word "cancer" is placed on the desk, rationality gets thrown out the window, and the patient demands aggressive treatment, usually out of proportion to the actual pathology...

...You might ask the obvious question, "Thyroid nodules are found in 67% of the population. What is causing this?" I would suggest that the most likely explanation is subclinical Iodine deficiency in the population. Iodine deficiency causes thyroid enlargement (goiter), thyroid nodules, and thyroid cancer.

Thyroid cancer appears linked to Iodine deficiency in both animal models and humans.
Studies have shown that iodine deficiency is associated with increased anaplastic thyroid cancer, the aggressive type unresposive to treatment and associated with high mortality rate. Population studies in which iodine supplementation was given showed reduced mortality from thyroid cancer. Incidentally, this reduced mortality was also associated with an increase in well differentiated papillary cancers, again suggesting the papillary type to be associated with a better outcome.
Make sure to take Iodine suppplements to reduce the risk of dangerous types of thyroid cancer."


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