Profesionales médicos

Aug. 19, 2025

As the incidence of papillary thyroid carcinoma (PTC) continues to rise, so do concerns about overdiagnosis and overtreatment. However, thyroid specialists at Mayo Clinic Comprehensive Cancer Center understand that there's a fine line between avoiding overtreatment of slow-growing cancer that may never cause medical issues and underdiagnosing more-advanced PTC. They walk that line by providing a precise diagnosis and personalizing care.

"It's critical to strike that balance when you detect thyroid nodules or see them in clinical evaluation," says thyroid and parathyroid surgeon Jeffrey R. Janus, M.D., chair of Otolaryngology at Mayo Clinic in Jacksonville, Florida. "We take steps to assess nodules with precision, in a way that's not overly aggressive but still provides the best possible clinical outcomes for patients now and in the long term."

The balance Dr. Janus refers to isn't hypothetical. It's a standard Mayo Clinic achieves using evidence-based diagnostic testing, a multidisciplinary team of specialists and the advanced expertise from seeing a large volume of patients. For example, data published in the Annals of Surgery in 2017 shows that performing more than 25 thyroidectomies a year reduces the likelihood of complications by 55%. Dr. Janus operates on several hundred patients a year.

"The number of thyroid nodules evaluated by the endocrinology team is exponentially more than I treat surgically," Dr. Janus says. "Our comprehensive approach to care allows us to accurately determine which patients with PTC need surgery or intervention."

Treating PTC effectively and appropriately involves three critical elements:

Multidisciplinary expertise and communication for efficient consolidation of care

PTC can present with a straightforward pathology or as an exceedingly complex disease requiring an entire spectrum of healthcare professionals. Having specialists together in one place can be a critical differentiator for diagnosing and treating PTC quickly and appropriately.

"Sometimes we see less common cases where people have a rare pathology or widely metastatic disease that needs the next tier of care," says Dr. Janus. "Our team approach helps us seamlessly transition from a routine case to something decidedly more complex."

Victor Bernet, M.D., an endocrinologist at Mayo Clinic in Jacksonville, Florida, is a key player on that team. Dr. Bernet previously served as the president of the American Thyroid Association (ATA) and currently sits on the ATA's task force that is developing new guidelines for thyroid nodule management. Those guidelines are expected to be released within the next year. "Thyroid nodules are not always straightforward," Dr. Bernet explains. "They require a combination of extensive experience in thyroid nodules and cancer as well as a multidisciplinary team that works together closely and values open communication."

Every thyroid nodule evaluation involves specialists in endocrinology, radiology and pathology. Depending on the disease stage and characteristics, the treatment team also may include:

• Experienced thyroid surgeon.
• Interventional radiologist.
• Laryngologist and speech pathologist.
• Medical oncologist.
• Radiation oncologist.

The team discusses cases at biweekly tumor board meetings. Between those meetings, the team members communicate and collaborate about patient care. They also work together to generate effective itineraries and coordinate appointments.

"We focus on providing accurate and high-quality care that is also efficient," says Dr. Janus. "And it can make a huge difference for patients."

Advanced diagnostic practices to personalize thyroid cancer treatment

Ultrasound is the gold standard when evaluating thyroid nodules, and an experienced ultrasonographer or radiologist can stratify a nodule based on its ultrasonographic characteristics. However, Dr. Bernet says that ultrasound is often just the first step in the diagnostic process for many people.

"We follow evidence-based staging guidelines, and our decisions are data-driven, but we treat each case individually," says Dr. Bernet. "We prioritize de-escalation of the intensity of therapy for low-grade PTC, but we also know that it's essential to identify more-complex cases of PTC early. That's why we take extra steps and offer a breadth of diagnostic testing when warranted."

The diagnostic process may include:

• Lymph node mapping, performed as part of every diagnostic ultrasound.
• Ultrasound-guided fine-needle aspiration biopsy, if indicated after a diagnostic ultrasound and implementation of a thyroid nodule risk stratification scoring system similar to the TIRADS or ATA system.
• Washout testing of the fluid collected during negative FNA biopsies to measure thyroglobulin or calcitonin.
• Molecular testing, including next-generation sequencing and polymerase chain reaction (PCR) testing, often performed for nodules in category 3 (atypia of undetermined significance) or category 4 (suspicious for follicular neoplasm) of the Bethesda System for Reporting Thyroid Cytopathology.
• Genetic testing for people with a relevant family health history or an uncommon medical presentation.

"We take every possible action to ensure that we are providing a precise diagnosis while avoiding any unnecessary testing or procedures," says Dr. Bernet. "Lymph node mapping helps us target what really needs to be biopsied: thyroid nodule(s) and/or neck lymph nodes. Washout testing for thyroglobulin improves sensitivity for detecting if thyroid cancer is in a lymph node, even if we don't see the actual cells. These additional measures are critical."

Treatment options for the full spectrum of PTC

Personalizing PTC treatment requires a wide range of options — from active surveillance to extensive surgery — based on the specifics of the individual cancer. Having the ability and expertise to offer efficacious treatments in place of or combined with traditional approaches helps ensure that every stage of thyroid cancer is treated appropriately. For example, Mayo Clinic interventional radiologists offer less invasive treatments, such as chemical or thermal ablation, to help control the primary tumor or lymph nodes with metastases when someone may not be an ideal surgical candidate or does not want surgery.

Dr. Janus reports very low surgical complication rates if surgery is indicated — a decision reached by the tumor board after a thorough diagnostic evaluation. Rates of hematoma and laryngeal nerve damage are both under 1%, which is well below the national average. But to reduce the need for invasive surgery even further, Mayo Clinic expects to introduce a transoral thyroid surgery program before the end of the year.

"We'll be able to remove the thyroid gland through the mouth," says Dr. Janus says. "Our scar outcomes associated with traditional thyroid surgery are fantastic, but scarless thyroid surgery provides another way to de-escalate treatment for PTC."

For more information

Mayo Clinic Comprehensive Cancer Center.

Adam MA, et al. Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Annals of Surgery. 2017;265:402.

Refer a patient to Mayo Clinic.