Specialty thyroid clinic settles in at SRMC

RIO RANCHO — Sandoval Regional Medical Center is now home to New Mexico's only thyroid cancer specialty clinic.

Dr. Nathan Boyd, an otolaryngologist at the Head and Neck Endocrinology Clinic at SRMC, was passionate in an interview Feb. 4 about bringing the almost "one-stop" service to the area. Boyd also has a fellowship in head and neck oncology as well as other distinctions. 

"That's most of my practice and maybe about five years ago or so I really focused that down even further to do mostly thyroid and parathyroid, which is the focus of this new clinic," he said.

The clinic was moved to SRMC in recent months. According to Boyd, thyroid cancer is one of the top 10 cancers in New Mexico. 

"It's not like super common, but because thyroid nodules are so common and that's kind of the precursor, we end up seeing quite a fair amount of it. In New Mexico, there's probably about 400-500 cases of thyroid cancer per year," he added.

Since the specialty is so rare in the state, the clinic ends up doing most of the care. 

"There aren't that many people in the state that do that type of work, and as our volume has picked up, I became more and more interested in it," he said.

Thyroid cancer has a good prognosis in general, according to Boyd.

"There are some exceptions to that, but for the most part, it's really good prognosis and it often affects patients who are a little younger. So, it's just really gratifying work to try to help people who are in the prime of their life deal with this cancer," he said.

He added that even with the good prognosis, thyroid cancer needs to be well managed. But that management requires a whole team, according to Boyd.

"There's so many different people involved in the care of these patients. We regularly meet with radiologists and pathologists and endocrinologists and nuclear medicine doctors, and I do the surgery part, but I'm really just one member of a big team," he said.

He also said the move to SRMC was in conjunction with some of the endocrinology team, which helped centralize the care to one area. 

An unknown part of the practice is parathyroids, but it's Boyd's favorite part, he said.

"Parathyroids are amazing. There are these four tiny little glands that are next to your thyroid —that's why they're called parathyroids — and they regulate the body's calcium," he said. "The most common thing with those is you can get a benign tumor in a parathyroid gland, and it makes your calcium go up really high, and if that happens, people feel terrible with bone and joint pain, fatigue ... They can get osteoporosis, kidney stones, it can exacerbate depression, all kinds of things."

He said they can do a surgery that cures the problem, which is why he loves it so much.

"That's actually my favorite surgery to do of all surgeries that I do because people feel so much better after parathyroid surgery," he said.

Boyd recognized the complexity of the medical field, adding that specialty care can be frustrating for patients.

"If you imagine what somebody has to go through to have a surgery. For thyroid cancer typically, they've seen a health care provider in a different setting who has done an ultrasound or felt their neck or they had some problems and they got a thyroid nodule. They go and see another provider to get a needle biopsy and probably more imaging. And then they get referred to see an endocrinologist, who does some additional workup, and then they get referred to see a surgeon. And then they have a surgery. Then they have a post-op visit. Then they have another visit with the endocrinologist," he said breathlessly. "It really adds up quickly, even for something that just needs one surgery."

The goal of the clinic, he said, is to centralize as much of that as they can into one place. 

The drive to the clinic might be frustrating for patients who live farther away, but Boyd said that's part of the reason they are trying to consolidate care into one place.

Like most specialties, this clinic serves the vast majority of New Mexico.

"One of the things that's tricky about New Mexico from a health care provider standpoint is it's a small population. It's only a couple million people that live in New Mexico, and yet when we take care of the entire spectrum of the complexity of health care at UNM, and what I mean by that is we get all of the hardest stuff," he said. "Like if you went to Texas, M.D. Anderson gets really complicated cases, but we get those cases, too. We just don't get a huge volume of them."

There's not really a direct explanation for why there is a large number of thyroid cancer cases in a year, but Boyd talked about factors that are common.

"One thing that people may have heard of is the thyroid cancer is you're at higher risk to get thyroid cancer if you've been exposed to radiation. So, for example, a lot of the people that were exposed to the Chernobyl accident many years ago, a lot of them got thyroid cancer. And so, as many know, we have a long history of the Manhattan Project, the nuclear testing, and all the other stuff in New Mexico," he said.

However, radiation exposure does not guarantee thyroid cancer's existence, he said.

"It appears that, when we look at the epidemiological data, in fact, one of the biggest factors in being diagnosed with thyroid cancer is your access to health care, because a lot of them are incidentally identified," he said.

Basically, patients that don't have access to health care get less diagnosis of thyroid cancer, he explained.

"Thyroid cancer is a little bit of a bad-luck cancer. I mean, we know that ... there's a little bit of an uptick in patients who are who are obese. That's thought to be related somewhat to estrogen mediation," he said.

However, estrogen levels do not occur with thyroid cancer, he explained. 

"One common misconception is, everybody knows that your thyroid hormone levels have to do with weight, for example. It turns out that patients who have thyroid cancer generally don't have a problem with their thyroid hormone levels. So, the diagnosis and treatment of thyroid cancer is really a separate question from the how much thyroid hormone you have," he said.

Losing weight with thyroid hormones puts strain on the heart and bones, according to Boyd, so he doesn't recommend considering it.

Boyd also doesn't recommend people get screened without first having some of the precursors to the cancer. Doctors also don't want to "over diagnose" a person, he explained.

"One of the issues that we're dealing with now is actually there are so many people that are incidentally diagnosed with thyroid cancer. And many of those patients, the risk of that thyroid cancer is super low. And, and for some of them, we don't even recommend treatment. We just recommend watching it," he said.

"Something that often comes up is, 'Well, should we just recommend that everybody gets an ultrasound at some point in their life to look for that?' Actually, the answer is no."

He does recommend getting checked if people feel a nodule, change in the voice, notice an inability to swallow or have pre-existing autoimmune disorders such as Hashimoto's Disease. However, most of those go through a person's primary care doctor.