Clinical Challenges in Endocrine Surgery: Genetic Testing for Thyroid Cancer

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 11 November 2021

⏱️ 56 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode from the Endocrine Surgery team at BTK we discuss the clinical applications of genetic testing for thyroid cancer. We walk through three cases of thyroid nodules and discuss why and how genetic testing can guide surgical and medical management. As usual we review key points such as imaging criteria for thyroid nodules, the Bethesda system for thyroid cytopathology, and MEN syndromes. We also go into a more nuanced discussion of how progress in genetic testing has led to more variability in management options.

Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.

Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department

Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department

Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research

Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship

Important Papers

Catherine Y Zhu, Ines Donangelo, Deepashree Gupta, Dalena T Nguyen, Joana E Ochoa, Michael W Yeh, Masha J Livhits, Outcomes of Indeterminate Thyroid Nodules Managed Nonoperatively after Molecular Testing, The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 3, March 2021, Pages e1240–e1247, https://doi.org/10.1210/clinem/dgaa887

Xing, Mingzhao & Alzahrani, Ali & Carson, Kathryn & Viola, David & Elisei, Rossella & Bendlova, Bela & Yip, Linwah & Mian, Caterina & Vianello, Federica & Tuttle, R & Robenshtok, Eyal & Fagin, James & Puxeddu, Efisio & Fugazzola, Laura & Czarniecka, Agnieszka & Jarząb, Barbara & O'Neill, Christine & Sywak, Mark & Lam, Alfred & Sykorova, Vlasta. (2013). Association Between BRAF V600E Mutation and Mortality in Patients With Papillary Thyroid Cancer. JAMA : the journal of the American Medical Association. 309. 1493-501. 10.1001/jama.2013.3190.

Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25(6):567-610. doi:10.1089/thy.2014.0335

Wang JR, Zafereo ME, Dadu R, Ferrarotto R, Busaidy NL, Lu C, Ahmed S, Gule-Monroe MK, Williams MD, Sturgis EM, Goepfert RP, Gross ND, Lai SY, Gunn GB, Phan J, Rosenthal DI, Fuller CD, Morrison WH, Iyer P, Cabanillas ME. Complete Surgical Resection Following Neoadjuvant Dabrafenib Plus Trametinib in BRAFV600E-Mutated Anaplastic Thyroid Carcinoma. Thyroid. 2019 Aug;29(8):1036-1043. doi: 10.1089/thy.2019.0133. PMID: 31319771; PMCID: PMC6707029.

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Transcript

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0:00.0	behind the knife, the surgery podcast,
0:03.2	where we take a behind-the-scenes intimate look
0:05.4	at surgery from leaders in the field.
0:07.6	Welcome back to the UCLA Endocrine Surgery team.
0:25.0	We're excited to be back and recording our next episode.
0:28.6	I'm Rift Gushanoy, I'm a PGY5 General Surgery resident here at UCLA.
0:33.2	I'm Dede Gsons, I'm the current UCLA Endocrine Surgery fellow
0:38.2	Michael Yee professor of surgery.
0:40.5	James Wu, one of the concerns of the UCLA.
0:43.8	Masha Levitts, Endocrine Surgeon at UCLA.
0:47.1	We started our first case at the UCLA Endocrine Surgery clinic.
0:51.2	So we saw a 38-year-old female with Hashimoto's thyroiditis
0:54.7	who presented for an evaluation of a right thyroid nodule.
0:58.2	This was first noticed five years ago
1:00.2	and the patient has no family history of endocrine disorders
1:03.5	or thyroid cancer.
1:05.7	We performed a bedside neck ultrasound
1:07.6	which showed a two-centimeter right thyroid nodule.
1:11.0	So I want to start by talking about the characteristics
1:13.5	on ultrasound that we look for in these thyroid nodules.
1:17.4	But can you talk a little bit about what characteristics are important here?
1:22.4	Sure, so there are a variety of characteristics
	...

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