Julie Ann Sosa, MD, MA, FACS, endocrine surgeon and chair of the Department of Surgery at UC San Francisco, has been named president-elect of the American Thyroid Association (ATA). She was previously the ATA’s treasurer.
Sosa has served on ATA guidelines committees for hyperthyroidism, thyroid nodules and differentiated thyroid cancer and is the current co-chair of the ATA practice guidelines committee for the management of differentiated thyroid cancer. In this interview, she talks about the guidelines, minimally invasive thyroid surgery, her research and clinical trials, and why “rare things are not rare at UCSF.”
Q: What does the role of president-elect of the ATA mean to you?
A: The ATA is one of the oldest professional organizations in all of medicine and is the premier professional society focused on diseases of the thyroid worldwide. Typically, it has been led by endocrinologists, so it’s relatively rare for a surgeon to be president-elect. This is very special to me.
The ATA publishes evidence-based guidelines on the management of benign and malignant thyroid disease. They are the gold standard of how thyroidology should be practiced.
I helped write two iterations of guidelines around the management of hyperthyroidism. In 2015, I participated on the guidelines committee focused around optimizing the management of adult patients with thyroid nodules and differentiated thyroid cancer. Those are perhaps the most cited guidelines ever published by the ATA because as many as half of Americans have a thyroid nodule. For about 30 years and until just a couple of years ago, thyroid cancer was the fastest-increasing cancer in the U.S., with incidence that rose by more than 300%. This was also observed in virtually every developed and developing country in the world.
A large part of the explanation for this was overdiagnosis. Asymptomatic adults were being screened, tiny nodules were being identified and biopsied, and a diagnosis of thyroid cancer was made. Though many of the nodules were clinically insignificant, patients embarked on treatments that came with risk but not always with benefit; overdiagnosis can lead to overtreatment. The 2015 guidelines recommended a “less is more approach” to avoid overdiagnosis and overtreatment. I’m now co-chairing the task force writing the next iteration of the guidelines, which hopefully will be ready to be released in 2022.
Q: What is the prevalence of thyroid surgery in the U.S. and what contributes to positive outcomes?
A: Thyroid surgery is one of the most common operations performed in the U.S. A few years ago, I was involved in a study that found a surgeon volume of at least 25 thyroidectomies a year is associated with the lowest risk of patient complications.
At UCSF, we have six high-volume endocrine surgeons who perform thyroid surgery, making us one of the largest such centers on the continent. We each perform more than 25 thyroid surgeries a year, which on average conveys significantly improved safety for patients. Also, more than 90% of our patients receive no opioids and do very well, with a speedy recovery and very little discomfort, which is managed effectively via other means.
Q: What are some of the specialized surgical procedures performed at UCSF?
A: We perform transoral thyroid surgery, which is scarless, and most of our thyroid operations are done in the outpatient setting; minimally invasive parathyroidectomy (MIP) can be done under local anesthesia. We’re able to use the rapid parathyroid hormone blood test right in the operating room and get the results within 15 minutes. Patients can go home the same day. A new procedure we offer is radio frequency ablation (RFA) for patients unable to have surgery.
Q: Can you describe your latest research and clinical trials?
A: We’ll be opening a new, first-of-kind trial soon on neoadjuvant selpercatinibfor patients with locally advanced medullary thyroid cancer. We also have clinical trials underway for the management of patients with other forms of locally advanced and metastatic thyroid cancer.
We’re conducting a natural history study on medullary thyroid cancer to understand how to optimally manage this rare disease. I joined forces with Dr. Elizabeth Grubbs at MD Anderson Cancer Center because we’re two of the largest medullary thyroid cancer centers in the world.
Patients who come to UCSF or MD Anderson with this disease are enrolled in the study. We enter data in the registry from their surgeons, physicians, geneticists and pathologists, and we collect information on patient-reported outcomes and preferences. The goal is to create a body of evidence and share it with other patients to help them make decisions when, otherwise, there are no robust data to support decision-making. We’re now enrolling other centers to join us, including The Ohio State University and the University of Colorado.
Q: Can you talk about your practice?
A: Many of my patients come from all over the Western U.S., Alaska and Hawaii. I have patients with medullary thyroid cancer who live on the East Coast who come to San Francisco for their care. That is because at UCSF we have the system in place to take care of high-risk patients, optimizing their opportunity to have a great outcome via superlative transdisciplinary care. Rare things are not rare at UCSF. They become relatively common.
I’m very passionate about thyroid disease and thyroid cancer and about the role the ATA plays. I’m very proud to be at UCSF because I believe we are standard-bearers for practicing evidence-based thyroidology.
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