Patients with papillary thyroid cancer commonly confront the perception that their malignancy is "good," but the favorable prognosis and treatability of the disease do not comprehensively represent their cancer fight. The "good cancer" perception is at the root of many mixed and confusing emotions. Clinicians emphasize optimistic outcomes, hoping to comfort, but they might inadvertently invalidate the impact thyroid cancer has on patients' lives.

Importance Voice changes after thyroidectomy are typically attributed to recurrent laryngeal nerve injury. However, most postoperative voice changes occur in the absence of clinically evident vocal fold paralysis. To date, no study has compared the prevalence, duration, and consequences of voice-related disability from the patient perspective with use of quantitative vocal measures. Objective To assess quality of life consequences of posthyroidectomy voice change from the perspective of patients with thyroid cancer and to compare patient-perceived voice changes with changes in quantitative vocal variables at 5 time-points in the first postoperative year. Design Prospective Mixed-methods Observational Study within a Randomized Clinical Trial (NCT02138214) Setting University of Wisconsin Hospital and Clinics Participants Forty-two patients with clinically node-negative papillary thyroid cancer without a pre-existing vocal cord paralysis were recruited and enrolled from outpatient clinics between June 6, 2014 and March 6, 2017 as part of an ongoing randomized clinical trial. Interventions Total thyroidectomy Main Outcome(s) and Measure(s) Semi-structured interviews, symptom prevalence, and instrumental voice evaluations (Laryngoscopy, Phonation Threshold Pressure, Dysphonia Severity Index, Voice Handicap Index) occurred at baseline (n=42), 2-week (n=42), 6-week (n=39), 6-month (n=35), and 1-year (n=30) postoperative time points. Results Participants had a mean age of 48 years (interquartile range, 38–58 years; age range, 22–70 years) and were mostly female (74% [31 of 42]) and of white race/ethnicity (98% [41 of 42]). Impaired communication was the primary theme derived from patient interviews from before thyroidectomy to after hyroidectomy. Voice changes were perceived by 24 participants at 2 weeks after thyroidectomy. After surgery, voice symptoms were prevalent and persisted for 50% (21 of 42) of participants out to at least 1-year of follow-up. Quantitative vocal perturbations were detected in Dysphonia Severity Index and Voice Handicap Index at the 2-week follow-up, but returned to baseline levels by the 6-week follow-up visit. Conclusions and Relevance Voice changes are common after surgery for papillary thyroid cancer and affect quality of life for many patients out to 1-year of follow-up. Directly querying patients about postoperative voice changes and questioning whether commonly-used aerodynamic and acoustic parameters detect meaningful voice are important in identifying patients whose quality of life has been affected by post-thyroidectomy dysphonia. Trial Registration NCT02138214; https://clinicaltrials.gov/ct2/show/NCT02138214

Swallowing symptoms after thyroidectomy are underreported in the literature. This study revealed that as many as 80% of patients who have thyroidectomy may experience swallowing-related symptoms after surgery, and many develop compensatory strategies to manage or reduce the burden of these symptoms. Considering the large number of individuals who may experience subjective dysphagia, preoperative counseling should include education and management of such symptoms.

The flow cytometric detection of aberrant antigen expression is one method proposed for the quantification of minimal residual disease (MRD) in acute leukemias. The present study was designed to investigate the stability of the aberrant antigen expression at relapse or at treatment failure of initial chemotherapy. For this purpose, multiparameter immunophenotyping with a panel of 15 monoclonal antibodies was used at diagnosis as well as at relapse (43 patients with overall 65 aberrations) and at treatment failure (35 patients with overall 66 aberrations). There was a significant decrease in the percentage of the initially described aberrant antigen expression on leukemia blasts at relapse (P = 0.001; n = 65) as well as at treatment failure (P = 0.0001; n = 66) considering all aberrations in the whole leukemia population. Concerning only patients with acute myelogenous leukemia (AML), significant decreases in the aberrant expression could be detected at relapse (P = 0.031; n = 42) and at treatment failure (P = 0.0001; n = 52). The changes in patients with acute lymphoblastic leukemia (ALL) were significant only at relapse (P = 0.006; n = 23). Initially, the most informative aberration was not detectable in four patients at relapse and in seven patients at treatment failure. A decrease of under 50% of the initial value was observed in another 8 patients at relapse and in 10 patients at treatment failure. In further studies assessing the detection of aberrant antigen expression for MRD, quantification of the relapses should be explicitly analyzed regarding the persistence of the initially described aberrant antigen expression. Cytometry (Comm. Clin. Cytometry) 42:247–253, 2000. © 2000 Wiley‐Liss, Inc.

Introduction: Little is known about the experiences and concerns of patients recently diagnosed with thyroid cancer or an indeterminate thyroid nodule. This study sought to explore patients' reactions to diagnosis with papillary thyroid cancer (PTC) or indeterminate cytology on fine needle aspiration. Methods: We conducted semistructured interviews with 85 patients with recently diagnosed PTC or an indeterminate thyroid nodule before undergoing thyroidectomy. We included adults with nodules ‡1 cm and Bethesda III, IV, V, and VI cytology. The analysis utilized grounded theory methodology to create a conceptual model of patient reactions. Results: After diagnosis, participants experienced shock, anxiety, fear, and a strong need to ''get it out'' because ''it's cancer!'' This response was frequently followed by a sense of urgency to ''get it done,'' which made waiting for surgery difficult. These reactions occurred regardless of whether participants had confirmed PTC or indeterminate cytology. Participants described the wait between diagnosis and surgery as difficult, because the cancer or nodule was ''still sitting there'' and ''could be spreading.'' Participants often viewed surgery and getting the cancer out as a ''fix'' that would resolve their fears and worries, returning them to normalcy. The need to ''get it out'' also led some participants to minimize the risk of complications or adverse outcomes. Education about the slow-growing nature of PTC reassured some, but not all patients. Conclusions: After diagnosis with PTC or an indeterminate thyroid nodule, many patients have strong emotional reactions and an impulse to ''get it out'' elicited by the word ''cancer.'' This reaction can persist even after receiving education about the excellent prognosis. Understanding patients' response to diagnosis is critical, because their emotional reactions likely pose a barrier to implementing guidelines recommending less extensive management for PTC.