Patients And Data Collection
We queried our prospectively maintained database from a medical center to retrospectively review and identify eligible patients. All data collection and analysis were performed after the study was approved by the Institutional Review Board of MacKay Memorial Hospital , which waived the need for patient consent. All identifiable profiles of each patient were unlinked to protect the patients privacy. The inclusion criterion for this study was as follows: adult patients who underwent lobectomy or total thyroidectomy for differentiated thyroid cancer from 2001 to 2017. The exclusion criteria included the following: patients undergoing biopsy only, the index operation performed elsewhere, age younger than 20 years at diagnosis, second primary malignancy other than thyroid cancer, and short follow-up . Patient demographics, comorbidities, tumour histology, and laboratory and imaging results were obtained from inpatient, outpatient, and procedure records.
Age At Diagnosis Of Thyroid Cancer Can Predict Recurrence
This finding is not surprising, says Victor J. Bernet, MD, chair of the division of endocrinology and associate professor of medicine at Mayo Clinic College of Medicine in Jacksonville, Florida, as well as president-elect of the American Thyroid Association. He was not involved in the study but reviewed the findings for EndocrineWeb.
Age is already ”plugged in” when researchers and physicians are trying to determine how likely a patient is to survivewhat is your prognosisafter being treated for thyroid cancer, Dr. Bernet says. Therefore, ”it is not surprising that could use a parameter that predicts survival or death and would also predict recurrence.”
This matters because the thyroid gland produces hormones that help regulate metabolism, blood pressure, heart rate and body temperature.² About 52,000 people will learn they have thyroid cancer during this year alone, and about 2,100 will die of the disease,³ based on estimates from the American Cancer Society.
We also know that women are more likely than men to be diagnosed with differentiated thyroid cancer, and at an earlier age. Women are typically diagnosed in their 40’s and 50’s, while men who develop thyroid cancer are more often in their sixth and seventh decades of life. Other factors, including having overweight or obesity as well as genetics also increases the risk that youll face differentiated thyroid cancer.²
Thyroid Cancer Survival Rate
Most thyroid cancers are very curable. In fact, the most common types of thyroid cancer papillary and follicular cancers have a more than 98% cure rate if theyre caught and treated at an early stage. The earlier you are diagnosed, the less likely it is that your cancer will have spread beyond the thyroid and the easier it is to treat.
Medullary thyroid cancer has a worse prognosis and is likely to include lymph node involvement. Once cancer has entered the lymph nodes it spreads readily through the lymphatic system, meaning your cancer will require more extensive and possibly more aggressive treatment.
The least common type of thyroid cancer, anaplastic thyroid cancer, has a very poor prognosis. The best results occur when localized anaplastic thyroid cancer is diagnosed early and completely removed via a thyroidectomy, as its very aggressive. Unfortunately, this cancer tends to be found after it has already spread.
Because most people dont die from thyroid cancer, its sometimes called a good cancer to get even by some physicians. Almost everyone I take care of has heard that, Dr. Lieb says. But I take issue with it. Physicians can feel very bad telling people they have cancer, and rather than saying your prognosis is good, some downplay the diagnosis. But there isnt a good cancer.
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Living As A Thyroid Cancer Survivor
For many people with thyroid cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer growing or coming back. This is very common concern if you have had cancer.
For other people, thyroid cancer may never go away completely, or it might come back in another part of the body. These people may get regular treatments with chemotherapy, radiation therapy, or other therapies to help keep the cancer under control for as long as possible. Learning to live with cancer that does not go away can be difficult and very stressful.
When Does Metastatic Thyroid Cancer Show Symptoms
Metastatic thyroid cancer, also known as stage 4 thyroid cancer, refers to cancer that has spread from the thyroid gland to distant areas of the body. This is the most advanced stage of thyroid cancer. At this late stage, many symptoms are likely to be present. In fact, symptoms typically appear at an earlier stage and can often be detected before the thyroid cancer has metastasized.
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Will I Be Cared For Mainly By One Provider Or Will There Be Multiple Ones
Thyroid cancer care is a team sport. Dr. Lieb says you can expect to be cared for by many people during your cancer treatment, including your primary care physician, your endocrinologist, and your surgeon. There will also be pathologists and social workers. Depending on the type of thyroid cancer, you may also see a nuclear medicine team, vascular surgeon, voice specialist, and imaging professionals.
Symptom Clusters And Obesity Definition
Physical and psychological symptoms were recorded during the systematic review routinely used in medical history obtained at follow-up visits. These subjective symptoms were retrospectively derived from the hospital charts. Considering that multiple symptoms may offer higher clinical significance than individual symptoms, common symptoms were further classified into three symptom clusters. The pharyngolaryngeal cluster consisted of globus sensation, sore throat, sputum retention, frequent throat clearing or chronic cough, and voice change. The psychoneurological cluster consisted of palpitation, anxiety, sleep disturbance, fatigue, numbness, muscle twitches and spasms, cold sweats, dizziness, and headache. The gastrointestinal cluster consisted of body weight loss, weight gain, upset stomach, lack of appetite, and taste alterations. Each symptom was graded as present or absent irrespective of the frequency or duration of symptoms. A total symptom score was calculated by adding up all symptoms across the three clusters.
Patients body weight was recorded at initial diagnosis. The definition of obesity was based on the cutoff values suggested by the Ministry of Health and Welfare, Taiwan. Underweight was defined as BMI< 18.5kg/m2, overweight as BMI between 24 and 27kg/m2, and obesity as BMI27kg/m2.
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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.
How Do I Choose A Thyroid Surgeon
A high-volume surgeon is best. Whether you opt for a general, endocrine, or head and neck surgeon, you want to choose a provider who does a lot of these surgeries every year, says Dr. Lieb. Dr. Chen says a good volume to shoot for is 100 per year or more.
You can find directories of qualified surgeons at the American Association of Endocrine Surgeons or the American Academy of Otolaryngology Head and Neck Surgery.
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Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- The age of the patient at the time of diagnosis.
- The type of thyroid cancer.
- The stage of the cancer.
- Whether the cancer was completely removed by surgery.
- Whether the patient has multiple endocrine neoplasia type 2B .
- The patient’s general health.
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
How Is It Treated
If the cancer is very small, your doctor may suggest you just keep an eye on it with regular ultrasounds. When you do need treatment, it’ll likely go like this:
Surgery. In most cases, your doctor removes the entire thyroid, along with any lymph nodes that look to be problems.
If the cancer is small, you might choose to have only part of your thyroid removed. Even in this case though, many doctors think it’s better to take it out completely. It can make follow-up care work better and lower the chances that cancer comes back.
Radioactive iodine ablation. Surgery alone may cure the cancer, so not everyone needs this step. After the operation, your thyroid gets tested. The results will help you and your doctor decide if you might need RAI ablation to keep cancer from returning.
This is typically a one-time treatment where you take a pill with radioactive iodine. Any leftover thyroid cells take in the iodine, which then kills them. It doesn’t usually have side effects, since only thyroid cells soak it up.
You typically get RAI ablation if you had nodules bigger than 4 centimeters or if the cancer:
- Grows beyond the thyroid
- Moves into the lymph nodes
- Spreads to another part of your body
Thyroid hormone pills. You start taking these after surgery. It gives your body the thyroid hormones that you no longer make on your own, since your thyroid has been removed. You’ll typically take one pill a day for the rest of your life.
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Thyroid Cancer: How Age Affects Risk Of Recurrence
with Victor J. Bernet, MD, and Jonathon O. Russell, MD, FACS
So, you’ve been diagnosed with differentiated thyroid cancer and have had successful treatment. Thats great news. Yet, it would be well within reason, even expected, if you find yourself wonderingwhat is my risk of recurrenceat any point in the future?
Many factors influence the chance that you may experience a return or relapse of thyroid cancer. New data suggest that age alone appears to be an independent risk factor for predicting whether differentiated thyroid cancer, the most common kind, will reoccur,¹according to study findings published in the journal, Thyroid.
It seems that the older you are at the time of your , the greater your risk of recurrence may be. That said, its important to understand that its not definite that the thyroid cancer will return, just an increased likelihood. Other factors, such as the stage of the cancer at diagnosis, still play a roleand the stage at diagnosis may soften the effects of increasing age,¹the researchers report.
Thyroid Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Thyroid Gland
The thyroid is a gland at the base of the throat near the trachea . It is shaped like a butterfly, with a right lobe and a left lobe. The isthmus, a thin piece of tissue, connects the two lobes. A healthy thyroid is a little larger than a quarter. It usually cannot be felt through the skin.
The thyroid uses iodine, a mineral found in some foods and in iodized salt, to help make several hormones. Thyroid hormones do the following:
- Control heart rate, body temperature, and how quickly food is changed into energy .
- Control the amount of calcium in the blood.
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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.
External Beam Radiation Therapy
External beam radiation therapy uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread.
Most people diagnosed with thyroid cancer do not need EBRT, but it may be recommended in particular circumstances. In a small number of cases, it may be given:
- after surgery and RAI treatment if the cancer has not been completely removed or if there is a high risk of the cancer returning
- as palliative treatment to relieve symptoms such as pain caused by cancer that has spread to nearby tissue or structures
- to help control medullary or anaplastic thyroid cancer .
Radiation therapy is usually given 5 days a week over several weeks. You may be fitted for a plastic mask to wear during treatment, which will help you stay still so that the radiation is targeted at the same area of your neck during each session.
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Nucleic Acids And Transfection
The following plasmids and expression vectors were transfected into the above thyroid cancer cell lines using transfection reagent TransIT-LT1 at a ratio of 3 L to 1 g DNA in Opti-MEM I reduced serum medium : DICER1 , IMPDH2 , PFKFB4 WT FN1 , MET . Patient mutations were recapitulated using the Quick-Change II XL site directed mutagenesis kit . Cell lines were transfected with various small interfering RNAs using lipofectamine RNAiMAX . One mL of Opti-MEM I reduced serum medium was mixed with 6 µL lipofectamine RNAiMAX and allowed to stand for 5 minutes. Then siRNA was added to the Opti-MEM mix to final concentrations of 100nM. For miR transfection and knockdown, 6 L of lipofectamine RNAiMAX was added to 1 mL of Opti-MEM I reduced serum medium. The microRNA miR negative control mimic , miR-221-5p mimic , miR-486-5p inhibitor , or miR-1179 inhibitor was then added to a final concentration of 100nM. Transfection and knockdown were confirmed with microRNA real time quantitative PCR .
Value And Rationale For C
With the current practice of intense postoperative surveillance searching for even miniscule disease, the efforts to achieve thorough lymph node dissection are worth serious consideration. Because therapeutic lymph node dissection is virtually unanimously supported, the focus of debate has revolved around what is termed prophylactic dissectionremoving nodes even when not grossly abnormal in the judgment of the surgeon. Also, until recently, few in Western countries have supported lateral jugular lymph node dissection . Therefore, C-VI prophylactic node dissection has attracted considerable attention and investigation. The reasons to undertake routine C-VI lymph node dissection include:
- Preoperative US in the initial cervical exploration is nearly blind to the detection of LNM in C-VI
- Surgeons cannot reliably differentiate innocent from LNM in many cases
- LNMs occur in up to 50% of patients operated on for PTC
- Missed LNM are typically found along the recurrent laryngeal nerve in the trachea-esophageal groove, a potentially dangerous location if reoperation becomes necessary
- Dissection would logically lead to reductions in relapse and consequently reoperation
- C-VI dissection can be accomplished safely, although this is a major statement of contention
- Disease staging could be changed for patients over 45 years, from stage I to stage III, with potential for additional treatment implications
- RAI is unreliably effective in cleaning up residual macroscopic LNM.
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What Are The Symptoms
Often, you won’t have any. You might only find out about it because of an imaging test for another problem. Or, during a routine physical exam, your doctor might just happen to feel a lump, called a nodule, on your thyroid.
Nodules are growths that may be solid or filled with fluid. They’re very common and often don’t cause any trouble. But about 1 in 20 are cancer.
As a nodule gets bigger, you may start to have symptoms like:
- Lump in your neck that you can see or feel
- Hard time swallowing
- Sore throat or hoarseness that doesn’t go away
- Swollen lymph nodes in your neck
- Trouble breathing, especially when you lie down
Doctors aren’t sure. It’s most common in women under age 40.
You may have a higher chance of getting papillary thyroid carcinoma because of things like:
Certain genetic conditions. Diseases like familial adenomatous polyposis , Gardner syndrome, and Cowden disease can raise your odds.
Family history. In a small number of cases, papillary thyroid carcinoma runs in the family.
Radiation therapy. If you had radiation to treat cancer for another condition when you were a child, it can raise your chances.
Gender. It’s much more common in women than men, but doctors aren’t sure why.