Getting a Second Opinion for Your Thyroid Cancer: Video

Hi, Dr. Michael Yeh from UCLA Endocrine Surgery. At UCLA, many patients visit the Endocrine Center seeking a second opinion about their thyroid cancer. Today, I want to talk specifically about what to expect when seeking a second opinion.

First, let me say that when we care for patients with thyroid cancer, there is often more than one acceptable treatment strategy. Options include partial removal of the thyroid, complete removal of the thyroid, radiofrequency ablation, and in some cases, just active surveillance alone. Often, more than one option may be appropriate, so if you see two or more thyroid specialists, you may naturally get different recommendations.

When a patient visits us seeking a second opinion, there are three possible outcomes:

We agree with the first opinion and recommend staying the course.
We recommend less aggressive treatment.
We may recommend more aggressive treatment.

Often, we will agree with the thyroid specialist you visited. If so, that's wonderful. We are happy always to provide some reassurance and answer any additional questions about your disease.

Okay, but what if we recommend something different?

There are times when we recommend less aggressive treatment. This is quite common today. Why? Because research over the past 10 years has shown that we can achieve good outcomes for patients with thyroid cancer while being less aggressive with surgery and follow-up treatments. It is important to know that the old standard for the treatment of nearly all thyroid cancers prior to 2015 or so was to perform a total thyroidectomy followed by radiation treatment for everyone. I really think that time is over now. Today, care for thyroid cancer is really individualized. New guidelines state that cancers less than four centimeters without spread outside the thyroid gland can be treated with just partial thyroid removal.

At UCLA and most academic centers, we tend to be early adopters and are faster to change our practice based on the latest evidence. Our goal is to achieve good cancer outcomes with as little risk as possible. So, if we find no high-risk features, we tend to recommend partial thyroid removal when possible. Partial thyroidectomy means that some patients can avoid the need to take thyroid hormone every day. Smaller operations mean fewer complications from surgery, and the decreasing use of radioactive iodine means fewer long-term side effects.

If we see signs of very low-risk disease, typically cancers that are only millimeters in size, we have learned that many of these cancers can be safely observed instead of going straight to surgery.

Of course, there are times when we recommend more aggressive treatment. The most common scenario when this happens is if we find signs of more advanced disease on an ultrasound. We always perform our own neck ultrasounds in clinic. If we see signs of the thyroid cancer growing outside of the thyroid or possible spread to lymph nodes, we will recommend more aggressive surgery. More aggressive surgery could include removal of the entire thyroid, removal of the nearby lymph nodes in the central neck, and sometimes removal of the lymph nodes on the side of the neck. So much of this depends on a thorough ultrasound. In our practice, this is done by us, the surgeons. I really don't think there's a substitute for this because you really want your surgeon to be fully equipped with a three-dimensional roadmap for your operation.

The bottom line here is that nobody wants too much surgery. Also, nobody wants less surgery than what they need to treat their thyroid cancer adequately. The key is to get this just right for every patient to achieve the best outcomes with the fewest complications.

If you would like to seek a second opinion at UCLA, patients can come for an in-person visit or chat with us virtually. Since the ultrasound examination is so important, in-person visits are often best for initial thyroid cancer evaluations.

Highlights:

The treatment options for thyroid cancer include partial or complete removal of the thyroid, radiofrequency ablation, or active surveillance alone. Multiple opinions may lead to different recommendations due to the individualized nature of the disease.
Less aggressive treatment for thyroid cancer is becoming more common as research shows that good outcomes can be achieved with minimal surgery and follow-up treatments. This approach reduces the risk of complications.
The old standard of total thyroidectomy followed by radiation treatment is no longer the norm. Treatment is now individualized based on the latest evidence, with a focus on achieving good outcomes with minimal risk.
More aggressive treatment may be recommended if signs of advanced disease are found on ultrasound, such as cancer growth outside of the thyroid or spread to lymph nodes. Thorough ultrasound examinations by the surgeons help determine the extent of surgery needed.
The goal is to find the right balance of surgery for each patient, avoiding both excessive and insufficient surgery for adequate treatment of thyroid cancer. Achieving the best outcomes with the fewest complications is the priority.
Seeking a second opinion at UCLA Endocrine Center can be done in person or virtually. In-person visits are often recommended for initial thyroid cancer evaluations due to the importance of thorough ultrasound examinations.
The UCLA Endocrine Center focuses on individualized care and offers second opinions to provide reassurance, answer additional questions, and ensure the best treatment plan for each patient.