Thyroid Cancer: What to Do After a Positive Diagnosis

“In recent decades, there has been a rise in the incidence of thyroid cancer, especially in so-called differentiated thyroid cancers, which are the most common.

One of the main reasons for this increase is the improvement in diagnostic techniques. Small thyroid nodules are increasingly detected incidentally during imaging exams such as ultrasound, CT, or MRI performed for unrelated reasons. This has led to more diagnoses, including very small and indolent tumors.

In fact, in most cases these are slow-growing tumors, with a very low 10-year mortality rate (around 0.5%). Despite the rise in diagnoses, mortality rates have remained stable.

However, some studies suggest there may also be a true increase in incidence, related to environmental factors such as radiation exposure or endocrine-disrupting chemicals,” explains Dr. Maggiore.

Discovering a thyroid nodule can be worrisome, but it is important to know that the majority of nodules are benign. Thyroid nodules are very common, especially in women, and are often discovered incidentally.

“The first step after diagnosis is to see an endocrinologist. They will assess the type of nodule, its size, and any associated symptoms. Based on this evaluation, further tests may be ordered, including:

• Thyroid ultrasound: the gold standard for nodule assessment. Since this is operator-dependent, accuracy largely depends on the experience of the radiologist or endocrinologist performing the exam.
• Blood tests: thyroid hormones (TSH, fT3, fT4) are essential to assess thyroid function. Depending on the clinical picture, tumor markers or autoimmune tests may also be requested (e.g., calcitonin, anti-thyroglobulin antibodies, anti-TPO antibodies).
• Fine-needle aspiration biopsy (FNA): a minimally invasive test performed under ultrasound guidance, allowing cytological analysis to determine whether the nodule is benign or suspicious for malignancy.

Based on the results, the specialist may recommend either:

• monitoring the nodule over time, or
• surgery.

It is important not to panic: most nodules are not dangerous and can be safely managed with regular follow-ups. Consulting experienced professionals is key to handling the situation calmly and effectively,” continues Dr. Maggiore.

When a thyroid nodule is diagnosed, particularly if malignancy is suspected, it is crucial to be evaluated in specialized centers where a multidisciplinary team works together. This ensures a comprehensive, coordinated approach that addresses all clinical, diagnostic, and therapeutic aspects.

The multidisciplinary team includes:

• Endocrinologists (or pediatric endocrinologists): who provide the initial clinical assessment, request appropriate tests, establish the diagnosis, and plan treatment or follow-up;
• Surgeons: at San Raffaele, the team includes both a general surgeon specializing in endocrine surgery and an ENT surgeon, capable of performing safe, precise operations with advanced techniques;
• Pathologists: who analyze cytological or tissue samples for definitive diagnosis;
• Radiologists and ultrasound specialists: with expertise in imaging of the neck;
• Nuclear medicine physicians: when radioiodine therapy or advanced diagnostic imaging is needed;
• Oncologists and radiation oncologists: in the rare cases of advanced thyroid cancer.

“Relying on a reference center where specialists collaborate within well-structured Disease Units guarantees a safe, personalized, and effective diagnostic–therapeutic pathway. This is especially critical when surgery is considered: the surgical team’s experience is a key factor in minimizing complications and achieving optimal results. An expert team not only treats the nodule but also provides patients with support and clarity at every stage from diagnosis to treatment decisions to long-term follow-up,” says Dr. Maggiore.

If FNA results or clinical assessment suggest malignancy, surgery is almost always required to remove either part or all of the thyroid. The surgical approach depends on the diagnosis:

• Partial thyroidectomy (lobectomy): removal of one lobe, usually if the nodule is confined to one side and there is no suspicion of lymph node metastasis;
• Total thyroidectomy: removal of the entire gland;
• Extended lymphadenectomy: required only in rare cases of aggressive tumors with cervical lymph node involvement.

“When it comes to thyroid surgery, the surgeon’s experience is crucial for both safety and efficacy,” Dr. Maggiore emphasizes.

The thyroid is a delicate gland located near vital structures such as the recurrent laryngeal nerves (responsible for vocal cord function) and the parathyroid glands (which regulate calcium metabolism). An experienced surgeon knows how to preserve these structures, minimizing complications such as:

• voice changes,
• hypocalcemia due to parathyroid injury,
• postoperative hematomas or infections.

Modern endocrine surgery employs innovative techniques to further improve outcomes, including:

• Minimally invasive or video-assisted thyroid surgery: smaller incisions, less postoperative pain, and faster recovery;
• Intraoperative recurrent laryngeal nerve monitoring: real-time monitoring of vocal cord function to prevent nerve injury;
• Parathyroid preservation techniques: methods for identifying and safeguarding the parathyroid glands during thyroidectomy.

“These tools and skills make a real difference, allowing for safer, less invasive surgery and faster recovery times,” concludes Dr. Maggiore.