Mark Lupo

Thyroid nodules are a common medical problem, with 4-5% of the population having a palpable nodule and nearly 50% having nodules detectable by thyroid ultrasound. The majority (90-95%) of these are benign and can usually be observed without surgery and those that are malignant most often have an indolent course that do not impact survival. Ultrasound pattern recognition results in far fewer biopsies. Some nodules that require biopsy are still indeterminate for malignancy under the microscope. Now genomic testing can help risk stratify those who can be observed versus those who need surgery, when in the past most were referred to surgery. The epidemic of thyroid cancer has become apparent, mostly owing to incidental nodules detected during other imaging studies. Many small low risk cancers can be observed without treatment or a less invasive surgery can be performed, sparing thyroid function for the patient. While the vast majority of cancer patients do well and the detection of these cancers is occurring earlier than ever before, the number of patients dying each year of thyroid cancer is unchanged. Targeted therapies and better understanding of tumor biology will hopefully allow us to do more for individuals who unequivocally need more.