Hi
I was wondering why I wasn't getting many questions via this website recently.
Turns out both the email address and the website had been down for some time. I'd accidentally let the email domain lapse, and so all the reminders about other bills (website costs, domain name, etc) didn't get to me!
Website is now running again, and hopefully the email address to contact me will be up again soon.
Apologies for the break in support.
Yours
​Dr Tom

Hi. This week I've received lots of questions from people with thyroid cancer via the website, and I've been busy replying to them as quickly as I can.
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Just a reminder to say please feel free to email me if you have a thyroid cancer question that I might be able to help with. I can't promise to be able to help, but I promise to try.
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A big thank you to all those who have asked about my recovery (after my recent 2nd heart valve replacement and other complications).
I'm slowly getting back towards my previous level of fitness, but it's been tough.
​Taking one day at a time.
As a marker of progress, here's a picture from a recent walk I managed in a forest near Rotorua, New Zealand. It was hard work, and the ferns made me think a dinosaur might appear at any moment, but after I got my breath back it felt great to be alive.

Whilst this is not my usual source of medical information, this thyroid cancer story in The Sun caught my eye.

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Here's some sensbile advice from the U.S. Preventative Services Task Force:

The task force reviewed studies on the benefits and harms of screening and treatment for thyroid cancer and found that for patients asymptomatic for the disease, the harms of screening and treatment are likely to be greater than the benefits. These harms can include permanent surgical damage to thyroid function and to the nerves that control speaking and breathing.

"While there is very little evidence of the benefits of screening for thyroid cancer, there is considerable evidence of the significant harms of treatment," said USPSTF member Karina Davison, Ph.D., M.A.Sc., in a news release.(www.uspreventiveservicestaskforce.org) "And in the places where universal screening has been tried, it hasn't helped people live longer, healthier lives."

Screening asymptomatic people for thyroid cancer will find many benign thyroid nodules, but some of those benign nodules can only be properly diagnosed after surgically removing them. Overall, this can lead to more harm than good.

​Trying to find an asymptomatic thyroid cancer that is likely to go on to cause significant harm if not treated at that time (compared to waiting until symptoms develop and then treating it) is extremely difficult. A bit like trying to find a needle in a haystack.

Perhaps concentrating the resources on those whom have symptoms, and working out how best to treat them, continues to be the more sensible way to go.

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Happy to say I'm still alive!
Recovery is going well, tho still very tired. Beginning to answer some emails, etc. Hoping to be back to work in the next couple of months. Many thanks for the kind thoughts and messages I've received - very much appreciated.
Stay well!
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Not all thyroid cancer is the same.

For some it's everything - the game changer.

For many it's a readily survivable kick in the teeth.
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But perhaps for many more it is an avoidable, unnecessary harm, caused by overdiagnosis and overtreatment.

A recent report in the New England Journal of Medicine further highlights that many of the thyroid cancers that are currently detected are small, and are unlikely to cause ill health. In fact over-enthusiastic (though well-meaning) treatment may be causing more harm for many than if it were left alone, or better still, if it was never known about.

It's attracted attention in the public press too 1, 2, 3, etc

Overdiagnosis is a growing issue, highlighted for example in the BMJ and Dr Welch's thought-provoking book Overdiagnosed. 

We are some way off knowing how best to investigate for thyroid cancer, particularly now that it's clear that harm can arise from over-investigating. 

Rightly or wrongly, I advise medical students "don't order an ultrasound of a thyroid, unless you are intending to annoy me". Whilst this is tongue-in-cheek, it is intended to get the point across, that unless there is good reason to investigate, don't do so, as you run the very real risk of causing harm. Most of us are better off not knowing that we harbour small, asymptomatic thyroid nodules. 

With more knowledge like this latest NEJM report, the best approach will hopefully become clear.

Whether coming to terms with thyroid cancer, or other challenges, it can be helpful to try to get the most out of every moment, to actively try to stop smell and the roses.

There was a time, not long ago, when I never thought I'd be running in the mountains.
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Last week, that's exactly what I did. The fresh air never felt so good. Here's hoping you are able to face your challenges full on, and get the most out of every step.

In a bold but positive step, a recent study has downgraded a certain type of cancer so that it is no longer considered to be a cancer.

Whilst this might sound a bit odd, it's actually remarkably sensible.
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It has been known that certain types of thyroid cancer behave in a much less aggressive way than others. At the least aggressive end of the spectrum some thyroid tumours hardly ever do anything nasty, like spread beyond the thyroid to cause trouble elsewhere. 

A large group of mainly thyroid cancer pathologists managed to conduct a pretty conclusive study looking at one of these least aggressive types of thyroid tumour (with the catchy name of  Non-invasive Encapsulated Follicular Variant of Papillary Thyroid Cancer), and showed that although the individual cells might look a bit like cancerous cells down the microscope, that they didn't behave in a cancerous way. The study found that 0 of the 109 cases of this tumour had an adverse outcome such as distant spread of the disease. 

Safe in the knowledge of how relatively well-behaved these tumour cells are, the authors proposed to re-name it NIFTP (Non-invasive Follicular Thyroid neoplasm with Papillary-like nuclear features). The observant among you will notice that the C word has been removed from its name, as it is now no-longer to be considered as a cancer. This means it no longer merits being treated like a cancer, so avoiding the need for further surgery or radioiodine or the extended and anxiety-provoking folllow-up, and the C-word doesn't need to appear on health insurance applications, etc, etc.

I think a big 'well-done' should go to the authors of the study - by their good work they have likely saved a huge amount of worry, expense and unneccessary medical interventions, to an estimated 45,000 patients world-wide each year.