72: Treatment of Thyroid Cancer in Japan, with Dr. Takahiro Okamoto from Tokyo Women’s Medical University

Key points from this episode include:

• Most Western countries carry out total thyroidectomies, whereas in Japan, the approach is more conservative with a fundamental practice of hemithyroidectomy whenever possible.
• By not doing a total thyroidectomy, this allows the patient to not avoid taking thyroid replacement medication.
• Complete thyroidectomy is conducted when 80-90% of lymph nodes have metastasis.
• I-131 treatment is decreasing despite cases of cancer increasing
• For I-131 treatment, patients wait more than 6 months post surgery.
• When receving I-131 treatment, patients be admitted to hospital for several days.
• TSH suppression therapy is common in Western countries, whereas in Japan, measures are taken to avoid TSH suppression by not removing all of the thyroid.
• Normal TSH in Japan is 4.3 or less.
• Culturally, Japanese patients are typically conservative compared to Western countries.  Even high risk patients opt for no TT.
• In Japan people are less aggressive and more patient as a culture, and this is reflected in their approach to treating thyroid cancer.
• For medullary thyroid cancer, treatment management differs in japan.  In Westerm countries, they receive TT.  But, in Japan, if its not familial it is treated with hemithyrodectmy.  Only when familial, is it treated with TT.
• Calcitonin
• Follicular diagnosis is difficult, benign and malignant is a big issue.
• Active surveillance is spreading now, the question is why?  We must consider the patient’s view.  Research from Japan focuses on the size of tumor, but must consider patient’s view.