FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S THYROID NEEDS MORE TESTS, PROBABLY SECOND OPINION

Question: I had a lump appear around my thyroid that is noticeable to the naked eye. My endocrinologist ran several tests, including a needle biopsy to insure that it was not cancer, which it was not. I was given Synthroid and have had five months when I felt well and had a reduction in the size of the lump. Now, the lump is getting bigger. The doctor wants to repeat all of the tests, including the painful needle biopsy, because he is concerned that the lump is now cancerous. Is this really necessary? Should I get a second opinion before I have the growth surgically removed?

Answer: Before I directly answer your questions, I need to explain some of the terms you used for others who read this column. First, an endocrinologist is a physician who has specialized in diseases of the glandular system, including thyroid problems. A needle biopsy is just what it sounds like it is a medical procedure where a needle is passed into the suspicious lump or cyst in order to obtain a sample of tissue to be studied under the microscope. In this case, the small needle is passed into the thyroid lump. The third term you used that needs explanations is "Synthroid." This is a brand name of artificially produced thyroid hormone. By taking it you relieve your thyroid gland of the need to produce this essential hormone that plays a key role in controlling your overall body metabolism.

New or unusual lumps anywhere on the body raise a concern about cancer. Fortunately, only a very small percent of thyroid lumps less than three percent are cancerous. The problem your doctor faces is determining whether you are in the unfortunate three percent, because cancer requires special treatment.

One easy approach from the doctor's perspective to determine if thyroid lumps are cancerous would be to surgically remove them all. For every 100 of these surgeries, though, 97 would be needless. I think you'll agree that's too much pain, suffering, risk and expense for the small number of actual cancers that would be discovered.

In actual practice, what we do is conduct a series of tests that give us increasing certainty about the nature of a suspicious lump. First, blood tests and thyroid scans can safely identify about one-half of thyroid lumps as being non-cancerous. Fine needle biopsy, although the needle doesn't look that "fine" when you are on the receiving end of it, can further select another 25 from the remaining 50 percent as having non-cancerous growths. This leaves about 25 percent the group into which you fit who have suspicious lumps that require further testing and/or surgical removal.

A needle biopsy isn't a particularly pleasant experience, but it is dramatically better than having thyroid surgery. The unfortunate problem is that it still may not provide a definite answer to the question of whether your cyst is cancerous. I'd suggest that you follow your endocrinologist's advice about having more tests. If surgery is recommended, then it is your right and also a wise choice from the perspective of a health-care consumer to have a second opinion.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.