A Patient's Guide to Thyroid Cancer Care
We usually don't pay much attention to our thyroid, a small, butterfly-shaped gland at the front of the neck, just below the voice box. Yet it plays an important role in keeping us healthy.
Getting Started with Thyroid Cancer
The Thyroid produces hormones that influence virtually every part of the body including regulating heart rate, blood pressure, body temperature, and metabolism as well as affecting the nervous system, muscles and various other organs.
Many thyroid cancer patients are initially unaware that they have the disease. Often, a lump is found on the thyroid during a routine physician exam or while taking a medical image of the neck for other conditions. In the vast majority of patients, the lump is simply an infection or other benign condition of the thyroid. However, about 5 percent of the time, this finding turns out to be cancerous (where the cells of the thyroid gland grow uncontrollably and form a tumor) and further treatment is needed.
Most patients do not experience symptoms. However, some may feel enlarged lymph nodes or nodules in the neck or have difficulty swallowing or speaking. Although other conditions can also cause these symptoms, it is best to have a physician examine you. For a referral to one of Cedars-Sinai's expert team members, please call 310-248-6510.
The exact cause of many cases of thyroid cancer is unknown, but certain factors increase the risk of the disease, including:
- Age: Papillary and follicular thyroid cancer are more common in adulthood. Sporadic medullary thyroid cancer usually occurs in adults, while familial medullary cancer either is an isolated condition or is found in association with other endocrine tumors (multiple endocrine neoplasia syndromes), generally occur in childhood or adolescence. Anaplastic thyroid carcinoma, albeit rare, usually occurs in individuals over the age of 60.
- Gender: Women are two to three times more likely to develop thyroid cancer than men.
- Family history: Approximately five percent of patients with papillary thyroid cancer have a parent or sibling with thyroid cancer and usually have a familial form of the disease. The familial forms of medullary thyroid cancer are usually transmitted in a dominant fashion and therefore if an individual has a parent with one of these syndromes they have a 50 percent chance of having the genetic mutation that causes these diseases. There are several inherited conditions that are associated with well-differentiated thyroid cancer including papillary or follicular cancers: Gardner's syndrome or familial adenomatous polyposis, Cowden's disease, and the Carney complex. If you or a family member have or have had any of these conditions, please contact our Medical Genetics Institute.
- Enlarged lymph nodes in the neck
- History of radiation to head or neck: This was once used to treat enlarged tonsils, acne and the thymus. There is also an increase of thyroid cancer in people exposed to the 1986 nuclear power plant explosion in Chernobyl.
You should seek prompt medical attention if you experience a lump in your neck near your Adam's apple, hoarseness or trouble swallowing or breathing. Although other conditions cause these symptoms, it is best to have a physician examine you.
Thyroid Cancer Frequently Asked Questions
Thyroid cancer is the fastest growing cancer diagnosed in the US and cases have more than doubled in the last 30 years. Some patients have no symptoms but some may experience difficulty swallowing, enlargement of the neck, hoarseness, or neck or throat pain. If you have any of these symptoms or feel a lump in your neck, make an appointment with one of our expert endocrinologists at the Thyroid Cancer Program who specializes in the treatment of these symptoms.
Your physician will feel your neck for any nodules and check your blood for the level of your thyroid stimulating hormone (TSH). If necessary, he/she will perform a quick and painless ultrasound procedure. This will provide a picture of your thyroid and show your physician if any abnormal lymph nodes are present in your neck. Your physician may perform a fine needle aspiration (FNA) biopsy where a thin needle is inserted into the nodule(s) and a sample is taken to the lab for analysis. If positive for thyroid cancer, your physician will recommend surgery to remove the thyroid and any affected lymph nodes. If negative, your physician may simply follow you and monitor any growth of the nodules.
Endocrinologists are the primary treating MD for thyroid cancer. Oncologists can assist the endocrinologist when targeted chemotherapies are needed for the rare aggressive thyroid cancers. An oncologist or primary care physician are excellent resources however, since thyroid cancer is still relatively rare, we recommend you see one of our endocrinologists from our Thyroid Cancer Center who all specialize in the treatment of thyroid cancer.
Thyroid cancer is typically treated by removing part or all of the thyroid and any affected lymph nodes. For some patients, radioactive iodine (RAI) treatment will be given to destroy any remaining thyroid cells. Thyroid hormone medication may also be prescribed for suppression of TSH levels which has also been shown to decrease recurrence of thyroid cancer in some patients. Follow up scans (ultrasounds, CT, MRI, PET) may also be done to monitor patients. Your endocrinologist will follow you closely to ensure that your medication is at the optimal level to decrease chances of recurrence.
All patients who have had their thyroid removed will need to take life-long thyroid hormone replacement. Approximately 50 percent of patients will need to take thyroid hormone supplementation after a hemithyroidectomy (partial removal of the thyroid) but it depends on each individual. Your thyroid is largely responsible for your metabolism, energy levels and other bodily functions. These hormones can be replaced via daily oral medications and your endocrinologist will work closely with you to determine the optimal level of medication that your body will need.
Your surgeon will go over in detail what you can expect but in general, you will be directed to not eat anything the night prior to your surgery. Depending on the extent of the surgery, it will take about 2-3 hours and you will most likely be discharged within 24 hours with instructions on how to care for yourself and the incision. During your hospital stay, your doctors will monitor you for complications. Although you may feel fatigued and your voice may feel weak, most patients are able to eat, drink and talk right after the surgery. Most people only take between 2-3 days off work. Your endocrinologist will call you within a few days with the results of your surgery and give you detailed instructions on how to follow up.
Most thyroid cancer recurrence occurs within the first 5-10 years after initial diagnosis. After the first few years of twice annual visits for blood tests and neck ultrasounds, your endocrinologist will likely see you annually.
While the recurrence rate for thyroid cancer is about 10-20 percent depending on size of the thyroid cancer, the chance of it returning is still there for over 20 years, although most recurrences are found within the first 10 years. Therefore, it is extremely important to have an experienced endocrinologist that specializes in the treatment of thyroid cancer on your team. Our Thyroid Cancer Center physicians are experts in this field and work together in providing you with exceptional care to improve your chances of disease-free survival.
As long as you are on an adequate amount of thyroid hormone, you should not expect to gain weight after your thyroid has been removed. It is important that you continue to maintain a healthy diet and exercise frequently to feel your best.
Radioactive iodine treatment (RAI treatment) may be prescribed about 6 weeks after your thyroid surgery to destroy any remaining thyroid tissue (papillary or follicular) in your body. It may also be used to treat thyroid cancer that is unable to be resected. Thyroid cells are the major cells in our body that picks up iodine so this type of treatment has less effect on other cells in your body. This type of treatment also makes it easier to monitor for recurrence and has been shown to improve survival rates for some patients.
Chemotherapy is not usually given for thyroid cancer unless it is a very aggressive form that is not responding to other forms of treatment. Your endocrinologist at the Thyroid Cancer Center is well versed in the treatment of thyroid cancer and will work you with to provide you with the very best outcome to ensure long term survival and low recurrence rates.
Patients are required to go on a low iodine diet if they will be undergoing radioactive iodine treatment or diagnostic scan. Patients are on the diet for about 2 weeks prior to treatment and this enables the body to rid itself of any traces of iodine so that the radioactive iodine scan is able to identify and destroy any remaining iodine cells in the body. Please visit thyca.org for more information or for a detailed low iodine diet cookbook.
About 5 percent of patients with well-differentiated thyroid cancer (papillary or follicular) will have at least two close relatives with thyroid cancer. This can occur sporadically or in association with other cancer syndromes. The less common medullary carcinoma of the thyroid has a greater tendency to run in families and there is a genetic test that is available to test for it. The majority of patients with thyroid cancer do not have a genetic abnormality that was passed to them and would potentially be passed to their children.
Yes, we treat all types of thyroid conditions including Hashimoto's, Graves', hyperparathyroidism etc.