Catherine Dinauer, MD

In my training at Walter Reed Army Medical Center, I was fortunate to have opportunities to conduct both basic science and clinical research, starting as a pediatric resident and continuing through pediatric endocrinology fellowship. As a fellow, my research focused on thyroid cancer in children. I developed a retrospective clinical database on patients <21 years of age diagnosed with thyroid cancer within the Dept of Defense. This cohort remains one of the largest to date and allowed us to investigate clinical questions related to treatment and recurrence. I obtained IRB approval to contact patients to collect follow up data, allowing us to assess recurrence and long-term outcomes of treatment more robustly. Our basic science investigations included analyzing paraffin-embedded tissue blocks for molecular markers, representing some of the earliest studies investigating the association between presentation and outcomes and the underlying genetic profile. I was mentored by Gary Francis, M.D., Ph.D., an expert in thyroid cancer, and conducted my research in collaboration with basic scientists, adult and pediatric endocrinologists, surgeons, and pathologists. This experience taught me the importance of a multidisciplinary team in conducting research. I also learned that my research preference tends towards the clinical realm.

Following my fellowship, I remained at Walter Reed as an Attending Pediatric Endocrinologist and became an Assistant Professor at the Uniformed Services University of the Health Sciences. I continued to work with Dr. Francis and colleagues on assorted pediatric thyroid cancer projects. In 1999, I was asked to serve as Assistant Chief and Chief of Clinical Studies in the Department of Clinical Investigation. This administrative position involved overseeing approved research protocols, running the Scientific Review Board, and serving as a member of the Human Use Committee as well as educating investigators on conducting research ethically, legally, and using sound methodology. I served in this position until 2001, at which point my military obligation was complete and I chose to resign my commission and focus on clinical medicine and spend time with my three young children.

In 2005, my family and I moved to Connecticut. I learned of the newly established Yale Pediatric Thyroid Center and was hired to provide clinical care on a part-time basis. With this affiliation came opportunities to resume research in pediatric thyroidology. With the then-director, Dr. Scott Rivkees, I worked on clinical projects related to treatment of Graves disease, such as investigating side effects of the standard medical treatment (with the anti-thyroid drug methimazole) and choice of definitive treatment (surgery versus radioactive iodine). We established a retrospective clinical database.

Upon my move to the Department of Surgery in 2012, I began working closely with Dr. Emily Christison-Lagay, pediatric surgeon. Based on her expertise (including training in pediatric surgical oncology) and studies showing children needing thyroid surgery fare best when operated on by a “high volume” surgeon, Dr. Christison-Lagay was designated as the surgeon for pediatric thyroid operations at Yale. We moved the clinical database over to the Division of Pediatric Surgery and obtained IRB approval to expand the study prospectively. We have queried the database on questions related to surgical management and outcomes of children with thyroid cancer and have also used the data collaboratively, e.g., with the Department of Pathology, to correlate clinical features with molecular genetics of tumors. The questions we've asked stem from our clinical work and known gaps in the field. I am interested in whether an unstimulated thyroglobulin level (which we use as a tumor marker) drawn 2-3 weeks after surgery for thyroid cancer can predict outcome and guide us in whether to recommend radioactive iodine treatment. I started investigating this question in 2020, working with a medical student. We have analyzed thyroid nodule cytology data, to determine the likelihood of malignancy in indeterminate nodules evaluated at our institution to refine recommendations on management (e.g., lobectomy vs total thyroidectomy).

In 2020, Nicole Deziel, PhD, MHS, Associate Professor in the Department of Environmental Health Sciences at the Yale School of Public Health, contacted me regarding collaboration on projects examining environmental risk factors for pediatric thyroid cancer. We have worked together since; I provide clinical input on her research examining possible environmental etiologies of thyroid cancer in children as well as epidemiology of thyroid cancer in the pediatric population.

The world of pediatric thyroidology is small and very collegial. Pediatric thyroid cancer is difficult to study as it is a relatively rare disease (although increasing in frequency) and may have late recurrence (decades later); there are no prospective data to date. For these reasons, studies pooling data from multiple institutions are imperative to provide more robust data and move the field forward. Yale has established itself as a leader in endocrine tumor care and research, including thyroid cancer in adults and children. Dr. Christison-Lagay and I have established Yale as an inaugural member of the Child and Adolescent Thyroid Consortium, along with four other institutions. The Consortium constitution was approved in 2020, and the members have created a joint database and as of 2025 are analyzing data related to the landscape of differentiated thyroid cancer in children. Operations are housed at Children’s Hospital of Philadelphia and the consortium has been expanded to include other institutions. This endeavor had been discussed for many years and to see it come to fruition has been extremely gratifying.