M. Regina Castro, MD is a consultant in the Division of Endocrinology at the Mayo Clinic in  Rochester, MN.  She is an Associate Professor of Medicine. She is the Associate Program Director for the Endocrinology Fellowship program,  and Director of Endocrinology rotation for the  Internal Medicine Residency.  She is also a member of the Thyroid Core Group at Mayo Clinic. She served from 2009 to 2015 as Thyroid Section Editor for AACE Self-Assessment Program and has authored several chapters on Hyperthyroidism, Thyroid Nodules and thyroid cancer. She has served on various committees of the ATA, including Patient Education and Advocacy committee, the  editorial board of Clinical Thyroidology  for Patients (CTFP),  Trainees and Career Advancement committee  and  is at present  the  Chair of the Patient Affairs and Education Committee. She currently serves on the ATA Board of Directors. Her professional/academic Interests:  Clinical research related to thyroid nodules and thyroid cancer,  clinical care of patients with various thyroid diseases, and medical education.

During this interview, the following topics are addressed:

• What is a thyroid nodule?  A lump that could be benign or cancerous
• The prevalence depends on how you search for them
• 60% of people in the U.S. will have nodules
• 90% are benign
• Sometimes done during routine physical exam
• Sometimes the patient discovers it
• Usually is discovered when imaging is done for other reasons — during CT scan
• Medical history of radiation to head or neck as a child, family history of thyroid cancer, size of nodule, abnormal lymph nodes in the neck
• Usually patients with a nodule are asymptomatic
• Best test to look at the nodule is an ultrasound of the nodule
• Features in the ultra sound determines how suspicious a nodule is
• A biopsy is ordered based on appearance, if nodules are clearly defined are more likely to suggest they are benign
• If nodule looks dark or borders are irregular, or increased blood flow within the nodule may cause concern
• Quality and resolution of thyroid ultra sound is high resolution and provides a clear look
• Coaching patients through the anxiety through a possible biopsy
• The majority of nodules can be observed
• ATA guidelines suggest observation based on the result of the biopsy
• Suspicious nodules that are less than 1cm are sometimes determined to best observe and not remove
• Cancer will be in only 5% of biopsies
• A smaller, low risk cancer should warrant a lesser surgery — and reduce the chance of surgical complications
• When to remove a nodule even if no cancer? 
• If other structures are being obstructed, such as breathing or swallowing, sometimes surgery relieves symptoms regardless if cancer or not
• Observation — and follow up recommendations
• 15% are labeled indeterminate
• If surgery, surgeon needs to be experienced — many surgeons conducting thyroid surgery are low in experience
• The Mayo Clinic thyroid cancer team
• Biopsy results in two hours versus two weeks

NOTES

The American Thyroid Association

Dr. Regina Castro

64: Managing Indeterminate Thyroid Nodules, with Dr. Kimberly Vanderveen from Denver Center for Endocrine Surgery