12210 Thyroid Cancer

Overview

Thyroid cancer is a disease in which cells in the thyroid gland — a small, butterfly-shaped gland at the base of the neck — grow out of control and form a tumor. The thyroid makes hormones that help control heart rate, body temperature, and energy. Most thyroid lumps are not cancer, but when they are, treatment often works well.

It is not one of the most common cancers, but it is the most common cancer of the endocrine system. Rates have been rising, mainly because doctors find small tumors more often due to better imaging.

It can happen at any age, but it is most often diagnosed in people in their 40s and 50s. Women are about three times more likely than men to develop it. People who had radiation to the neck as children or who have a family history are at higher risk.

Symptoms

Common symptoms

• A lump or swelling in the front of the neck
• Swollen lymph nodes in the neck
• A hoarse voice that does not go away
• Trouble swallowing or breathing
• A feeling that something is stuck in the throat
• A persistent cough not caused by a cold

Symptoms in children

• A firm or hard lump in the neck
• Enlarged lymph nodes
• Rapid growth of the neck (children's thyroid cancers tend to grow faster)
• Voice changes

Symptoms in older adults

• A new neck lump that may or may not be painful
• Hoarseness or voice changes
• Difficulty swallowing or breathing
• Weight loss or fatigue
• Sometimes, no symptoms at all — the cancer is found on a scan for another reason

Causes

Main causes

• The exact cause is usually unknown. Cancer begins when thyroid cells get changes (mutations) in their DNA, which tells the cells to grow too quickly and not die normally.
• A family history of thyroid cancer, especially medullary thyroid cancer, can play a role.
• Exposure to high levels of radiation, especially during childhood, increases the risk.

Risk factors

• Being female
• Being between ages 30 and 60
• Having a family history of thyroid cancer
• Past radiation treatment to the head or neck
• Certain inherited conditions, such as familial medullary thyroid carcinoma
• Standing low iodine levels in the diet, though this is rare in developed countries

When to see a doctor

See a doctor urgently if:

• If you have a new lump in your neck that is growing quickly
• If you have trouble swallowing or breathing
• If you have hoarseness that lasts more than 2 weeks

Book a routine appointment if:

• If you notice any lump, bump, or swelling in the front of your neck
• If you feel a persistent pressure in your neck
• If you have thyroid nodules and they change in size or the way they feel

Diagnosis

Your doctor will ask about your symptoms and check your neck. If they find a lump, they will often order an ultrasound of your thyroid — a safe, painless scan that shows the size and structure of any nodules. If a nodule looks suspicious, the next step is a biopsy called fine-needle aspiration. This involves using a thin needle to collect a tiny sample of cells from the nodule, which is sent to a lab to look for cancer cells.

Tests that may be done

• Physical exam of the neck
• Ultrasound of the thyroid
• Fine-needle biopsy (FNA) to test cells
• Blood tests to check thyroid hormone levels and markers like thyroglobulin or calcitonin (in some types)
• CT or MRI scans if cancer may have spread

What to expect at your appointment

If you are told you have a thyroid nodule, you may feel anxious, but most nodules are not cancer. If a biopsy is needed, it usually takes only a few minutes and is done in the office. Your doctors will explain each step of the plan. A specialist (an endocrinologist or an ear, nose, and throat surgeon) will likely be involved.

Treatment

For most people, surgery to remove part or all of the thyroid gland is the main treatment. Depending on the type and stage of cancer, other treatments may be used to remove any remaining cancer cells or to reduce the risk of it coming back. Your team will tailor the treatment to your specific situation, and there are many options that can cure thyroid cancer.

Self-care at home

• Take your thyroid hormone medication exactly as prescribed — this is often needed after surgery to replace what your body no longer makes.
• Keep all follow-up appointments because thyroid cancer can come back, even years later.
• Tell your doctor about any new neck lump, hoarseness, or trouble swallowing.
• Stay engaged with your health care team and ask questions when you don't understand.

Medical treatments

Treatment may include surgery (thyroidectomy), radioactive iodine therapy to destroy any remaining thyroid tissue, external radiation for certain types, and in advanced cases, targeted therapies or chemotherapy. Note: I am describing these generally — your doctor will discuss what is right for you. Some people also need lifelong thyroid hormone replacement.

When is surgery considered?

Surgery is the most common first step for most types of thyroid cancer. The surgeon may remove only the lobe containing the tumor (lobectomy) or the whole thyroid gland (total thyroidectomy). The choice depends on the size, type, and spread of the cancer.

Living with this condition

After treatment, you may need to take a daily thyroid hormone pill to keep your body's metabolism normal. Some people feel tired or have a low mood as their body adjusts. Regular blood tests will help your doctor find the right dose. Most people return to work and their usual activities within a few weeks to months.

Lifestyle tips

• Take your medicine at the same time each day, usually on an empty stomach.
• Eat a balanced diet — you do not need special 'cancer diets' unless your doctor says otherwise.
• Stay active. Even light walking can help boost your energy.
• Avoid smoking, because it can interfere with treatment and overall health.
• Keep a simple record of symptoms and side effects to share with your team.

Diet and exercise

There are no special foods that can cure or cause thyroid cancer. If you had radioactive iodine treatment, your doctor may briefly recommend a low-iodine diet before the treatment — this is short-term and important for the therapy to work. After that, eat a normal balanced diet. Exercise is safe and beneficial. If you feel neck stiffness after surgery, gentle neck exercises (as taught by your physiotherapist) can help.

Mental health and emotional wellbeing

A cancer diagnosis is hard news, and it's normal to feel anxious, sad, or overwhelmed. Many people worry about recurrence. Talking with a counselor, joining a support group, or simply opening up to close friends or family can be very helpful. Please remember that thyroid cancer often has a very good prognosis, and you are not alone.

Prevention

There is no known way to prevent most thyroid cancers. Many happen for no obvious reason. If you have a family history of medullary thyroid cancer, genetic testing and sometimes preventive surgery may be discussed with a specialist. Avoiding unnecessary radiation exposure, especially in childhood, is one precaution.

Vaccines

There is no vaccine for thyroid cancer.

Screening programmes

There is no routine screening test for thyroid cancer in the general population. People at high risk may be offered ultrasound checks.

Complications

If left untreated

• The cancer can grow into nearby structures in the neck, making swallowing or breathing difficult.
• Cancer cells can spread to lymph nodes in the neck.
• It may spread to distant organs, such as the lungs or bones.

Long-term outlook

The outlook for thyroid cancer is often excellent. Many types are slow-growing and respond very well to treatment. Most people with thyroid cancer can be cured, especially when it is caught early. Even if it returns, there are effective ways to manage it. Your medical team will work with you to help you live well.

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