Thyroid cancer

About

The Trust’s department of thyroid and endocrine surgery is the first and largest department of its type in the UK. It specialises in the management of all aspects of thyroid disease. The service sees, offers advice about, and treats thyroid cancer, benign thyroid diseases, parathyroid and adrenal disease. We investigate and treat large numbers of patients with goitre (swelling of the thyroid that causes a lump in the neck) and all types of suspected and confirmed thyroid cancer. We treat over 70 new and recurrent thyroid cancers per year as well as managing the follow-up care of several hundred more, and thyroidectomy for benign thyroid disease in over 250 cases.

This is the largest thyroid cancer service in the UK with three dedicated specialist surgeons and the only centre in the UK that can offer pioneering robotic assisted thyroid surgery. Professors Palazzo and Tolley have established national and international reputations and Miss Di Marco has recently joined them after a distinguished higher specialist training, achieving the gold medal in the Fellowship of the Royal College of Surgeons examination and spending a year as the prestigious T.S. Reeve Fellow at the University of Sydney, Australia. All three surgeons are contributors to the British Association of Endocrine and Thyroid Surgeons’ national database, where activity and results are monitored for quality against national key performance indicators.

The departmental outcomes are comparable to those of specialist centres around the world. The thyroid cancer service is built around a thyroid cancer multidisciplinary team (MDT) that includes endocrinologists, radiologists, pathologists and specialist nurses. All patients with thyroid cancer are discussed at a weekly team meeting that is peer review approved.

The inpatient stay following thyroid cancer surgery at our Trust is one third of other London hospitals, so our patients are able to spend less time in hospital and more time recovering comfortably at home with the associated benefits.

As well as thyroid surgery, all three surgeons also specialise in parathyroid disease and Professor Palazzo and Miss Di Marco in adrenal disease. The team are dedicated to treating only these conditions and have an active departmental research portfolio.

Our surgeons take a collaborative approach in complex cases, undertaking multi-consultant procedures where appropriate.

Multidisciplinary team (MDT)

Our three surgeons work closely with our specialist endocrinologists, anaesthetists, nuclear medicine physicians, oncologists, geneticists and thyroid cancer specialist nurse.

The department has a weekly, peer-reviewed MDT for thyroid cases of suspected and known thyroid cancer attended by our surgeons, endocrinologists, radiologists, histopathologists and nuclear medicine physicians. Clinicians wishing to have their cases discussed at the Imperial thyroid cancer MDT should contact one of the Imperial clinicians or email ICHC-tr.thyroidMDT@nhs.net

Conditions and treatments

Thyroid cancer is a rare disease arising from the thyroid gland, a small gland at the base of the neck. Thyroid cancer is uncommon but increasing in incidence – approximately one per cent of all UK cancers originate from the thyroid gland. The most common symptom of cancer of the thyroid is a painless lump or swelling that develops in your neck, but it may also cause changes to the voice or lymph node enlargement.

This service manages patients with thyroid lumps both to address symptoms and to exclude malignancy. All clinics have a joint surgical and endocrine oncological make-up and are supported with imaging, isotope studies, cytology, histopathology and specialist nurses of the highest standards.

Our service offers complete management of thyroid cancer. While not all patients with thyroid cancer will follow this treatment pathway, our most common treatments include:

• Thyroidectomy: Partial or complete surgical removal of the thyroid gland. This is the most common treatment for thyroid cancer.
• Radioiodine treatment: This is a treatment that usually follows thyroid surgery. A patient swallows radioactive iodine via a capsule or liquid and the radioactive iodine travels through the blood stream to the neck and destroys any cancer cells that may remain after surgery.
• Referral to an endocrine clinic for functional thyroid disease and follow-up care: You may come to our clinic with a suspected malignancy (cancer) and discover that you do not have cancer. However, if you have functional thyroid disease, you will need to work with your doctor to manage your condition.

Patients who have had their thyroid removed have their thyroid hormone levels checked to ensure they are on the most appropriate replacement dose. This is important as they will require hormone replacement therapy for the rest of their lives. 

Additional information

Teaching and training

The department teaches undergraduates and postgraduates at Imperial College London and has a strong tradition of training future endocrine surgeons. The department trains rotational specialist registrars and offers the Selwyn Taylor Fellowship annually to outstanding senior trainees (from the UK and abroad) who are about to become consultant endocrine surgeons. Potential candidates should contact Professor Palazzo (f.palazzo@nhs.net).

Emergencies

Our three surgeons provide a comprehensive an on-call service for thyroid and endocrine surgical emergencies and transfers from primary care and other hospitals including acute presentations and post-operative complications. They are happy to be contacted regarding thyroid and endocrine surgical emergencies and to answer non-urgent queries from referring physicians.

Further online resources

• Butterfly Thyroid Cancer Trust
• DVD – “Thyroid Cancer Uncovered”
• British Association of Endocrine and Thyroid Surgeons