Thyroid Cancer Is Easy To Cure But Only If You Can Find It
Cancer of the thyroid gland is easy to survive but hard to find unless youre really looking for it. Doctors say those with a family history of the disease ought to make the effort.
Few Americans would list thyroid cancer as a health condition they worry about. Although its among the ten most common types of cancer in the United States, and diagnosis rates continue to rise, the vast majority of thyroid cancers grow slowly and respond well to treatment.
Thyroid cancer wasnt something Dr. Stacie Chasin worried about, either, even after her mother and uncle were diagnosed with papillary thyroid cancers in 2011. Chasin, an internist in Goshen, New York, initially shrugged off the advice that she have an ultrasound to see whether she had the cancer, too.
The thyroid is a butterfly-shaped gland about 3 centimeters wide that sits below the Adams apple. Nodules, or growths, on the thyroid are not uncommon, and most are benign.
But the nodules are so small they are hard for doctors to find. Most are discovered accidentally when patients undergo imaging tests for other conditions. A thorough physicians assistant noticed a bump on Chasins mothers thyroid during a routine exam.
Learn Everything You Need to Know About Thyroid Cancer »
In 2013, Chasin stopped by the radiology department that sits next to her office to get an ultrasound done and end her familys nagging. The test detected a single large nodule, which also turned out to be a papillary cancer.
Thats it.
Managing Thyroid Cancer Without Surgery
Thyroid cancer rates have risen dramatically in the past few decades, likely due to the explosion of imaging technologythe more you look, the more you find.
The good news is life expectancy has not changed significantly. In fact, the mismatch of incidence and death rates proves thyroid cancer is rarely life-threatening. Enter active surveillance, a non-surgical option appropriate for low-risk cancers.
The rush to remove all suspicious tumors is a thing of the past, says endocrinologist Hyesoo Lowe, MD, medical director of the Columbia Thyroid Center, referring to the old if its cancer its gotta come out standard of care. Today, low-risk thyroid cancer can be monitored, checking in on tumor growth over time and usually avoiding surgery.
Most thyroid cancersabout 80% of casesare papillary thyroid cancers , which have the best prognosis. PTC is often detected incidentally, during a test for something else, like a scan for unrelated neck pain. The tumors are usually small, one reason, along with a lack of symptoms, people may not know they have cancer.
Because PTC is usually slow-growing, patients have two treatment choices: surgery and surveillance. In active surveillance, patients have neck ultrasounds twice a year for two years to monitor changes, if any, in the tumor.
Patients have options, says Lowe. We can customize treatment to their considerations, clinically and personally.
That said, theres strict criteria for active surveillance:
Ways To Shrink Benign Nodules
That is why I believe that a number of dietary and lifestyle changes can help improve symptoms of Hashimotos and reduce the size of thyroid nodules.
As mentioned above, many root causes of Hashimotos are associated with the development of thyroid nodules, so addressing them may reverse their growth and shrink them! Here are some tips that may help to reduce the size of your thyroid nodules:
- Address nutrient deficiencies in iodine, selenium, and vitamin D While iodine deficiency is rare in those with Hashimotos, those that are indeed low in iodine may benefit from taking a multivitamin with iodine, like Nutrient 950 from Pure Encapsulations. A dose of up to 250 mcg of iodine per day has been found to be helpful and beneficial in people with Hashimotos however, doses above 300 mcg can be potentially inflammatory. Vitamin D and selenium supplementation may also help. You can read more about addressing vitamin D and selenium deficiencies in my articles.
- Clear out toxins Supporting your livers detoxification pathways as well as opting for non-toxic, natural personal products can greatly reduce your bodys toxic burden and result in optimal thyroid health. Check out my article on liver support for more information.
- Consider smart supplementation Some of my readers have reported an elimination of nodules utilizing the systemic enzyme Wobenzym, and others with turmeric.
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Can I Lower The Risk Of My Cancer Progressing Or Coming Back
If you have thyroid cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. Unfortunately, its not yet clear if there are things you can do that will help.
Adopting healthy behaviors such as not smoking, eating well, getting regular physical activity, and staying at a healthy weight is important. We know that these types of changes can have positive effects on your health that can extend beyond your risk of cancer.
How Thyroid Cancer Is Treated
In many cases, a team of doctors works together to create a patients overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For thyroid cancer, this team may include a surgeon, medical oncologist, radiation oncologist, radiologist, nuclear medicine physician, and endocrinologist. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, speech therapists, and others.
Thyroid cancer is commonly treated by one or a combination of treatments. The common types of treatments used for thyroid cancer are listed below, followed by an outline of common cancer treatments given by stage of disease .
Treatment options and recommendations depend on several factors, including the type and stage of thyroid cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Talk with your health care team about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called shared decision-making. Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for thyroid cancer because there are different treatment options.
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Treating Metastatic Thyroid Cancer
Metastatic or advanced thyroid cancer means the cancer has spread beyond the thyroid, to other parts of your body.
If you have metastatic thyroid cancer, your doctor will aim to slow down the growth of the cancer and reduce or relieve any symptoms you have.
Treatment includes chemotherapy, targeted therapies and radiotherapy. Or you may be suitable for a clinical trial.
Read more about metastatic cancer.
Papillary Thyroid Cancer Surgery For Spread Of Cancer To Lymph Nodes Along The Side Of The Neck
- Just the presence of enlarged lymph nodes does not mean papillary thyroid cancer has spread and does not require additional surgery
- A procedure called an anterolateral neck dissection , in untreated patients, should only be performed in instances where an ultrasound with fine needle aspiration has confirmed papillary thyroid cancer spread to lymph nodes in the side of the neck
- The papillary thyroid cancer anterolateral neck dissection is not the same neck dissection as for other cancers that occur in the neck. Papillary thyroid cancer spreads to particular areas of the neck called levels. Removing just some of the lymph nodes has been called “cherry picking” and is the wrong surgery! A papillary thyroid expert surgeon trained and experienced to perform modified neck dissections specifically for thyroid cancer is needed to prevent recurrent or persistent disease.
- The anterolateral neck dissection, in skilled hands, spares all critical nerves, muscles, and blood vessels which are not directly involved with cancer . It ads approximately 40 minutes of surgery to remove the lymph nodes and fatty tissue.
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Chemotherapy Or Targeted Therapy As Part Of Your Treatment Plan
At this time, the use of other systemic chemotherapy and targeted therapy for the treatment of thyroid cancer is determined on an individual basis and is most often given as part of a clinical trial. See the Latest Research section for more information.
Learn more about the basics of preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.
What Kind Of Treatment Follow
After your thyroid cancer treatment is complete, you and your treatment team will decide on a follow-up plan. You may have an annual whole body iodine scan to monitor for any signs of cancer. All thyroid cancer patients will require thyroid replacement hormones. Your doctor will regularly monitor your thyroid levels, including a protein called thyroglobulin . Tg is made by normal thyroid tissue and abnormal thyroid cancer cells. Once the thyroid is destroyed or removed, your Tg level will be low or zero. Rising levels of Tg may mean your cancer has returned. Your doctor may also use ultrasound exams to ensure no new nodules are forming. Medullary thyroid cancer patients will also have their blood checked for calcitonin and CEA levels. These markers may be the first sign that medullary thyroid cancer has returned. Anaplastic thyroid cancer patients will need to continue seeing both a medical and a radiation oncologist. These appointments start soon after treatment to address any side effects and determine next steps. Your doctor may order CT or PET scans at these visits. See the PET/CT Scan page for more information.
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How Is Thyroid Cancer Treated With Thyroid Hormone Replacement
After the thyroid has been removed in thyroid surgery, the body no longer has access to the thyroid hormones it produced. As a result, people who have had their thyroids removed need to take daily thyroid hormone replacement pills.
Normally, the thyroid makes its hormones after getting a signal from the pituitary gland called TSH . When the thyroid is removed in surgery, thyroid hormone levels in the body drop. The pituitary gland senses this, and it sends out even more TSH in an attempt to get those levels back up.
Even though there is no longer a thyroid to act on, TSH can stimulate cancer cells that may have been left over from the surgery and cause them to grow and spread. Thyroid hormone replacement pills help prevent this by signaling to the pituitary gland that the hormone levels are fine, and so not as much TSH is needed.
Medullary thyroid cancer and anaplastic thyroid cancer do not come from cells that are affected by TSH, so hormone replacement does not prevent their recurrence. The pills are still needed post-surgery, however, to replace the thyroids normal activity.
In order to find and maintain the right dose of thyroid hormone, blood tests for thyroid function are checked periodically after surgery. Generally, these blood tests are done every two months until a stable dose has been achieved, after which they may be done less frequently.
Keeping Health Insurance And Copies Of Your Medical Records
Even after treatment, its very important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
At some point after your cancer treatment, you might find yourself seeing a new doctor who doesnt know about your medical history. Its important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.
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Thyroid Cancer Causes And Risk Factors
Its not clear exactly what causes thyroid cancer to develop. However, there are a number of known potential risk factors, some of which can be modified and others that cant. According to the National Cancer Institute, risk factors for developing thyroid cancer include:
Other research led by Dr. Harari is looking at whether certain environmental exposures, including to pesticides and flame retardants, have a link to thyroid cancer.
What Are The Stages Of Thyroid Cancer
Once you have been diagnosed with thyroid cancer, you will undergo testing to determine how far the cancer has spread, also known as the stage. Knowing the stage of your cancer helps your doctor to decide the most appropriate treatment.
The staging of papillary or follicular thyroid cancers is based on the age of the person at diagnosis specifically if they are younger or older than age 55 and the extent to which thyroid cancer cells have spread. The staging of anaplastic and medullary thyroid cancers does not take age into account.
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How Is Thyroid Cancer Treated With Radioactive Iodine Ablation
A normal thyroid gland needs iodine to produce its metabolism-controlling hormones. With radioactive iodine treatment, radioactive iodine, swallowed in pill form, travels through the body until it is taken up by cells of the thyroid, just like the regular iodine found in everyday foods like salt and milk. Unlike regular iodine, though, the radioactive iodine is toxic to thyroid cells.
Radioactive iodine treatment helps prevent thyroid cancer from returning after surgery. It is typically used for papillary thyroid cancer and follicular thyroid cancers that have spread to lymph nodes or other body parts.
Radioactive iodine treatment does not work for medullary thyroid cancer and anaplastic thyroid cancer or for thyroid lymphoma because these forms of cancer do not involve the types of thyroid cells that use iodine.
Because all the radioactive material gets directed to the thyroid, Radioactive iodine treatment does not harm other cells in the body.
Second Cancers After Thyroid Cancer
Survivors of thyroid cancer can be affected by a number of health problems, but often their greatest concern is facing another cancer. Cancer that comes back after treatment it is called a recurrence. But some cancer survivors may develop a new, unrelated cancer later. This is called a second cancer.
Unfortunately, being treated for cancer doesnt mean you cant get another. People who have had thyroid cancer can still get the same types of cancers that other people get. In fact, they might be as risk for certain types of cancer.
People who have or had thyroid cancer can get any type of second cancer, but they have an increased risk of developing:
Adrenal cancer risk is especially high in people who had the medullary type of thyroid cancer.
Patients treated with radioactive iodine also have an increased risk of acute lymphocytic leukemia , stomach cancer, and salivary gland cancer.
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Thyroid Nodules Causes And Risk Factors
Thyroid nodules are very common and there are several conditions that can cause them to develop in your thyroid gland, including the following:
- Iodine deficiency: Low iodine levels are associated with an increased risk of developing goiters or an enlarged thyroid gland.
- Hashimotos disease: Hashimotos disease causes inflammation of the thyroid gland and can cause the thyroid gland to become enlarged. This disorder results from the underproduction of thyroid hormone and can lead to the gradual destruction of the thyroid gland itself.
- Overgrowth of thyroid tissue: Sometimes theres an overgrowth of normal thyroid tissue, which is called a thyroid adenoma. Its unclear why this happens, but it can lead to lumps in the thyroid gland and an overproduction of thyroid hormones.
- Thyroid cyst: A fluid-filled cyst can develop in the thyroid, which may be the result of abnormal thyroid tissue growth. These cysts are often a mix of solid and fluid components and are usually benign. Sometimes, however, solid components in a cyst can be malignant.
- Thyroid goiter: A goiter an abnormal enlargement of the thyroid gland that causes a bulge in the neck. This can occur when theres an overproduction or underproduction of thyroid hormones.
- Thyroid cancer: Most thyroid nodules are benign and are caused by other factors, but sometimes a nodule is caused by cancerous cells in the thyroid. If a nodule is hard, large and painful, there is a greater risk of malignancy.
What Are Possible Side Effects Of Radiation Therapy
Radioactive iodine :Patients generally tolerate this treatment well. Short-term side effects include tenderness and swelling around the thyroid, nausea, swelling of the salivary glands, dry mouth, and sometimes changes in how things taste. Some patients find they are unable to make tears, leading to dry eyes and problems with contact lenses. Less frequent side effects include a lower sperm count in men and irregular periods in women. Women should avoid becoming pregnant for 6-12 months after treatment. Patients who have had I-131 treatment may have a slightly higher risk of developing leukemia in the future. This is extremely rare.
External beam therapy : After several EBT sessions, patients may become tired. Getting adequate rest is important. Doctors usually advise patients to try to stay as active as they can. Patients may have skin changes or irritation in the neck area where the radiation has passed through the skin. Other side effects include trouble swallowing, dry mouth, and hoarseness. Most of these side effects are easy to manage and go away once treatment ends.
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Watchful Waiting Aka Active Surveillance
Dr. Harari notes that there has been increased interest in watchful waiting, also known as active surveillance, for thyroid cancer. In New York at Memorial Sloan Kettering Cancer Center, it is the standard of care for certain populations, she says.
Watchful waiting can be a good choice for people who have small nodules that are not growing quickly or are not invasive in nature. It can also be a good treatment option for people who are very worried about having surgery, Dr. Harari says.
One reason why watchful waiting is garnering interest is that while diagnoses of thyroid cancer have increased over the last decade, mainly as a result of increased imaging done for other purposes, mortality from it hasnt changed.
People are having chest CTs for other reasons and they pick it up, or they have a carotid artery ultrasound and see it, Dr. Lieb says. But if these nodules hadnt been discovered, many of them wouldnt have caused a problem at all they are small, low-risk cancers.
Dr. Chen agrees. The fact that we are finding more and smaller cancers hasnt impacted the death rate, she says. So when we operate on people with small early-stage cancers, we may be doing unnecessary surgery with the potential for complications because all surgeries have risks. So we have someone who probably wouldnt die of thyroid cancer, but we have given them a lifelong problem with nerves, voice loss, and hypoparathyroidism . Its not good.