Thyroid Cancer
The thyroid gland is located in the lower front of the
neck, below the larynx (Adam’s apple) and above the
collarbones. Thyroid cancer (carcinoma) usually appears as
a painless lump in this area. In most cases, the lump affects
only one side, and the results of thyroid function tests
(blood tests) are usually normal.
There are four main types of thyroid cancer (papillary,
follicular, medullary and anaplastic). The vast majority
of cases are either papillary or follicular, and both types
are treatable with radioiodine.
Symptoms of thyroid cancer
Many patients with thyroid cancer have no symptoms whatsoever,
and are found by chance to have a lump in the thyroid gland
on a routine physical exam or an imaging study of the neck
done for unrelated reasons (CT or MRI scan of spine or chest,
carotid ultrasound, etc.). Some patients with thyroid cancer
become aware of a gradually enlarging lump in the front portion
of the neck which usually moves with swallowing. Occasionally,
the lump may cause a feeling of pressure. Obviously, finding
a lump in the neck should be brought to the attention of your
physician, even in the absence of symptoms.
Diagnosis
To obtain a diagnosis, a physician first takes a detailed
history and performs a careful physical examination, especially
of the thyroid gland. The best diagnostic approach for a specific
patient will be determined by your physician after careful
consideration of all the facts. The tests may include:
- Fine-needle aspiration biopsy – this is usually
done first and, if positive, significantly reduces the need
for more elaborate and expensive testing.
- Ultrasonography – this may be required for guidance
of the fine needle biopsy if the nodule is difficult to feel.
- Thyroid scan – this can be done to see if the mass
is capable of concentrating radioiodine, particularly in
those rare patients with associated hyperthyroidism
- Blood studies
Treatment of thyroid cancer
Fortunately, most types of thyroid cancer can be diagnosed
early and cured completely, but a thoughtful and comprehensive
investigation is necessary. If thyroid cancer is suspected
after review of all the information, referral to an experienced
thyroid surgeon is recommended.
The usual approach is to remove the portion of the thyroid
containing the lump, along with most of the remaining thyroid
gland and any abnormal lymph glands. If cancer is confirmed,
further consultation with the endocrinologist is appropriate.
Radioactive iodine treatment is usually recommended in order
to destroy any remaining malignant thyroid cells and to reduce
the risk of recurrence of this disease.
After radioiodine therapy, thyroid medication (levothyroxine)
should be started and the dose carefully adjusted to each patient’s
unique requirements, which will prevent the development of
persistent hypothyroidism and decrease the likelihood of cancer
recurrence. Periodic monitoring is supervised by the endocrinologist,
and may include ultrasound examinations, radioiodine body scans,
and periodic testing of a blood protein called thyroglobulin,
which is found in normal thyroid cells but can also be produced
by thyroid cancer cells.
The optimal frequency of further monitoring studies to be
certain that the cancer does not recur will be determined by
your physician. Fortunately, most types of thyroid cancer are
associated with a very good prognosis when diagnosed early
and treated by a physician who is familiar with the management
of this disease. |
