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.
How Is Thyroid Cancer Managed Or Treated
Treatments for thyroid cancer depend on the tumor size and whether the cancer has spread. Treatments include:
- Surgery: Surgery is the most common treatment for thyroid cancer. Depending on the tumorâs size and location, a surgeon may remove part of your thyroid gland or all of the gland . The surgeon also removes any nearby lymph nodes where cancer cells have spread.
- Radioiodine therapy: With radioiodine therapy, you swallow a pill or liquid containing a higher dose of radioactive iodine than whatâs used in a diagnostic radioiodine scan. The radioiodine shrinks and destroys the diseased thyroid gland along with cancer cells. This treatment is very safe. Your thyroid gland absorbs almost all of the radioiodine and the rest of your body has minimal radiation exposure.
- Radiation therapy: Radiation kills cancer cells and stops them from growing. External radiation therapy uses a machine to deliver strong beams of energy directly to the tumor site. Internal radiation therapy involves placing radioactive seeds in or around the tumor.
- Chemotherapy: Intravenous or oral chemotherapy drugs kill cancer cells and stops cancer growth. Very few people diagnosed with thyroid cancer will ever need chemotherapy.
- Hormone therapy: This treatment blocks the release of hormones that can cause cancer to spread or come back.
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Different Kinds Of Thyroid Cancer
There are 4 main types of thyroid cancer. They are listed below. Your doctor can tell you more about the kind you have.
- Papillary thyroid cancer is the most common kind of thyroid cancer. It may also be called differentiated thyroid cancer. This kind tends to grow very slowly and is most often in only one lobe of the thyroid gland. Even though they grow slowly, papillary cancers often spread to the lymph nodes in the neck.
- Follicular cancer is the next most common type. Its more common in countries where people dont get enough iodine in their diet. These cancers do not tend to spread to lymph nodes, but they can spread to other parts of the body, like the lungs or bones.
- Medullary cancer is a rare type of thyroid cancer. It starts in a group of thyroid cells called C-cells. C-cells make calcitonin, a hormone that helps control the amount of calcium in the blood.
- Anaplastic cancer is a rare type of thyroid cancer. It often spreads quickly into the neck and to other parts of the body, and is very hard to treat.
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Tests That May Be Done
Blood tests: Blood tests alone cant tell if a thyroid lump is cancer. But they can help show if the thyroid is working the way it should.
Ultrasound: For this test, a small wand is moved over the skin in front of your neck. It gives off sound waves and picks up the echoes as they bounce off the thyroid gland. The echoes are made into a picture on a computer screen. How a lump looks on ultrasound can sometimes help tell if its cancer, but ultrasound cant tell for sure.
Radioiodine scan: For this test, a low dose of radioactive iodine is swallowed or put into a vein. Over time, the iodine is absorbed by the thyroid gland. A special camera is then used to see the radioactivity. Nodules that have less iodine than the rest of the thyroid can sometimes be cancer.
CT or CAT scan: Its a special kind of x-ray that takes detailed pictures of the thyroid and can show if the cancer has spread.
MRI scan: This test uses radio waves and strong magnets instead of x-rays to take pictures. MRI scans can be used to look for cancer in the thyroid, or cancer that has spread.
PET scan: In this test, you are given a special type of sugar that can be seen inside your body with a camera. If there is cancer, this sugar shows up as hot spots where the cancer is found. This test can be very useful if your thyroid cancer is one that doesnt take up radioactive iodine.
Thyroid biopsy
If the diagnosis is not clear after an FNA biopsy, you might need another kind of biopsy to get more cells to test.
Conditions That May Lead You To Believe You Have Thyroid Cancer
When discussing thyroid cancer its important to discuss conditions that may lead you to believe you have thyroid cancer and may prompt a search into this disease.
The conditions listed below result in physical changes to the thyroid gland which can be felt both from a symptomatic standpoint but also from a physical and anatomical standpoint.
Thyroid Nodules
The first of the conditions that may cause a thyroid cancer scare is a thyroid nodule.
Thyroid nodules are actually incredibly common with estimates that up to 7% of the entire Worlds population may have a thyroid nodule.
So what is a thyroid nodule?
A thyroid nodule is really just a mass or growth on your thyroid gland.
The vast majority of the time these nodules are considered benign .
But if you feel an irregularity or bump on your thyroid gland it will obviously cause some distress.
Take comfort in knowing that most thyroid nodules are not thyroid cancer, but some thyroid cancers may arise from thyroid nodules.
Depending on the size, and certain characteristics, your doctor may also order a biopsy to rule out thyroid cancer.
Goiter
A thyroid goiter is another condition that may result in you believing you have thyroid cancer.
The term goiter is actually a very non-specific term and it really means an enlargement of the thyroid gland.
The problem with this term is that it doesnt say anything about the cause!
It just means an enlargement of the thyroid gland. Period.
Dont let this be your number 1 concern.
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Which Cancers Have Recommended Screenings And How Well Do They Work
Currently, there are four types of cancers that have recommended screenings from the U.S. Preventive Services Task Force : breast, cervical, colorectal and lung cancers. The NORC report says that as of 2017, these four cancers made up 29% of all cancer cases and 25% of all cancer deaths in the U.S.
The study researchers found that the percent of cancers detected via screening varies depending on the type of cancer: 61% of breast cancers 52% of cervical cancers 45% of colon cancers and 3% of lung cancers.
While prostate cancer screening is not widely recommended by USPSTF, the report included data on it. It showed that 77% of prostate cancers were spotted by the relevant cancer screening.
The fact that only a handful of cancers have a recommended screening test means that about 57% of all diagnosed cancers currently do not have a recommended screening test, according to NORCs estimate. The research team reports that these diseases are typically found in patients with later-stage cancers that are more difficult to treat. In total, these diagnoses account for 70% of cancer-related deaths, NORC says.
Theres a lot of cancers that we dont routinely screen for theyre rare enough, Scott said. Those cancers are cancers that we dont have a screening test for, or a good diagnostic screening test for.
Thyroid Nodules Are Common But Usually Are Not Cancer
Your doctor may find a lump in your thyroid during a routine medical exam. A thyroid nodule is an abnormal growth of thyroid cells in the thyroid. Nodules may be solid or fluid-filled.
When a thyroid nodule is found, an ultrasound of the thyroid and a fine-needle aspiration biopsy are often done to check for signs of cancer. Blood tests to check thyroid hormone levels and for antithyroid antibodies in the blood may also be done to check for other types of thyroid disease.
Thyroid nodules usually don’t cause symptoms or need treatment. Sometimes the thyroid nodules become large enough that it is hard to swallow or breathe and more tests and treatment are needed. Only a small number of thyroid nodules are diagnosed as cancer.
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The Johns Hopkins Thyroid And Parathyroid Center
Our experts provide patients with a personalized treatment plan, tailored to your unique condition and your personal needs. You will benefit from our team of experts, who are at the forefront of diagnosing and treating patients with a variety of thyroid and parathyroid conditions including tumors, nodules and hyperparathyroidism.
What To Do If You Suspect You Have Thyroid Cancer
So what do you do if you suspect that you have thyroid cancer or if you have any of the symptoms we discussed above?
The first step is to make an appointment with your Doctor and to determine what the actual cause is.
In most cases this visit will include the following:
- Complete history and physical exam including thyroid exam, family history, and history of radiation exposure
- Other blood tests such as inflammatory markers
These basic tests will provide significant information on your condition and may help guide further treatment and management.
If a thyroid nodule is found your doctor may also order a fine needle aspiration of the tissue and examine the tissue for thyroid cancer.
For most conditions it may be appropriate for your Doctor to simply monitor your condition and re-evaluate for changes with further imaging studies.
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What Will Happen After Treatment
Most people do very well after treatment, but you may need follow-up care for the rest of your life. This is because most thyroid cancers grow slowly and can come back even 10 to 20 years after treatment. Your cancer care team will tell you what tests you need and how often they should be done.
Be sure to go to all of these follow-up visits. You will have exams, blood tests, and maybe other tests to see if the cancer has come back. At first, your visits may be every 3 to 6 months. Then, the longer youre cancer-free, the less often the visits are needed.
Sometimes treatments may not cure your cancer. You many need to keep getting treatment and care. From time to time tests will be done to see how your treatment is working.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life.
What Is The Follow
Periodic follow-up examinations are essential for all patients with thyroid cancer, because the thyroid cancer can returnsometimes several years after successful initial treatment. These follow-up visits include a careful history and physical examination, with particular attention to the neck area. Neck ultrasound is an important tool to view the neck and look for nodules, lumps or cancerous lymph nodes that might indicate the cancer has returned. Blood tests are also important for thyroid cancer patients. Most patients who have had a thyroidectomy for cancer require thyroid hormone replacement with levothyroxine once the thyroid is removed . The dose of levothyroxine prescribed by your doctor will in part be determined by the initial extent of your thyroid cancer. More advanced cancers usually require higher doses of levothyroxine to suppress TSH . In cases of minimal or very low risk thyroid cancer, it is typically recommended to keep TSH in the normal range. The TSH level is a good indicator of whether the levothyroxine dose is correct and should be followed periodically by your doctor.
In addition to routine blood tests, your doctor may want to check a whole-body iodine scan to determine if any thyroid cancer cells remain. These scans are only done for high risk patients and have been largely replaced by routine neck ultrasound and thyroglobulin measurements that are more accurate to detect cancer recurrence, especially when done together.
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What Is The Treatment For Thyroid Cancer
Radioactive iodine therapy . Thyroid cells and most differentiated thyroid cancers absorb iodine so radioactive iodine can be used to eliminate all remaining normal thyroid tissue and potentially destroy residual cancerous thyroid tissue after thyroidectomy . The procedure to eliminate residual thyroid tissue is called radioactive iodine ablation. Since most other tissues in the body do not efficiently absorb or concentrate iodine, radioactive iodine used during the ablation procedure usually has little or no effect on tissues outside of the thyroid. However, in some patients who receive larger doses of radioactive iodine for treatment of thyroid cancer metastases, radioactive iodine can affect the glands that produce saliva and result in a dry mouth. If higher doses of radioactive iodine are necessary, there may also be a small risk of developing other cancers later in life. This risk is very small, and increases as the dose of radioactive iodine increases. The potential risks of treatment can be minimized by using the smallest dose possible. Balancing potential risks against the benefits of radioactive iodine therapy is an important discussion that you should have with your doctor if radioactive iodine therapy is recommended.
If your doctor recommends radioactive iodine therapy, your TSH level will need to be elevated prior to the treatment. This can be done in one of two ways.
Tests For Thyroid Cancer
Your doctor may do some tests to check for thyroid cancer:
- Ultrasound to get detailed information about your thyroid including the size of any thyroid nodule and whether it is full of fluid or solid.
- Blood tests to check your hormone levels and function of the thyroid. Calcitonin levels may also be checked.
- Biopsy if you have a thyroid nodule or enlarged lymph node in your neck, you may need a fine needle aspiration biopsy, to collect a sample of cells and check whether it is cancerous.
Your doctor might ask you to have further tests. These can include:
- CT scans uses x-rays to take pictures of the inside of your body and then compiles them into one detailed, cross-sectional picture.
- PET scans uses an injection of a glucose solution to help cancer cells show up more brightly on the scan.
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When To See A Healthcare Provider
If you feel a new swelling or lump in your neck, or if an imaging test incidentally reveals a thyroid growth, it’s important to schedule an appointment with your healthcare provider right away.
During your appointment, your healthcare provider will:
- Perform a physical examination, including a neck examination
- Order an ultrasound of your thyroid
- Check blood tests that may include a thyroid-stimulating hormone , free thyroxine , and thyroid antibodies
Depending on the results of these tests, your primary care or family healthcare provider may refer you to a healthcare provider who specializes in thyroid care . An endocrinologist may take another look at the thyroid nodule with ultrasound in his or her office and perform a fine-needle aspiration biopsy to see whether cancer cells are present.
Thyroid Cancer Healthcare Provider Discussion Guide
Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.
The diagnosis of thyroid cancer has been on the rise both in the United States and worldwide, due in large part to the sophistication of high-resolution imaging tests. In other words, these thyroid nodules that would never have been found years ago are now being identified.
While the majority of these small nodules end up not being cancer, determining which ones are is keyâthis is because most thyroid cancers are curable, especially those that are small and have not spread.
Signs And Symptoms Of Advanced Medullary Thyroid Cancer
5 percent of thyroid cancer diagnoses. Detecting the cancer early can be difficult.
Medullary thyroid cancer commonly advances from the thyroid into the lymph nodes. Undiagnosed medullary thyroid cancer can spread into other neck tissues and eventually reach the liver, lungs, bone, and brain. Once it reaches distant parts of the body its unlikely to be cured.
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Side Effects Of Thyroid Surgery
The risks of thyroid surgery include:
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Damage to the laryngeal nerve. It can be stunned, or one vocal cord wont move the same way as the other, Dr. Harari explains. About 5% of people temporarily experience this complication, and 1% have permanent damage. There are procedures to regain vocal strength, and an ENT specialist can assist the patient in these efforts.
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Hypoparathyroidism, or, as sometimes surgeons decide to remove one or more of the parathyroid glands four tiny glands that regulate the bodys calcium levels and are located near the back of the thyroid. People whose thyroid surgery involves a central neck incision have a 10% risk of parathyroid complications.
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Vagus nerve issues. Lateral neck incisions can risk impacting the vagus nerve, Dr. Harari says. This can have effects on the voice as well as the shoulder or tongue.
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Loss of thyroid function. After surgery, you will probably need to take pills for the rest of your life to replace lost thyroid hormones. If your parathyroid glands are also removed, you may also need to take calcium and vitamin D.
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