NLM Director’s Comments Transcript
New Thyroid Test Reduces Unnecessary Surgery: 08/13/2012

Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what's new this week in MedlinePlus.

A new gene test more precisely detects the status of some thyroid nodules and could reduce unnecessary surgery for thyroid cancer, finds a novel study and accompanying editorial recently published in the New England Journal of Medicine.

The study finds a new test that screens for 167 genes expressed by thyroid tumors efficiently detected benign, malignant and equivocal thyroid nodules in cases where earlier tests produced only indeterminate results. In a study of 265 indeterminate thyroid nodules, the gene expression test detected 78 of the 85 malignant nodules (subsequently confirmed by a histopathology diagnosis).

Following the same procedure, the gene expression test also detected 94 percent of remaining nodules that had some evidence of cancer, 95 percent of the nodules within a clinically defined grey area between malignant and benign, and 93 percent of the benign nodules.

An accompanying editorial explains the gene expression test is an innovative tool that more accurately discerns a patient’s health status when existing tests of thyroid nodules are indeterminate. The gene expression test was not assessed in situations where other assessments provide robust evidence of a benign or malignant thyroid nodule. MedlinePlus.gov’s thyroid cancer health topic page explains a thyroid gland can develop nodules that physicians assess to determine whether the nodules are benign or malignant.

The author of the editorial, J. Larry Jameson, M.D., University of Pennsylvania, writes the study contributes significantly to the quest for diverse diagnostic tools for patients with thyroid nodules. While Jameson notes the development of the array of current tests (and we quote): ‘has been a long but successful journey’ (end of quote), he adds the gene expression test helps better discern whether suspicious but lower-risk nodules are benign, malignant, or somewhere in between.

The study’s 18 researchers explain about 15 to 30 percent of nodules that may be linked to thyroid cancer cannot be diagnosed as benign or malignant by using a current state-of-the-art diagnostic test called a ‘fine needle-aspiration’ (or a needle-based biopsy).

The study’s authors add surgery is recommended when patients have an indeterminate diagnosis as a precaution to prevent the development (or expansion) of thyroid cancer. However, the authors note surgery sometimes becomes unnecessary after the fact when thyroid nodules turn out to be benign.

In addition, physicians often remove part or all of the thyroid gland as a precaution during surgical procedures, said Erik Alexander M.D., the study’s lead author, to Bloomberg News. In remarks to a press release about the study from Brigham and Women’s Hospital in Boston, Dr. Alexander added more than half of current thyroid surgeries may be unnecessary (when previous thyroid nodule tests are indeterminate).

Overall, the study’s authors imply the findings enhance thyroid cancer care by improving the assessment of a patient’s risk, potentially saving a thyroid gland when possible, minimizing unnecessary surgery, and reducing medical costs.

MedlinePlus.gov’s thyroid cancer health topic page explains the thyroid is a butterfly shaped gland in your neck just above your collarbone. The thyroid gland makes hormones that help the body function normally. About 1,780 Americans die of thyroid cancer annually and about 57,000 new cases are diagnosed each year.

An overview of the common tests used to screen for thyroid cancer (from the Mayo Foundation for Medical Education and Research) is available in the ‘overviews’ section of MedlinePlus.gov’s thyroid cancer health topic page. Information about the fine needle aspiration test can be found in the ‘diagnosis/symptoms’ section of MedlinePlus.gov’s thyroid cancer health topic page.

A guide to how thyroid cancer is diagnosed (provided by American Cancer Society) is found in the ‘diagnosis/symptoms’ section.

MedlinePlus.gov’s thyroid cancer health topic page contains the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the thyroid cancer health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.

To find MedlinePlus.gov’s thyroid cancer health topic page, type ‘thyroid cancer’ in the search box on MedlinePlus.gov’s home page, then, click on ‘Thyroid cancer (National Library of Medicine).’ MedlinePlus.gov also has a health topic page devoted to thyroid diseases.

Before I go, this reminder… MedlinePlus.gov is authoritative. It's free. We do not accept advertising …and is written to help you.

To find MedlinePlus.gov, just type in 'MedlinePlus.gov' in any web browser, such as Firefox, Safari, Netscape, Chrome or Explorer. To find Mobile MedlinePlus.gov, just type 'Mobile MedlinePlus' in the same web browsers.

We encourage you to use MedlinePlus and please recommend it to your friends. MedlinePlus is available in English and Spanish. Some medical information is available in 43 other languages.

Your comments about this or any of our podcasts are always welcome. We welcome suggestions about future topics too!

Please email Dr. Lindberg anytime at: NLMDirector@nlm.nih.gov

That's NLMDirector (one word) @nlm.nih.gov

A written transcript of recent podcasts is available by typing 'Director's comments' in the search box on MedlinePlus.gov's home page.

The National Library of Medicine is one of 27 institutes and centers within the National Institutes of Health. The National Institutes of Health is part of the U.S. Department of Health and Human Services.

A disclaimer – the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider. I want to take the opportunity to wish you a very happy holiday season and a healthy New Year. The National Library of Medicine and the 'Director's Comments' podcast staff, including Dr. Lindberg, appreciate your interest and company – and we hope to find new ways to serve you in 2012.

I look forward to meeting you here next week.