Stacie Kahan, MD, endocrine surgeon and general surgeon at White Plains Hospital, and a multidisciplinary team of experts marshal cutting-edge technology to deliver effective care for patients with a broad spectrum of endocrine disorders, including thyroid cancer.
Detection and Diagnosis of Thyroid Cancer
While thyroid cancer is relatively uncommon compared with other cancers, the American Cancer Society (ACS) reports that diagnoses of the condition have tripled in the past three decades. The ACS suggests that is due to ultrasound technology capable of detecting smaller thyroid nodules. Further, women are at three times the risk of men for developing the condition.
The majority of thyroid nodules — a common sign of thyroid cancer — are asymptomatic, and they are often discovered by patients’ primary care providers during routine examinations. In other cases, patients may notice a lump on the neck. Diagnosis includes a detailed evaluation to ascertain whether less common symptoms are present as well.
“Often patients are directed to an endocrinologist to discuss symptoms. Patients are asked if they have difficulty swallowing or a ‘lump-in-the-throat’ sensation,” says Dr. Kahan, who is board-certified in general surgery and fellowship-trained in endocrine surgery. “They may be asked about trouble breathing, neck pain, difficulty lying flat at night or voice changes, although those symptoms are much rarer.”
Dr. Kahan often sees patients following diagnosis. If she determines a thyroid nodule requires further testing, she normally orders an ultrasound and, if necessary, a fine needle aspiration (FNA) biopsy. This minimally invasive procedure uses a fine-gauge needle to remove cells from the nodule. The physician uses ultrasound to ensure accurate placement of the needle within the thyroid nodule. Recovery time is brief, and an FNA biopsy is typically performed on an outpatient basis with local anesthetic. FNA biopsy is the most effective diagnostic tool short of surgery, Dr. Kahan explains.
If a nodule is found to be cancerous or indeterminate for cancer, Dr. Kahan often recommends surgery.
Thyroid Cancer Treatment at White Plains Hospital
Patients with the most common thyroid cancers that have not spread beyond the thyroid have a relative five-year survival rate of almost 100%, according to the ACS, and surgery plays a crucial role in that success.
“The mainstay of treatment for thyroid cancer is surgery,” Dr. Kahan says. “If the cancer is limited to the thyroid itself, surgery is usually curative. If a biopsy before or after thyroid surgery reveals the cancer has spread to the lymph nodes, patients may additionally undergo radioactive iodine ablation. Removal of the lymph nodes during the surgery may also be indicated.”
During partial or total thyroidectomy, Dr. Kahan makes small, discreet incisions in a crease low on the patient’s neck. The gland and any other excised tissue are sent to the lab for testing.
Complications with surgical-site healing are rare, and hospital stays and recovery times are short.
“Thyroid surgery is typically an outpatient procedure,” Dr. Kahan says. “For patients undergoing total thyroidectomy, it’s a one-night stay; they go home soon after breakfast the following morning. Procedures are performed under general anesthesia.”
White Plains Hospital has further enhanced the safety of those procedures by adding new operating rooms with state-of-the-art equipment. To prevent surgical damage to surrounding nerves — in particular the recurrent laryngeal nerve — White Plains Hospital uses two types of advanced nerve-monitoring systems: Nerveäna and NIM. Dr. Kahan describes these systems as probes that adhere to the endotracheal tube between the vocal cords, with other leads placed on the skin. They are used during every operation, and they help keep nerve injury rates during thyroid procedures below 1%.
“Nerve monitors are like the new technology in our cars,” Dr. Kahan says. “If we get too close to something, they beep and let us know. The nerve monitor confirms what I’m seeing is, in fact, a functional nerve. With every step, I go back and check that the nerve is intact and functioning throughout the operation.”
“The most important thing to know about thyroid cancer is that it’s manageable. The prognosis for well-differentiated thyroid cancer is excellent. Thyroid cancer survival rates are often recorded at 20 years instead of five.”
— Stacie Kahan, MD, endocrine surgeon and general surgeon at White Plains Hospital
Treatment for Parathyroid and Adrenal Disorders
White Plains Hospital also prioritizes effective treatment of disorders of the parathyroid and adrenal glands.
For patients with hyperparathyroidism — a parathyroid gland secreting excess parathyroid hormone (PTH), leading to potentially damaging levels of calcium in the blood — the surgical team removes the gland. The team then confirms the patient has experienced a 50% drop in PTH within 10 minutes of removal, according to Dr. Kahan.
Because of their proximity to the thyroid, parathyroid glands may also be impacted by thyroidectomy. Whether a condition is confined to the parathyroid glands or arises during thyroid surgery, Dr. Kahan and her team treat each of a patient’s four parathyroid glands as if it were the only one, removing it during surgery only when unavoidable.
“Parathyroids are very sensitive. We protect them to the fullest extent possible during endocrine surgery, but if they are disturbed in any way, we may observe a drop in the patient’s calcium,” Dr. Kahan says. “There are several ways to manage that with medication, however, and permanent calcium deficiency is rare.”
Providers at White Plains Hospital also have high-level expertise in treating the rarely occurring cases of adrenal disease. If adrenal nodules are detected, the team tests whether the nodules are secreting excess hormones, including cortisol, epinephrine and norepinephrine.
“Most adrenal nodules are not functional, but the ones that are can cause serious health issues long term,” Dr. Kahan explains. “Patients who have a nodule should be tested for excess hormone production, in which case we can perform an operation to correct that.”
The team’s wide-ranging expertise also enables White Plains Hospital to treat conditions such as Graves’ disease and goiter, as well as extremely rare cases of medullary and anaplastic thyroid cancer. Experienced specialists in endocrinology, radiology, laryngology, ear, nose and throat, and radiation oncology — as well as implementation of tumor boards to discuss complex cancer cases — are among the key components of the hospital’s success in treating endocrine disorders.
“White Plains Hospital has a great, collaborative, multidisciplinary team,” Dr. Kahan says. “We have ample, highly advanced resources here, but we still have a community feel — taking care of our own.”
Visit wphospital.org/endocrinesurgery for more information.