Thyroid cancer has one of the highest survival rates when compared to other types of cancers, with a cure rate of 90-95 per cent. According to doctors, the main challenge about thyroid cancer is getting the diagnosis right. For this, one requires an experienced cytopathologist — one who studies and diagnoses diseases at the cellular level and advises for surgery.
However, with just 15 cytopathologists and general surgeons performing thyroid cancer-related surgeries in Delhi, the national capital is seeing a rise in cases of misdiagnosis of thyroid cancer which in turn leads to long-term complications.
According to officials at AIIMS, many patients suffering from long-term complications due to misdiagnosis have been referred to the hospital.
A 21-year-old woman who had 1.5 cm right thyroid nodule — a lump within the thyroid gland at the base of the neck – was suspected of having “papillary thyroid cancer” based on a needle test. According to a specialist at AIIMS, it is the “the standard recommendation is to remove the affected lobe”.
However, when the woman was referred to AIIMS, it was found that a general surgeon she had consulted earlier had performed a total thyroidectomy — an operation that involves the surgical removal of all or part of the thyroid gland. The surgeon had “inadvertently removed the parathyroid glands”, which controls calcium level in the blood.
The “over-treatment” has now resulted in serious complications — every time the woman has tried to conceive, it has ended in medical termination of her pregnancy.
“A low-risk patient needs minimal treatment and regular follow up only with thyroxine supplements. Over zealous treatment, whether surgery or radio iodine, leads to complications,” said a senior official of AIIMS.
In the second case, a 48-year old man — who has now been referred to AIIMS — had a 4 cm thyroid nodule in the left lobe. He underwent a lobectomy — surgical removal of a lobe of an organ, in this case the thyroid gland — at a medical college.
Sources said that patient was not given “any advice to be on regular follow up”. Five years later, he had a mass in the right buttock region, which turned out to be from thyroid cancer.
“In this case, the pathologist had missed the cancer in the first instance and it resulted in metastatic spread — the spread of cancer from one organ or part of the body to another without being directly connected to it,” said a doctor at AIIMS.
In another case, a five-year-old girl who had a thyroid nodule had undergone a thyroidectomy after a pathologist found papillary thyroid cancer. However, sources said the surgeon had not recommended further treatment “despite an x-ray of her chest showing disease in the lungs”.
“When she was referred to AIIMS, it was found that she had a thyroid mass in the neck, lymph nodes and lungs. She was not taking thyroid hormone supplement… She had developed fits. When we took a CT scan, we found massive calcium deposits in the brain which were causing the fits. After prolonged treatment at AIIMS, she is doing better,” said an AIIMS doctor.
On the rise in cases of misdiagnosis of thyroid cancer, Dr C S Bal, Professor & Head, Department of Nuclear Medicine, AIIMS, said, “Delhi requires experienced thyroid cytopathologists who can make a clear and confident diagnosis. The new paradigm in thyroid cancer is ‘lesser is better’- less surgery, less radio iodine and less thyroid hormone suppression for low-risk patients. Of course, we need aggressive treatment for high-risk thyroid cancer patients and an in-between approach for intermediate-risk patients. To implement this, we need trained man-power in the form of cytopathologists, endocrine/thyroid surgeons and better equipped nuclear medicine facilities to tackle thyroid cancer in India.”
As of now, Delhi has only one institute for cytopathology — Indian Council of Medical Research’s Institute of Cytopathology. There is no training centre for endocrine surgery, including at AIIMS.
“The health outcome for thyroid cancer patients in Delhi may be severely impacted in the coming years if the shortage of trained cytopathologists, endocrine surgeons as well as radioiodine therapy facilities is not addressed on an urgent basis,” Dr Bal added.