Dr. Mike Natter Answers Top Thyroid Cancer Questions
Written by Melissa Schenkman, MPH, MSJ
Mike Natter, MD, is an endocrinologist at NYU Langone who humanizes medicine using his creativity and talent for visual art to teach, explain, and practice the art of medicine. He was awarded the Endocrine Fellow of the year in 2021 and 2022, as well as Fellow’s Teaching Award in 2022.
What’s it like to be young, healthy, and invincible, and suddenly diagnosed with thyroid cancer or another condition?
While your doctor, nurse, or physician’s assistant can sympathize and understand from years of caring for patients, Mike Natter, MD, actually knows. He was diagnosed with Type 1 Diabetes at age 9 and has been managing his condition ever since.
This life-changing experience in Natter’s childhood not only shaped his career path but his compassion for others and his humble nature. While he wanted to keep an open mind during his medical school rotations through all the different fields, endocrinology was a natural choice given both his experience with Type 1 Diabetes and his fascination with the endocrine system.
“I found that the endocrine system is extremely elegant, with negative feedback loops maintaining a beautiful orchestra all without us even knowing it… until of course we have an endocrinopathy, and then I try to re-balance that symphony,” Natter said.
Negative feedback is our body’s way of balancing our endocrine system by sending signals to glands to stop the release of a hormone, when too much of that hormone has been sensed as being in our blood.
What causes thyroid cancer?
When the orchestra conducted by your thyroid gland–a butterfly-shaped gland in your neck–flows normally it produces thyroid hormone. It’s a hormone that controls how multiple parts of your body function, including how fast your heart beats, your metabolism, and your energy levels.
No one knows exactly what causes the symphony of your thyroid gland to stop
harmonizing and thyroid cancer to develop, but there are two factors that can increase your risk: exposure to radiation around the neck area and inherited conditions.
If a person’s neck is exposed to high doses of radiation–a common therapy, for
example, to treat enlarged thymus glands in the 1950s–a person can get thyroid cancer years later. The same goes for inheriting genes from your parents that already have sustained damage to their genetic code–your DNA—which prevents them from stopping your cells from becoming cancerous and growing out of control once they do.
(Learn more about how the thyroid gland works and what happens when it doesn’t, in our award-winning thyroid gland animation.)
Types of Thyroid Cancer
Did you know that all thyroid cancers aren’t the same? According to the Moffitt Cancer Center, are actually four main thyroid cancer types:
Papillary–the most common type of thyroid cancer and the one most commonly diagnosed in millennials, ages 30-42–is the slowest growing and spreading of all thyroid cancer types.
Follicular–like papillary thyroid cancer, is three times more common in men than women. However, it only accounts for 10-15% of cases. Follicular thyroid cancer has a greater chance of getting into the blood vessels and traveling to distant organs.
Medullary–even less common in 5-10% of cases–develops in the parafollicular cells which regulate our bodies’ calcium and phosphate levels, which affect our bone health.
Anaplastic–the most aggressive form of thyroid cancer and the least common, accounts for 5% of cases. This typically does not affect millennials, but instead people older than 65.
Now that you know more about what the thyroid gland does, how thyroid cancer can develop, and the different kinds, we asked Dr. Natter, what those of us in our 20s, 30s, and early 40s should know if we (or our friends) get diagnosed with thyroid cancer.
Q&As with Endocrinologist, Dr. Mike Natter
YMyHealth: If you are a millennial who has been diagnosed with thyroid cancer, what are some key questions you would recommend asking your doctor about before starting treatment?
Dr. Natter: It is important to know the kind of thyroid cancer you have, the options for treatment, the long-term management/surveillance you should do (follow-up labs, medication, etc.), and any other questions you may have about the specifics of any step.
YMyHealth: What are some of the different treatment options that are available to patients and what can millennials expect?
Dr. Natter: Commonly, patients will undergo a total thyroidectomy which means surgical removal of the entire thyroid gland. In some cases, this will be followed by radioactive iodine treatment (which will destroy any remaining microscopic thyroid tissue).
Why iodine? The thyroid gland uses iodine to make its hormone, kind of like the raw material for thyroid hormone. If we give a radioactive version of iodine (I-131), that will kill the cell that takes it up, which is preferentially thyroid tissue. Patients will then effectively have no thyroid gland tissue left and as such will need to take thyroid hormone replacement for the rest of their lives (usually in the form of Synthroid).
Monitoring with ultrasound imaging and labs (and/or occasionally more advanced imaging techniques) will be done semi-frequently for the first 5 years and then spaced out. Depending on the kind of thyroid cancer (see above) and/or specific genetic mutations found in the patient’s thyroid tissue, we know how aggressive or non-aggressive cancer may be which will guide the type of treatment you receive.
Dr. Natter is a talented artist who uses his creativity to teach medical students and residents about medicine through visual art. You can find his fascinating art and insights @mike_natter on Twitter and @mike.natter on Instagram.
YMyHealth: There have been some studies out recently that have shown thyroid cancer survivors have higher bankruptcy rates and greater financial stress in general compared to patients with other types of cancer. This is deeply concerning for millennials, many who have been struggling with finances since the start of their adult lives. What’s your advice for millennial thyroid cancer patients and survivors?
This is upsetting news. Sadly, the clinical providers usually have little say or insight into how many of the financial decisions are made in healthcare. Often, a lot of price rates for surgeries and procedures get decided at a higher level of hospital administration and in negotiations with large insurance companies and the rates can vary greatly.
Usually, there is little transparency into how these rates get set and there can be a great deal of discrepancy from institution to institution, state by state, and even neighborhood by neighborhood. Pharmaceutical pricing is another messy area also with opaque barriers to how pricing is decided.
Anytime you are dealing with a chronic condition that requires surgical intervention, monitoring, testing, and/or medication, there is going to be a large burden of cost. Personally, I believe that cost should be offset in some way and not fall solely on the patient.
It is extremely important to ask questions upfront before any testing, diagnostics, or treatment gets underway. Even if you are “covered” by insurance, there may be other aspects that may end up not being “technically” covered or they are covered up to a certain cost point that is not readily transparent.
I advise talking to your insurance company and your doctors’ office administrators to flesh out all potential costs ahead of time to avoid any surprises and seek equivalent alternatives with your healthcare provider where possible if the cost becomes an issue.
Learn more about thyroid cancer–whether it’s really increasing in millennials and what you should ask your doctor–from an endocrinologist, Dr. Mike Natter, in his second YMyHealth blog.
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