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 Thyroid Cancer

In the United States, there are over 11,000 new cases of thyroid cancer each year.  Females are more likely to have thyroid cancer at a ratio of three to one.  Thyroid cancer can occur in any age group, although it is most common after age 30 and its aggressiveness increases significantly in older patients.  The majority of patients present with a nodule on their thyroid which typically does not cause symptoms.

The thyroid gland is an endocrine gland located in the neck, below the larynx (voice box) and the clavicles (collarbones).  It is bow tie shaped, having two halves (lobes) joined by a bridge or “isthmus.”  Endocrine glands produce hormones to regulate physiological functions in the body.  The thyroid gland manufactures thyroid hormone, which regulates the rate at which the body carries on its necessary functions.

Diseases of the thyroid gland are very common, affecting millions of Americans.  The most common diseases are an over-active (hyperthyroidism) or under-active (hypothyroidism) gland.  The thyroid gland can become enlarged from abnormal activity and is often called a “goiter.”  Sometimes an inflammation of the thyroid gland (Hashimoto’s disease) will cause enlargement of the gland.  Patients may develop “lumps” in the thyroid gland which should undergo evaluation.  Occasionally, symptoms such as hoarseness, neck pain, and enlarged lymph nodes occur along with the thyroid nodule.  Although as much as 10% of the population will have thyroid nodules, the vast majority are benign.  Only approximately 5% of all thyroid nodules are malignant.  The evaluation of a thyroid nodule includes a thorough medical history and a physical examination.  Other tests include an ultrasound examination of the thyroid gland, blood tests of thyroid function, a radioactive thyroid scan, fine needle aspiration biopsy, chest X-ray or CT or MRI scan.  A nodule which is cold on thyroid nuclear scan is more likely to be malignant; nevertheless, the majority of these are benign as well.

Abnormalities of thyroid function (hyper or hypothyroidism) are usually treated medically.  If there is insufficient production of thyroid hormone, this may be given in a form of a thyroid hormone pill taken daily.  Hyperthyroidism is treated mostly by medical means, but occasionally it may require the surgical removal of the thyroid gland.  Fine needle aspiration biopsy is the single best test to determine the nature of a thyroid nodule.  It is a safe, relatively painless procedure that can be performed in an office setting.  A needle is passed into the lump and samples of tissue are taken.  Several passes with the needle may be required.  There is little pain afterward and very few complications from the procedure occur.

Treatment of benign thyroid nodules of diffuse enlargement (goiter) is often treated with thyroid hormone, called “suppression” therapy, to shrink or prevent additional growth of the mass.  If the lump continues to grow, removal of all or part of the thyroid gland is a common recommendation.  If the fine needle aspiration biopsy is suspicious for or suggestive of cancer, thyroid surgery is required.

The treatment for thyroid cancer is usually surgical removal of all or part of the thyroid gland.  A biopsy during the operation may be used to determine if all of the thyroid gland should be removed.  Patients may require lymph node removal, or neck dissection, as part of their surgical treatment.  Complications of thyroid surgery are rare.  They include bleeding, vocal cord paralysis causing a hoarse voice, difficulty swallowing, numbness of the skin on the neck, and low blood calcium.  Patients who have all of their thyroid gland removed have a higher risk of low blood calcium port-operatively and may have to take thyroid hormone and/or calcium supplements permanently.

Following surgery, radioactive iodine is often recommended in addition to surgery for thyroid cancer.  Routine follow-up is required for patients diagnosed with thyroid cancer and yearly thyroid scans and blood tests including a blood test for thyroid cancer are often performed.  Thyroid cancer responds very well to appropriate treatment, and cure rates are very high.  Certain factors help predict the curability of a patient with thyroid cancer.  Advanced age, a large tumor, aggressive type of thyroid cancer, and male sex tend to be unfavorable features.  Surprisingly, spread to lymph nodes in the neck usually does not alter a patient’s prognosis.  Patient benefit from evaluation and treatment from a variety of medical specialties, including Endocrinology, Head and Neck Surgery, Nuclear Medicine, Pathology, Radiology, and others to provide comprehensive medical care.

For more information about thyroid cancer, please contact your physician or the American Cancer Society.