Per-Olof Hasselgren, MD, PhD
George H.A. Clowes Distinguished Professor of Surgery, Harvard Medical School
Surgery Vice Chair of Research
My research is focused on clinical studies related to endocrine surgery. Recent studies involved different aspects of the follicular variant of papillary thyroid cancer (FVPTC). In one project, we determined the relationship between follicular adenoma and FVPTC and found that increasing numbers of tumors diagnosed as FVPTC were accompanied by a simultaneous decrease in cases signed out as follicular adenoma. The study, published in Surgery (2016;159:1396-1406), suggests that patients with tumors diagnosed as FVPTC may sometimes be subjected to unnecessarily extensive surgical treatment and radioiodine treatment.
In another project, the influence of thyroid hormones on cervical brown adipose tissue (BAT) was examined. The study is important because BAT activation by thyroid hormones may protect from obesity, insulin resistance/diabetes, and the metabolic syndrome. The study was a feasibility investigation to determine the possibility of using BAT obtained during neck surgery (thyroidectomy or parathyroidectomy) to examine the regulation of BAT activity and was published in THYROID (2016;27:1-10).
We are presently performing studies testing whether certain features of “suspicious for cancer” cytology combined with features of preoperative thyroid ultrasound may make it possible to differentiate between invasive FVPTC and Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) This would make it possible to recommend less aggressive surgery in many patients with cytology being “suspicious for cancer.”
Although NIFTP can be managed as a non-malignant tumor, invasive FVPTC continues to be considered a malignant tumor. We recently performed genetic analysis of an invasive FVPTC in a patient with an aggressive variant of invasive FVPTC. A 47-year-old man presented with a metastasis to his right iliac bone as the initial manifestation of a 1.6 cm invasive FVPTC (Figures 1 and 2).
The patient underwent total thyroidectomy but despite additional aggressive treatment, the disease progressed, resulting in the patient’s demise. Next-generation sequencing of the primary tumor using a pan-cancer targeted mutation and gene fusion panel revealed NRAS Q61K mutation and no other oncogenic alterations, suggesting that an isolated RAS mutation in invasive FVPTC may be associated with aggressive clinical behavior, challenging the prevailing concept that thyroid neoplasms with isolated RAS mutations are associated with favorable clinical behavior. The patient was reported in Int J Surg Case Rep (2017;38:1-5).
A study was recently initiated to determine the role of different preoperative imaging tests (ultrasound, Sestamibi scanning, and four-dimensional CT, 4D-CT) in patients with primary hyperparathyroidism. In particular, we will investigate the results of 4D-CT, a novel modality of preoperative imaging in patients with hyperparathyroidism.
Ongoing studies are based on a prospective database in the Section of Endocrine Surgery that has been active for about 15 years and contains information from more than 6,000 patients.
Administrative responsibilities and Committees
Vice Chairman, Research
Director, Section of Endocrine Surgery
Chairman, Department of Surgery Appointment-Reappointment-Promotion Committee (through June 2017)
Recruitment of an additional member of the Section of Endocrine Surgery
Benjamin James, MD, was recently recruited to the Section of Endocrine Surgery. Dr. James performed a Fellowship in Endocrine Surgery at the University of Chicago followed by a Fellowship in Research in Endocrine Surgery at the same institution. After completing these fellowships, he joined the faculty of the Department of Surgery at Indiana University, Indianapolis, where he built a thriving practice in endocrine surgery. He is a welcome addition to the Section of Endocrine Surgery at BIDMC and brings novel and innovative surgical approaches to the treatment of thyroid, parathyroid, and adrenal disorders.
- Associate Editor: Metabolism
Editorial Board: Nutrition; International Journal of Interferon, Cytokines, and Mediator Research
- Ad hoc reviewer: Multiple journals, including American Journal of Physiology, Annals of Surgery, British Journal of Surgery, Endocrinology, Journal of Surgical Research, World Journal of Surgery, Critical Care Medicine
Creation of a Surgical History Group in the Department of Surgery (together with Dr. Sidney Levitsky). The following activities took place during 2017:
- Study visit to the Warren Anatomical Museum, Harvard Medical School
- Surgical Grand Rounds by Dr. Peter Kopp: “From First Successful Thyroidectomy to the Nobel Prize in Physiology and Medicine: The Legacy of Theodor Kocher (1841-1917)”
- Lecture by Frederick Millham, MD: “Did a Surgeon Lose the U.S. Civil War? The Wounding and Death of General Thomas J (Stonewall) Jackson”
Teaching, Training, and Education
Surgery Grand Rounds
May 24, 2017: “Current Best Practices in the Management of Thyroid Nodules”
Student Teaching (preceptor groups, HMS students)
July – September, 2016
October – December, 2016
January – March, 2017
April – June, 2017
Gavrila A, Hasselgren PO, Glasgow A, Doyle AN, Lee AJ, Fox P, Gautam S, Hennessey J, Kolodny G, Cypess AM. Variable cold-induced brown adipose tissue response to thyroid hormone status. Thyroid 2016;27:1-10.
Mehrzad R, Nishino M, Nucera C, Dias-Santagata D, Hennessey JV, Hasselgren PO. Invasive follicular variant of papillary thyroid cancer harboring the NRAS mutation Q61K and presenting with bone metastasis – A case report. Int J Surg Case Rep 2017;38:1-5.
Hasselgren PO, Cannon JW, Fischer JE. Perioperative management: Practical principles, molecular basis of risk, and future directions. Chapter 2. In Fischer JE (ed). Mastery of Surgery, 7th edition, 2017.