Treating Thyroid Cancer Without Surgery – Is this Really an Option?
I remember somewhat recently reading a study out of Finland where thyroid cancers were NOT surgically treated. Tumors less than 1.5 cm were treated with primary active surveillance as opposed to surgery with staggering results. It is a controversial approach, but more research is suggesting that the rates of certain types of thyroid cancers are being over-diagnosed. More people aren’t getting thyroid cancer, it’s just the improvements in technology are finding nodules more frequently, which is leading to more intervention. Surprisingly enough, a high number of diagnoses are made on patients who are completely asymptomatic. The thyroid cancer is found as a result of something completely unrelated to thyroid problems. In fact, a 2017 study shows that in people with a diagnosis of thyroid cancer who opt out of surgical treatment, the incidence of death from thyroid-related cancer death was lower than that of other causes.
When I was first diagnosed with thyroid cancer, the recommended treatment was to take it out. Something in me said to stop. Wait a beat. Take a breath. And along the way, some people thought I was crazy for defying the standard protocol for treatment. And yet here I am, years later, not just surviving. Rather, I’m thriving. My journey has been a difficult one, yet every step of the way I have known I was on the right path. The dots are all there. They are just waiting to be connected. And sure enough, my decision to say “Stop. Hold on. Let me catch my breath and think about what course of treatment is best for me” was the correct one. Now science is backing up what I have known all along.
When to Consider Active Surveillance
As more research continues to emerge, active surveillance for Papillary Thyroid Cancer is still a controversial approach. However, I don’t think it will be controversial for long. Studies suggest that tumor size has little to do with distant metastasis. In fact, a 2018 study published this past March continues to suggest the instances of PMC are over-diagnosed, and a more conservative approach of watchful waiting and monitoring is a better option than having the thyroid removed and then treating with radioactive iodine.
In 2010, a controversial study published findings suggesting there is little significance in the size of PTC. The study finds there is no significant difference in outcome or long-term prognosis in patients with tumor sizes less than 1 cm versus those with tumor sizes greater than 1 cm. The results are groundbreaking and have led to further investigation over the way we diagnose and treat thyroid cancers.
Why Not Just Remove it to be Safe?
This may seem like a logical question, and one that I have encountered many times since my own diagnosis. People live long, full, satisfying lives without their thyroid gland. Medications can supplement some of the thyroid stimulating hormone, or TSH, and for many survivors it is a relief to just have it zapped or cut out and be done with it. And for those patients who have a good outcome, that is fantastic. However, it is impossible to know which direction your personal journey will take you. Some patients have a great outcome, while others have substantial difficulties after having thyroid removal or ablation. The most commonly prescribed medication for managing thyroid hormone is called Synthroid, and it imitates only one thyroid hormone, the T3.
For many patients, women in particular, T3 replacement does little to manage symptoms associated with their overall health and well-being. T4 and other thyroid panel hormones are difficult to replace with synthetic medications. Many patients struggle to find the right balance, and even more never do. They spend the rest of their lives dealing with health issues. Fatigue, deep muscle pain, damage to salivary glands, chronic cough and hoarseness, weight gain, hair loss, cold intolerance, gut problems, stomach problems, dry skin, sleep disturbances, restless leg syndrome, headaches—the list is endless. A lifetime of managing just one or two of these conditions alone could be exhausting. Let alone several more? No thanks. As a wife and a mother, I wanted more for myself and my family. And it turns out, perhaps medical professionals have been jumping the gun all along on suggesting removal or ablation or radiation to thyroid cancer.
Over the past three decades, there has been a significant increase in the number of people diagnosed with thyroid cancer. Interestingly enough, oftentimes thyroid cancers are found during autopsy and are completely unrelated to cause of death and were completely asymptomatic in patients. Finland is making advances in treatment of thyroid cancer, whereas the United States is being much more aggressive in diagnosing and treating thyroid cancers. A 2009 study showed that incidental thyroid cancers found during autopsy is as high as 35.6% in Finland, whereas the United States has just a .01% prevalence of occurrence. The results can be attributed to a number of factors, though favor more aggressive diagnosis and treatment in the United States than other parts of the world. Additionally, genetics and environment can play a role in incidence of thyroid cancer. The point is, in many of those 35.6% of people with incidental thyroid cancers in Finland, the cause of death was only attributed to that cancer in a very small portion.
These results point more favorably to a watch and wait approach towards treatment. In my own case, my journey has been exhaustive in searching for the best way to treat my entire being. It is not just the thyroid cancer being targeted. My journey has been mind, body, and spirit and is helping to connect the dots of the whole being. The body isn’t a separate entity. It is more than just a vessel to carry my blood and bones around. It is only a small part of the whole being that is essentially me. Focusing on healing the whole person has been enlightening, and the results show in every aspect of my life. I’m not simply a cancer survivor. I am a cancer thriver.