The Ever-Changing Tailored Management of Thyroid Cancer

InFocus Issue 21, January 2021

ENT Surgeon Dr Jo-Lyn McKenzie is a leading adult and paediatric Ear, Nose and Throat (ENT) surgeon with special skills in advanced Head and Neck Cancer surgery. Dr McKenzie offers Brisbane Private Hospital her insight into recent developments in the management of Thyroid Cancer, and how she can assist patients to navigate complex treatment options. 

Through excellence in research, interdisciplinary cooperation and comprehensive guideline development the management of thyroid cancer is continuously evolving. This is bringing great benefits to patients where we are able to offer more minimalistic and tailored treatment strategies. Some neoplasms are no longer considered malignant and others are able to be offered observational treatment even with a malignant needle aspirate diagnosis. 

Not all nodules require a biopsy and the development of the TIRADS grading system to guide use of fine needle sampling of thyroid nodules has helped to simplify decision making for thyroid surgeons.  This has allowed more refined surgical options to be available to patients with thyroid cancer including more minimalistic surgery or even non-operative management at times. 

However, patients and practitioners can find the variability in management of thyroid cancer overwhelmingly complex. All patients with nodules which meet criteria for a fine needle aspirate on their ultrasound assessment benefit from seeing a surgeon trained in thyroid and neck surgery to talk through the issue and their management options. 

ENT Surgeons are increasingly involved in the management of this condition, which not all doctors in the community are aware of. These patients are always managed with multidisciplinary input and the best outcomes come through collaboration with ENT and other thyroid surgeons as well as endocrinologists. This is one of the most enjoyable parts of my job, collaborating with colleagues to ensure each patient gets a tailored, specific management strategy and follow-up plan.

I was lucky enough to train with some of Brisbane’s leading head and neck and thyroid surgeons doing complex thyroid surgery at Princess Alexandra Hospital. We looked after a lot of advanced disease and am happy to be able to offer that service to patients at Brisbane Private. 

In offering a rounded head and neck service, patients find it satisfying to be able to have their voice box assessed preoperatively and postoperatively as well as to actively manage any complications that can arise. 

I manage everything from simple thyroid nodules up to complex, recurrent and advanced thyroid disease involving the trachea and surrounding structures. I also perform parathyroid surgery for patients with hypercalcaemia from parathyroid adenomas. 

The use of nerve monitoring of the recurrent laryngeal nerve augments my ability to offer a very low complication rate for nerve injury, one of the most concerning parts of thyroid surgery.