MultiCare doctors collaborate across specialties to identify and treat patient’s hidden thyroid cancer

When Teresa Moen first began experiencing pelvic pain several years ago, she wasn’t exactly thinking of it as something positive. But as it turned out, those initial symptoms might have been one of the luckiest things to ever happen to her.

After a scan revealed masses in her pelvis, Moen, 51, was referred to Christopher Breed, MD, gynecologic oncologist at MultiCare Regional Cancer Center – Puyallup, who determined that the masses were benign (non-cancerous).

That could have been the end of the story. But when Dr. Breed performed a CT scan during treatment, he was surprised to discover another unexpected growth in Moen’s neck near her thyroid gland. Without hesitation, he referred Moen to William Duke, MD, FACS, otolaryngologist at MultiCare ENT, Allergy & Med Aesthetics – Puyallup.

“Dr. Breed and I were able to communicate and coordinate well about Teresa, and we got her in right away for evaluation,” says Dr. Duke. “If it weren’t for his diligence and quick follow-up, the mass in her neck might have been found too late.”

After performing a PET scan, which shows doctors how tissues and organs work on a cellular level, Dr. Duke began to strongly suspect that the mass in Moen’s neck was cancerous. A biopsy indicated abnormal cells, which wasn’t conclusive for cancer, but all the test results were concerning enough that he recommended Moen undergo surgery as the best course of action.

Once Moen’s surgery began, Dr. Duke found not just a tumor on her thyroid, but a large clump of lymph nodes also taken over by the same mass and stuck to her carotid artery and jugular vein, the two types of blood vessels in the neck that are essential for exchanging blood between the brain and the heart. Because the entire mass was so dense, Dr. Duke was forced to remove Moen’s thyroid gland along with the tumor.

Next, he painstakingly separated the rest of the cancer from the carotid artery and jugular vein, careful not to damage those essential structures. But because the tumor had so encased both of those blood vessels, he was forced to leave some of it still there.

Care coordination in action  

After surgery, the tumor was analyzed more closely in the lab and confirmed to be metastatic thyroid cancer that had indeed begun in the thyroid and spread to Moen’s lymph nodes. When a round of radiation following her surgery did not succeed in shrinking the cancer remaining in Moen’s neck, Dr. Duke took her case to his regular multidisciplinary endocrine conference.

“Every month, I meet with endocrinologists, pathologists and radiologists to talk about patients with complex cases,” he says. “It’s a great example of care coordination, where providers from across different specialties work together towards the best possible decisions and outcomes for our patients.”

The consensus from the meeting was that Dr. Duke should go ahead with a second surgery to remove the rest of the cancer.

During that second surgery, Dr. Duke saw that the cancer had spread even further, almost completely encasing the internal jugular vein, wrapping about one-third of the way around the carotid artery, and invading the vagus nerve that governs speaking, swallowing and breathing.

Because he had enough time to expose the entire carotid artery, Dr. Duke was able to find a tiny space between the artery and the cancer and insert a tool that allowed him to peel the cancer away. He then painstakingly separated the lining — just a few cell layers thick — from the vagus nerve so that he could remove all the cancer from that structure. But to eliminate the cancer from the internal jugular vein, his only choice was to cut away the entire vein — luckily, a procedure that most patients are able to adapt to.

The surgery was a success, and Moen has experienced no lasting side effects to her voice or any damage to her ability to breathe or swallow.

“With the energy I have now, I just feel great”

Throughout her entire ordeal, Moen says that the care she received was wonderful.

“Emotionally, it was traumatic to hear that I had cancer,” she says. “But I had a great support system, a great team of doctors who kept me in the loop every step of the way. It was so nice to know that I came up during their conference and that I was at the forefront of their minds.”

“During my treatment and recovery,” she continues, “All of my providers were just phenomenal. The nurses were so kind, Dr. Breed was competent and caring, and Dr. Duke took so much time with me and my family, consistently asking, ‘What questions can I answer for you now?’”

Even though Moen never experienced any symptoms from her thyroid cancer, today she is feeling dramatically better than she did before her surgeries. She has more energy, the diabetes she had been struggling with has begun to stabilize, and as a result she’s lost about 60 pounds.

Because the thyroid gland regulates metabolism, Moen’s thyroid disease had likely been making it much harder for her to manage her blood sugar levels and diabetes.

“I feel fantastic these days,” she says. “My attitude is definitely better, and I’ve become more active, walking the dogs every day. With the energy I have now, I just feel great.”

Learn more about thyroid cancer and other thyroid diseases and how MultiCare otolaryngologists can treat them.