Tailored thyroid care for individuals is possible at Johns Hopkins — as its head and neck surgeons offer the full spectrum of approaches along with high expertise in each modality.
Until recently, patients with benign thyroid nodules or thyroid cancer had few choices — and the ones they were offered could be subject to a physician’s or surgeon’s bias. However, says endocrine head and neck surgeon Jon Russell, the team approach and expertise available at Johns Hopkins provides patients with various options for personalized care.
“The conversation after diagnosis has expanded exponentially to help us get to know our patients and what’s important to them.”
“We are national and international leaders in several thyroid treatment techniques,” Russell says, “so we can create an experience for patients where patients can say, ‘This is what’s important for me.’”
Russell explains that many centers have expanded beyond removing the entire thyroid gland through an open incision on the neck, an approach that Johns Hopkins founding surgeon William Stewart Halsted helped pioneer in the late 1800s. For example, some hospitals now offer scarless thyroidectomies, in which the gland is removed through a transoral or transaxillary approach, or through an incision in a natural crease such as under the lower lip. Others offer radiofrequency ablation, a nonsurgical method to shrink nodules or cancers. Still others may offer active surveillance of small cancers. And very few are using new techniques such as parathyroid autofluorescence to improve patient safety.
But it’s rare for any center, he says, to offer all these options — as is the case at Johns Hopkins — with high expertise in each modality.
Each of these approaches comes with pros and cons, Russell says. For example, although an open thyroidectomy is a definitive approach for nodules and cancers, it leaves a prominent scar on patients’ necks and leaves them dependent on taking exogenous thyroid hormone for the rest of their lives. Scarless thyroidectomies don’t leave patients with a visible reminder of their surgeries, but the need to take thyroid hormone remains. Radiofrequency ablation can remove only the nodule, an approach also being tested for malignant thyroid tumors, which avoids the need for exogenous thyroid hormone in many patients. But it also leaves the risk of new nodules developing, which may require more invasive treatment in the future.
Rather than dictate to patients which treatment they’ll receive, Russell says, he and his colleagues instead start a dialogue with patients about the advantages and disadvantages of each option, helping them decide which option is the best based on their personal priorities.
“The conversation after diagnosis has expanded exponentially to help us get to know our patients and what’s important to them,” Russell says. “It’s so rewarding to help patients define what they want and help them accomplish the goals they may not have realized they had.”