January is Thyroid Awareness Month, and physicians from the Hilda and J. Lester Gabrilove Division of Endocrinology, Diabetes and Bone Disease and the Department of Otolaryngology – Head and Neck Surgery at the Mount Sinai Health System are emphasizing the importance of being aware of symptoms that may be related to thyroid disease.
The thyroid gland is located in the front of the neck and under the voice box. It produces hormones that help the body control the rate of metabolism, and regulate the production and consumption of energy. When thyroid function is accelerated, the condition is called hyperthyroidism; when slowed, it is called hypothyroidism. Imbalances in thyroid function may be a result of environmental, autoimmune, or genetic factors. Additionally, thyroid issues may lead to cancer.
Thyroid disease affects roughly 200 million people worldwide, and thyroid cancer is on the rise, with roughly 52,000 new cases diagnosed in 2019, according to the American Cancer Society. Three out of four thyroid cancer diagnoses are made in women. Data from the American Thyroid Association shows that more than 12 percent of the U.S. population will develop a thyroid condition in their lifetime, and the cause of these problems is largely unknown. An estimated 20 million Americans have some form of thyroid disease and up to 60 percent of them don’t know they have it, so they go undiagnosed and untreated.
Women are five to eight times more likely than men to have thyroid issues, and one in eight women will develop a thyroid disorder. People with a family history of thyroid disease and/or thyroid cancer, and exposure to high doses of radiation, are also at increased risk.” Terry Davies, MD, Co-Director of the Mount Sinai Thyroid Center at Union Square and Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai
How to perform a thyroid neck self-exam:
- If you do see any bulges or protrusions in this area, see your physician. You may have an enlarged thyroid gland or a thyroid nodule and should be checked to determine whether cancer is present or if treatment for thyroid disease is needed.
Symptoms and facts about thyroid disease
- The number of new cases of thyroid cancer is growing most rapidly among all cancers in both men and women, due to increased detection.
Thyroid disease and pregnancy
Pregnant women should be aware of changes to their thyroid gland, which can be affected by different levels of pregnancy hormones. The thyroid hormone greatly contributes to the development of a healthy baby, and it is important that expectant mothers be properly diagnosed with and treated for thyroid disease. Otherwise, they could be at higher risk of miscarriage or preterm delivery, and their children may have developmental delays. For that reason, thyroid function is routinely checked in pregnant women.
When it comes to thyroid cancer, a large number of women develop this during their reproductive age. Since thyroid cancer tends to be mediated by hormones in the body, it tends to grow faster when patients are pregnant. There is no special cancer screening recommendation for pregnant women.
Mount Sinai is a leader in noninvasive thyroid treatment
Radiofrequency ablation for thyroid nodules
Mount Sinai West is one of only two hospitals in New York State offering a minimally invasive procedure to treat non-cancerous thyroid nodules that are symptomatic and would have otherwise required invasive surgery for removal. The procedure is called radio-frequency ablation (RFA). It offers eligible patients a much quicker recovery, less pain and risk of infection, and no scarring. With RFA, surgeons use guided ultrasound to deliver radio-frequency current to heat up and shrink the thyroid nodule. RFA can be done on patients with large non-cancerous nodules that cause swallowing, voice, breathing, and neck discomfort.
Patients who undergo RFA can return to normal activity the day after the procedure and can exercise within several days. Additionally, they are extremely unlikely to require permanent thyroid hormone medication. Patients who have standard thyroid nodule surgery typically can’t resume normal activity for at least a month and 20 to 30 percent of these patients require thyroid medication.
“Radiofrequency ablation for thyroid nodules has been performed in Korea for over a decade and throughout Europe and their outcomes are excellent. The published data shows impressive nodule shrinkage rates of more than 80 percent with RFA that is maintained over years of follow-up,” explained Catherine Sinclair, MD, Associate Professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai and Director of Head and Neck Surgery at Mount Sinai West. “Thyroid nodules are very common and, although many people will never require any intervention for their nodules, there is a significant minority who will seek treatment due to symptoms. I expect RFA to be a terrific new option for these patients.”
Ethanol ablation for thyroid nodules
Another noninvasive procedure, performed at Mount Sinai-Union Square, ethanol ablation is when an alcohol solution is injected into thyroid nodules, killing cells and causing the masses to slowly shrink. The procedure leaves only a small scar and is performed in office with local anesthesia.
“The candidates for RFA and ethanol ablation are very similar,” says Maria Brito, MD, Co-Director of the Mount Sinai Thyroid Center at Union Square. Dr. Brito and Michael Via, MD, both Associate Professors of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai, are two of only a handful of physicians in the New York metropolitan region to perform ethanol ablation.
“The procedures will not necessarily eliminate the nodule completely, and patients will still need to have ultrasound follow-ups to monitor the nodule,” Dr. Brito says. “But in appropriate cases, they are a terrific option. They make it very easy for the patient.”