Managing Indeterminate Thyroid Nodules

Saving people from unnecessary surgery, pain, and suffering.

Kimberly Vanderveen, MD is a Colorado native and graduate of Bear Creek High School in Lakewood, CO. She received her bachelor’s degree with honors from Muhlenberg College in Allentown, PA. She then earned her medical degree from Northwestern University in Chicago, IL in 2001. Dr. Vanderveen completed her surgical residency at UC-Davis in Sacramento, CA. During her residency, she also obtained a master’s degree in Clinical Research and was actively involved in cancer research and education. After her surgical training, Dr. Vanderveen completed a fellowship in Endocrine Surgery at the Mayo Clinic in Rochester, MN. She is knowledgeable in both medical and surgical aspects of endocrine diseases. She specializes in surgery for diseases of the thyroid, parathyroid, adrenal glands and is a high volume neck and adrenal surgeon.

In this episode, the following topics are discussed:

  • Two roads of tests: rule out and malignant markers
  • Rule-out tests picks up innocent behavior pattern.  Most common is Afirma
  • Malignant markers, or rule-in tests, are useful at determining extent of surgery, and help avoid a second or third surgery.  ThyroSeq, ThyraMIR, Rosetta
  • Do patients get both tests?  Rule out and behavior?
  • Approximately 15% of FNA’s come back indeterminate.  Some  centers as high as 30%
  • Managing indeterminate nodules when a patient chooses no surgery.
  • Taking into account emotional, financial, and lifestyle goals of the patient.
  • Addressing priorities and goals of the patients should come first.
  • Additional molecular testing, surgery, or active surveillance.
  • Profiling a patient who choose to remove thyroid even if indeterminate ? is usually due to fear and the C word.
  • Price of molecular test is $3000 – $6000

NOTES

Kimberly Vanderveen, MD

American Thyroid Association

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