Children still need those mumps shots

Q: Why do children still need to be immunized against mumps? I haven’t heard of anyone getting mumps since I was a kid.

G.S.

Santa Rosa, Calif.

A: While it’s true that mumps has largely been eradicated in the United States, there have been outbreaks — most notably a series of outbreaks on college campuses in 2006. Looking at those epidemics, the resurgence of mumps was not due to a vaccine-resistant strain of mumps virus. Also, the vast majority of those students had properly received a second mumps vaccine, typically given before the start of kindergarten. Therefore, the most likely cause of the mumps epidemic was that the mumps vaccine’s effectiveness had gradually waned.

For those unfamiliar with mumps, it’s a viral infection that causes sudden onset of swelling of one or more salivary glands in the neck. It generally runs its course within a week, and is treated with Tylenol or Advil/Aleve for fever and pain.

Approximately 5 percent of males see testicular involvement; meningitis, encephalitis and deafness occur in fewer than 1 percent of cases.

The lessons learned from the 2006 college mumps epidemic are that mumps is still around; mumps vaccination is still necessary; and that either a longer-lasting mumps vaccine should be developed or additional mumps booster doses might protect folks who work or live in close proximity with one another.

Q: I am concerned about a recent thyroid scan that showed I have a “cold lesion” on my thyroid gland. I visited an endocrinologist who performed a biopsy with “inconclusive” results. My thyroid itself is functioning fine. My doctor recommends that the nodule be removed by surgery. What should I do?

D.H.

Cumming, Ga.

A: Let me reassure you about a few things. Thyroid nodules are actually very common; one in 12 to 15 women/one in 40 to 50 men will show some sort of thyroid nodule on a thyroid sonogram. Most of these can’t be felt on exam. About 90 percent to 95 percent of thyroid nodules are benign/non-cancerous. Most thyroid nodules occur in folks like you with perfectly normal thyroid function.

Historically speaking, a nuclear thyroid scan was used to tell if a thyroid mass was solid or a fluid-filled cyst. It identifies a lesion as “hot” or “cold” depending on whether it takes up the contrast dye. The trouble is that it was incorrectly assumed that “cold” nodules were cancerous and “hot” nodules were benign. Since many “cold” nodules are benign, a thyroid scan can’t make the diagnosis for you; a fine needle tissue biopsy is needed.

In your case, the needle biopsy was “inconclusive.” This likely means that there were an insufficient number of thyroid cells obtained by biopsy and no diagnosis is possible. I’d repeat the biopsy, since there’s a 50-50 chance that there will be an adequate number of thyroid cells on a repeat needle biopsy. By the way, 5 percent to 10 percent of thyroid needle biopsies are non-diagnostic or inconclusive.

If your repeat biopsy does show thyroid cancer, most of it is slow-growing and unlikely to metastasize (spread) beyond the lymph nodes in the neck. Surgery followed by radiation treatment is the usual protocol for most thyroid cancers. While all this may sound scary, in the vast majority of folks, these steps will cure thyroid cancer.

Dr. Mitchell Hecht is a Roswell physician specializing in internal medicine. Send questions to “Ask Dr. H,” P.O. Box 767787, Roswell, GA 30076.