BackTable / ENT / Podcast / Episode #35
with Dr. David Goldenberg
Dr. David Goldenberg talks with us about the management of thyroid nodules, including workup, imaging and patient counseling.
BackTable, LLC (Producer). (2021, November 2). Ep. 35 – Thyroid Nodules [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. David Goldenberg
Dr. David Goldenberg is a professor and the chair of the department of otolaryngology - head and neck surgery at Penn State in Hershey, Pennsylvania.
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
In this episode, head & neck surgical oncologist Dr. David Goldenberg joins Dr. Gopi Shah and Dr. Ashley Agan to discuss diagnosis, treatment, and follow up for various types of thyroid nodules in adults.
First, Dr. Goldenberg describes his workup for thyroid nodules, which includes palpation, ultrasound, and TSH levels. He emphasizes that a thyroid ultrasound must involve the scanning of both sides of the neck in order to make comparisons between normal and abnormal findings. After evaluating the ultrasound and having open dialogue with pathologists and radiologists, his team decides if Fine Needle Aspiration (FNA) is necessary. The doctors discuss how to counsel patients when FNA yields indeterminate results. The course of further treatment and surveillance should take into account the patient’s risk tolerance, the presence/absence of compressive symptoms, and the patient’s ability to return for a later biopsy.
Dr. Goldenberg describes how the use of molecular testing is becoming more common in diagnosing thyroid cancers. Specifically, the BRAF mutation usually signifies thyroid cancer, and the TERT mutation signifies a very aggressive form of thyroid cancer.
Finally, the doctors discuss surgical decision-making between a full thyroidectomy and a partial lobectomy. Dr. Goldenberg focuses on damage to the recurrent laryngeal nerve as potential complication and emphasizes the importance of justified interventions and continual surveillance.
“Head and Neck Endocrine Surgery” by Dr. David Goldenberg: https://www.thieme.com/books-main/otolaryngology/product/6136-head-neck-endocrine-surgery
[David Goldenberg MD]
Typically what the cytopathologist is looking for is papillary thyroid cancer. Now, why do I say that? First of all, the overwhelming majority of these are going to be papillary thyroid cancer, if they're going to be a cancer. Okay? The second, most common follicular thyroid cancer, as well as its cousin Herthel cell cancer, you cannot make the diagnosis by fine needle aspiration biopsy because the criteria that differentiates malignant from benign are invasion of the thyroid capsule, the capsule of the tumor and invasion or invasion of vasculature. And neither of those things can be seen on FNA.
Medullary thyroid cancer. Very rare. I recently had a lady who, you know, she had a biopsy, which was indeterminate and it turned out to be medullary thyroid cancer, so that certainly can happen. And, you know, usually obviously, the more horrific thyroid cancers such as anaplastic and lymphoma are not subtle in their presentation.
But, you know, if we're looking for papillary thyroid cancer, they look for a nuclear inclusions, and nuclear grooves, and nuclear enlargement, that kind of thing.
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