What Is The Thyroid
The thyroid gland is located in front of the neck. It looks sort of like a butterfly with one wing on each side of the neck. The thyroid is important in many ways for keeping your body healthy. It sends out certain chemicals that help control many activities in the body, such as breathing and pumping blood. The thyroid helps childrens bodies develop as they grow up, including getting taller and putting on muscle. It helps control weight and is also involved in other functions.
How Is Thyroid Cancer Diagnosed In Children
The first step in treating a child with thyroid cancer is forming an accurate and complete diagnosis. In addition to a medical history and physical exam, a physician may order a number of different tests to diagnose thyroid cancer and determine whether it has spread.
- Blood tests are used determine if the thyroid is working properly.
- Ultrasound is the best imaging technique to visualize a known or suspected thyroid nodule. Ultrasound uses sound waves to assess the location and characteristics of nodules in the thyroid gland. Because ultrasound uses only sound waves, it does not expose the patient to any harmful radiation.
- Fine-needle aspiration uses a very thin needle to take a sample of a thyroid nodule and/or lymph nodes to gather information about whether the thyroid nodule may be a thyroid cancer.
- Surgery is sometimes needed to determine whether a thyroid nodule is a thyroid cancer, if the result of fine-needle aspiration is not definitive.
- Computerized tomography scan is sometimes needed to take detailed images of the neck or chest, to help determine what surgery or other treatments are needed.
- Genetic testing is useful in many cases to determine whether a thyroid cancer may be part of an underlying genetic condition.
Prophylactic Thyroidectomy In Patients With Men 2a And Men 2b
MTC is the most common cause of mortality in patients with MEN 2A and MEN 2B, and many patients who inherit these syndromes develop MTC in the first decade of life. Therefore, prophylactic thyroidectomy and central-compartment lymph-node dissection is being performed in children with these syndromes. Surgery is offered to patients when the diagnosis is made on the basis of RET mutational analysis. Children with RET mutations whose parents decline surgery should be monitored with annual measurement of calcitonin levels. Thyroidectomy is performed when results are abnormal.
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What Are Follicular Thyroid Cancer And Hurthle Cell Carcinoma
Follicular thyroid cancer makes up about 10% of all cases of thyroid cancer.
Follicular thyroid cancer does not often spread to the lymph nodes, but it can spread to other organs, like the liver, lungs, bones, and brain.
Hurthle cell carcinoma is a form of follicular thyroid cancer, and accounts for 3% of all thyroid cancer cases. It is more likely to spread to lymph nodes than follicular thyroid cancer.
Evaluation And Management Of The Solitary Thyroid Nodule
The key to the workup of the solitary thyroid nodule is to differentiate malignant from benign disease and, thus, to determine which patients require intervention and which patients may be monitored serially. History taking, physical examination, laboratory evaluation, and fine-needle aspiration biopsy are the mainstays in the evaluation of thyroid nodules. Imaging studies can be adjuncts in select cases.
A 2015 consensus statement from the American Thyroid Association on preoperative imaging for thyroid cancer surgery stated the following :
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What To Do If You Notice Signs Of Thyroid Cancer
If you experience signs of thyroid cancer, its important to consult with your doctor to get an accurate diagnosis.
First, your doctor may conduct a physical examination, manually palpating your neck and throat to check for abnormal growths or areas of swelling, including the thyroid and lymph nodes. Your doctor may also gather your personal and family medical history, ask about your symptoms and risk factors, including any inherited genetic mutations.
A blood test called a tumor marker test may be recommended to check for high levels of certain hormones, such as:
- Triiodothyronine
- Thyroid-stimulating hormone
If cancer is suspected, one or more of the following diagnostic tests may be ordered:
Ultrasound. An ultrasound over the neck region may be done to locate any nodules that are present on your thyroid and determine whether theyre made up of solid or liquid material.
Chest X-ray: This basic imaging test may be done if your doctor suspects the cancer has metastasized to your lungs.
Magnetic resonance imaging scan: Using magnets, an MRI scan creates highly detailed images of the thyroid and surrounding areas.
Computed tomography scan or positron emission tomography scan: A CT scan uses contrast dye that helps your doctor pinpoint the size and location of your cancer, and whether it has metastasized to surrounding tissues. A PET scan is similar but uses an injection of radioactive sugar instead of contrast dye .
Expert cancer care
What Causes Thyroid Cancer
Thyroid cancer forms in the tissue of gland located at the front of the throat, below the cartilage known as the Adams apple. A relatively rare disease, thyroid cancer accounts for about 3 percent of all new cancer cases.
Although cancer research has not identified the exact cause of thyroid cancer, certain risk factors may increase an individuals chance of developing the disease.
Factors increasing the risk of thyroid cancer may include:
- Inherited genetic conditions, such as a mutation of the RET gene, familial adenomatous polyposis , Gardner syndrome, Cowden disease and Carney complex type 1
- Family history of thyroid cancer in a parent or sibling
- Low-iodine diet
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What Is The Prognosis For People Who Have Thyroid Cancer
Eight out of 10 people who have thyroid cancer develop the papillary type. Papillary thyroid cancer has a five-year survival rate of almost 100% when the cancer is in the gland . Even when the cancer spreads , the survival rate is close to 80%. This rate means that, on average, youre about 80% as likely to live for at least five years after diagnosis as someone who doesnt have metastatic papillary thyroid cancer.
Five-year survival rates for other thyroid cancer types include:
- Follicular: Close to 100% for localized around 63% for metastasized.
- Medullary: Close to 100% for localized around 40% for metastasized.
- Anaplastic: Close to 31% for localized 4% for metastasized.
Management Of Thyroid Cancer
Malignant diagnoses require surgical intervention. Papillary thyroid carcinoma and medullary thyroid carcinoma are often positively identified on the basis of FNAB results alone. Cervical metastases discovered preoperatively or intraoperatively should be removed by means of en bloc lymphatic dissection of the respective cervical compartment while sparing the nonlymphatic structures.
Well-differentiated neoplasms
Patients with follicular neoplasm, as determined with FNAB results, should undergo surgery for thyroid lobectomy for tissue diagnosis. The extent of surgical therapy for well-differentiated neoplasms is controversial. Primary treatment for papillary and follicular carcinoma is surgical excision whenever possible. Total thyroidectomy has been the mainstay for treating well-differentiated thyroid carcinoma. Modifications to total thyroidectomy include subtotal thyroidectomy to reduce the risk of recurrent laryngeal nerve injury and hypoparathyroidism.
A 2015 consensus statement from the American Thyroid Association on the management of patients with differentiated thyroid cancer who have recurrent/persistent nodal disease stated the following :
Hürthle cell carcinomas
Medullary thyroid carcinomas and familialmedullary thyroid carcinomas
Anaplastic thyroid carcinoma, primary thyroid lymphoma, thyroid sarcoma
The treatment for thyroid sarcomas is total thyroidectomy. Radiation therapy may be used in an adjunctive setting.
Postsurgical management
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Are There Complementary Therapies I Can Try
While there are no great studies showing that complementary and alternative medicine can cure or treat thyroid cancer, you might find some of them helpful for relieving stress, such as aromatherapy or massage therapy.
Ask your doctor before taking any herbal supplements, and if you are already taking some, be sure to let your provider know what and how much, as some herbs can impact thyroid function or interfere with medications.
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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Classification Of Cytology And Staging Of Thyroid Cancer
The classification of cytology is based on the microscopic appearance of the cells obtained during a FNA. The so-called Bethesda system includes six classes . The Bethesda classification is used to assess the risk of malignancy in a thyroid nodule with higher Bethesda classifications being more suspicious for cancer.
The staging of a thyroid cancer is used to help decide best treatment and estimate the prognosis. The most commonly used staging is the TNM system based on the size of the tumor , the absence or presence of lymph node metastases and distant metastases . Thyroid cancers are staged from I to IV, with the higher stages representing more advanced cancers requiring more aggressive treatment.
Importantly, the cancer staging requires that tissue is examined . Staging of the cancer therefore is typically not performed until after surgery has been performed.
For more information on these topics, see Chapter 3: Doctors, tests, and classifications and Chapter 5: Thyroid Cancer in Thyroid Cancer and Thyroid Nodules In 30 Minutes.
Papillary Cancer And Its Variants
Most cancers are treated with removal of the thyroid gland , although small tumors that have not spread outside the thyroid gland may be treated by just removing the side of the thyroid containing the tumor . If lymph nodes are enlarged or show signs of cancer spread, they will be removed as well.
In addition, recent studies have suggested that people with micro-papillary cancers may safely choose to be watched closely with routine ultrasounds rather than have immediate surgery.
Even if the lymph nodes arent enlarged, some doctors recommend central compartment neck dissection along with removal of the thyroid. Although this operation has not been shown to improve cancer survival, it might lower the risk of cancer coming back in the neck area. Because removing the lymph nodes allows them to be checked for cancer, this surgery also makes it easier to accurately stage the cancer. If cancer has spread to other neck lymph nodes, a modified radical neck dissection is often done.
Treatment after surgery depends on the stage of the cancer:
People who have had a thyroidectomy will need to take daily thyroid hormone pills. If RAI treatment is planned, the start of thyroid hormone therapy may be delayed until the treatment is finished .
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Looking For More Of An Introduction
If you would like more of an introduction, explore this related item. Please note that this link will take you to another section on Cancer.Net:
- ASCO Answers Fact Sheet:Read a 1-page fact sheet that offers an introduction to thyroid cancer. This free fact sheet is available as a PDF, so it is easy to print.
Thenext section in this guide is Statistics. It helps explain the number of people who are diagnosed with thyroid cancer and general survival rates. Use the menu to choose a different section to read in this guide.
What Are The Symptoms Of Thyroid Cancer
Thyroid cancer often presents as a lump or nodule in the thyroid and usually does not cause any other symptoms . Blood tests generally do not help to find thyroid cancer and thyroid blood tests such as TSH are usually normal, even when a cancer is present. Neck examination by your doctor is a common way in which thyroid nodules and thyroid cancer are found. Often, thyroid nodules are discovered incidentally on imaging tests like CT scans and neck ultrasounds done for completely unrelated reasons. You may have found a thyroid nodule by noticing a lump in your neck while looking in a mirror, buttoning your collar, or fastening a necklace. Rarely, thyroid cancers and nodules may cause symptoms. You may complain of pain in the neck, jaw, or ear. If a nodule is large enough to compress your windpipe or esophagus, it may cause difficulty with breathing, swallowing, or cause a tickle in the throat sensation. Even less commonly, you may develop hoarseness if a thyroid cancer invades the nerve that controls your vocal cords.
Cancers arising in thyroid nodules generally do not cause symptoms, and thyroid function tests are typically normal even when you have cancer. The best way to find a thyroid nodule is to make sure that your doctor examines your neck as part of your periodic check-up.
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How Is Thyroid Cancer Treated
Treatment usually involves surgery to remove all or part of the thyroid gland. This is performed under general anesthesia with a small incision in the lower neck in most cases. Some select patients with cancer may qualify for trans-oral endoscopic removal. In appropriate cases, lymph nodes are also removed from the neck.
The decision about how much thyroid should be removed is based on several factors that you should discuss with your doctor, including the size of the nodule, your age and gender, and the type of cancer. Most thyroidectomies are accomplished without affecting surrounding structures and function, either as an outpatient visit or with an overnight stay.
After surgery, thyroid hormone may be prescribed to keep the bodyâs functions in balance. In select cases, additional treatments such as radioactive iodine may be given at an interval after surgery. Standard radiotherapy and chemotherapy are infrequently used. Innovative approaches involving immunotherapy, a treatment that uses the bodyâs immune system to identify and fight the cancer cells, and targeted chemotherapy, which uses medicines to turn off the cancer cellsâ ability to grow and spread, may be recommended in some cases.
Considering Complementary And Alternative Methods
You may hear about alternative or complementary methods that your doctor hasnt mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.
Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctors medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.
Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known about the method, which can help you make an informed decision.
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Help Getting Through Cancer Treatment
People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.
Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.
Different types of programs and support services may be helpful, and can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.
The American Cancer Society also has programs and services including rides to treatment, lodging, and more to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.
Thyroid Hormone Replacement Therapy
Thyroid hormone replacement therapy is often prescribed after thyroid surgery to replace the hormones that are no longer being produced by your thyroid tissue. Depending on how much of your thyroid was taken out, you may have to take the medication most commonly levothyroxine for the rest of your life.
Thyroid hormone replacement can also help prevent the growth or recurrence of thyroid cancer. It does this by lowering your circulating level of the hormone TSH, which is secreted by your brains pituitary gland and tells your thyroid to make more thyroid hormone. High TSH levels can stimulate the growth of thyroid cancer cells. Higher doses of replacement thyroid hormone tell your body to make less TSH, slowing the growth of any thyroid cancer cells and lowering the odds of your cancer coming back.
It can take a few adjustments to find the correct dosage of thyroid hormone replacement. During this time, you may need to see the doctor every 6 to 8 weeks for a blood draw to determine if your levels are optimal.
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