Thyroid Cancer Recurrence in
What should you do about it?
More Surgery, More Radioiodine?
The new role for PEI, percutaneous ethanol injections, and Dye
localization procedures, for the treatment of thyroid cancer recurrence.
What if you have had prior neck surgery for thyroid cancer nodes,
and a new recurrence happens on the same side and area? There are
several choices. First, re-operation is the Treatment of choice,
but it has a higher risk of parathyroid, and recurrent nerve injury.
The ultrasound lymph node “road map” is one way to decrease
the complication rate. Also intra-operative ultrasound can locate
the site for the surgeon. If the surgeon wants, one hour before
surgery, we can place a tiny amount of dye on the anterior surface
of the biopsy proven abnormal cancer node, with a marker on the
skin directly over the abnormal node. This has been very helpful
to the surgeons.
However, the patient may refuse further surgery, or is not a good
candidate for re-operation. What can be done for them? The cancer
nodes can by treated as an outpatient with PEI. The procedure is
an offshoot of high frequency ultrasound guided FNA. A # 25-27 needle
is positioned by USG, and then minute quantities of ethanol are
slowly injected into the node. This is a new procedure and is very
operator depended. Mayo clinic studies have shown that the node
is rendered inactive even if it is still visible on the ultrasound.
The Doppler blood flow to the node is destroyed, and the tumor marker,
thyroglobulin, TG, is decreased or even rendered undetectable. As
for more radioiodine, it has a poor record in abalating cancer nodes.
Therefore surgery, assisted surgery with dye localization, or PEI
are the three main ways of treating, recurrent, thyroid cancer.