Thyroid Cancer

Early thyroid cancer often has no symptoms and may be discovered at an annual physical exam.

As the mass grows, you may experience one of more of these symptoms:

• Neck swelling
• Nodule on the thyroid
• Neck pain
• Trouble with breathing and swallowing
• Hoarse voice
• Chronic cough
• Pressure feeling on the trachea

Any of these symptoms could also be caused be a mass on the thyroid that is benign, so you should see your doctor right away for evaluation. Early diagnosis and treatment of thyroid cancer is crucial to prevent it from spreading.

There are several types of thyroid cancer including: Papillary, which is the most common form of thyroid cancer; Follicular, which is most common in adults over 50 years of age; medullary, which occurs in roughly 3% to 4% of all cases. There are also several other rare forms, including anaplastic and thyroid lymphoma.

Thyroid cancer is staged by type since the affected cells tend to act differently.

Papillary and Follicular

Stage I. Any size mass on the thyroid. May involve tissues around the thyroid and lymph nodes close to the thyroid. No spread of cancer past the thyroid area.

Stage II. Any size mass that involves the thyroid but is also found outside the thyroid area. It also involves lymph nodes and may be found in the lungs and/or bone.

Stage III. Mass larger than 4 centimeters in the thyroid and cancer cells are found outside the thyroid. It may also be found in the lymph nodes near the voice box.

Stage IV. Cancer is found in the trachea, voice box, lymph nodes, and esophagus. Stage IVB it is found in the spinal column and blood vessels that supply the lungs. It may or may not be found in the lymph nodes. In Stage IVC it is found in the lungs, bones, and lymph nodes.

Medullary

Stage 0. No tumor on the thyroid, but positive blood test.

Stage I. Nodule that is 2 centimeters or smaller.

Stage II. Nodule that is 2 centimeters or larger on the thyroid gland. May be in tissues around the thyroid but is not found in the lymph nodes.

Stage III. Any size mass found in lymph nodes around the voice box and trachea and possibly in tissues around the thyroid.

Stage IV. Any size mass found outside the thyroid, in the trachea, voice box, and esophagus. Cancer is also found in nearby lymph nodes. Stage IVB it is found in the spinal column, blood vessels that supply the lungs, and lymph nodes. Stage IVC cancer is found in lymph nodes, bones, and lungs.

Anaplastic

This cancer spreads very quickly and is classified as:

Stage IVA. Found in the actual thyroid gland and lymph nodes.

Stage IVB. Spread outside the thyroid gland and lymph nodes.

Stage IVC. Spread throughout the body, lymph nodes, lungs, and bones.

Cells in the thyroid begin to change and grow too fast. They do not die and slough off like normal cells, and instead form masses on the gland. These abnormal cells can grow into the nearby lymph nodes and spread throughout the body.

There are several factors which may increase your risk of thyroid cancer. Simply having a risk factor does not mean you will get thyroid cancer; however, it is important to have your thyroid checked at each yearly physical if any of the following apply:

Gender. Thyroid cancer is three times more common in women.

Age. The risk for thyroid cancer is highest among women between 40 and 50 years of age, and men between 60 and 70 years of age.

Low iodine intake. There tend to be more cases of thyroid cancer in areas where people do not get enough iodine in their diets. People in the United States are at less risk if they eat iodized table salt.

Exposure to radiation. Exposure to radiation from medical treatments can increase risk of thyroid cancer.

Family History. A family history of medullary thyroid cancer can increase the chances of thyroid cancer. People with colon polyps are at increased risk for papillary thyroid cancer. This is due to a familial syndrome known as, familial adenomatous polyposis.

If you have a thyroid nodule and any of the symptoms listed above, see your doctor right away. They will take a medical and family history and perform a physical exam. The doctor will check your neck and feel your thyroid while you swallow. Your thyroid and lymph nodes in the area will be checked. But do not panic! Less than 1 in 10 thyroid nodules are cancerous.

To determine the condition of your tumor, your doctor may order one or more of the following tests:

Blood work

• Thyroid stimulating hormone (TSH) to check if your hormones are high/low
• Calcitonin levels
• Calcium levels

Note: High or low thyroid hormones are not an indication of thyroid cancer but can give your doctor an idea how your thyroid is working and if the nodule is caused by something else.

Scans

• Thyroid scan – Radioactive dye is given. Specialists will determine how much dye the nodule absorbs (a nodule that is cold may need a biopsy. Hot nodules are normal.)
• Ultrasound – Ultrasound with doppler flow can check to see if nodules are normal or abnormal

Biopsy

• Fine needle aspiration (FNA) – The doctor will give you something to numb your throat and use a fine needle to aspirate some of the fluid from the nodule. The fluid is evaluated by a pathologist. If they cannot determine if you have thyroid cancer, the doctor may opt to “watch and wait”, checking the nodule every few months for changes.
• Lobectomy – If the aspirated fluid is suspicious the doctor may opt to take out one half of the gland and do a full biopsy. The only way to biopsy the actual tissue in the thyroid is to remove part of the gland or the whole gland.

Your treatment plan will be decided by you and your treatment team according to your individual needs. Possible treatments include:

• Thyroidectomy or partial thyroidectomy (lobectomy) to remove affected lymph nodes
• Additional surgery to remove cancer from areas it has spread to
• Lymph node removal to prevent the cancer from spreading to other areas
• Possible radioactive iodine treatment to shrink tumors that show iodine uptake
• Thyroid hormone therapy to suppress the gland and stall cancer growth
• Radiation iodine treatment
• Chemotherapy to kill off cancer cells throughout the body
• Tracheostomy is needed in some cases to relieve symptoms

With thyroid cancer, no alternative medicine has been found to cure the disease. These remedies may help relieve symptoms and improve the immune system to help fight the cancer in conjunction with medical treatments. These include:

Mind/body techniques. Meditation, reiki, healing touch.

Support groups. Cancer support groups can help you share your feelings with others.

Spirituality and faith. Connecting spiritually can help you feel stronger emotionally.

Exercise. Yoga, walking, swimming with your doctor’s permission can increase your energy.

Dietary changes. Increase fruits and vegetables. Drink at least one to two cups of green tea daily. With your doctor’s okay, increase foods with Omega-3 fatty acids (i.e. salmon, walnuts, flax).

Take vitamins. Take a good multivitamin that contains antioxidants (e.g., vitamin C).

Try asian mushrooms. Maitake, shitake, and agaricus may boost the immune system to help fight cancer cells.

Radioactive iodine and women. Women with thyroid cancer of childbearing age need to use birth control after treatment with radioactive iodine. Treatment may affect the ovaries and cause irregular periods for up to a year.

Manage side effects. Radioactive iodine can cause neck pain, stomach upset, dry mouth, nausea, and salivary gland pain. Eating hard candy can help with oral side effects.

Manage fatigue. After thyroidectomy, your doctor will not start full thyroid hormone replacement until radioactive iodine treatment is complete. They will give you a special thyroid hormone and you may feel more tired than usual. During this phase of treatment, pace your activities and sleep when you need too. They symptoms of hypothyroidism may include weight gain, feeling very tired, weakness, trouble remembering or thinking, depression, and constipation.

Protect others from radiation. For the first 24 hours after you are treated with radioactive iodine, do not go out in public or get too close to members of your family. Make sure if you are male, sit down to urinate because your urine contains high levels of radiation. Any splashed urine can transmit radiation to others.

Low iodine diet. Your doctor will ask you to follow a low-iodine diet. This includes avoiding seaweed, iodized salt, seafood, dairy and eggs, Red Dye #3, chocolate, soybean and soy products, and multivitamins. This is to help prepare the cells in the body to need iodine, so they take up the radioactive iodine better.

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Andrew Weil, M. (2015, August 9). Condition Care Guide. Retrieved from Dr. Weil: https://www.drweil.com/drw/u/ART03194/Thyroid-Cancer-Dr-Weil.html

Arnold L. Goodman MD, F. (2014, October 28). Thyroid cancer diagnosis. Retrieved from Endocrine Web: https://www.endocrineweb.com/guides/thyroid-cancer/thyroid-cancer-diagnosis

Mayo Clinic. (2014, April 14). Causes of Thyroid Cancer. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/thyroid-cancer/basics/causes/con-20043551

National Cancer Institute. (2015, June 17). Thyroid cancer treatment options by stage. Retrieved from National Cancer Institute: https://www.cancer.gov/types/thyroid/patient/thyroid-treatment-pdq#section/_93

Thyroid Cancer Survivors Association. (2015, May 12). Thyroid cancer types, stages and treatment overview. Retrieved from Thyroid Cancer Survivors Association: https://www.thyca.org/about/types/