Thyroid Cancer

Overview

Thyroid cancer is a disease in which cells in the thyroid gland grow out of control. The thyroid is a small, butterfly-shaped gland in the front of your neck. It makes hormones that help control your heart rate, temperature, and energy. Most thyroid cancers grow slowly and are highly treatable.

Thyroid cancer is not one of the most common cancers, but its diagnosis has increased in recent years because doctors are finding it more often with ultrasound and other scans. Still, it is fairly uncommon compared to cancers like breast or lung cancer.

Anyone can get thyroid cancer, but it is about three times more common in women than in men. It can happen at any age, but it is most often diagnosed in people between the ages of 30 and 60. Children and older adults can also get it, but it is rare in children.

Symptoms

Common symptoms

• A lump or swelling in the front of the neck that you can feel or see
• A feeling that something is stuck in the throat
• Difficulty swallowing
• Hoarseness or a voice that keeps changing
• Discomfort or pain in the neck or throat
• Swollen lymph nodes in the neck

Symptoms in children

• A firm, growing lump in the neck is often the first sign
• Voice changes that last more than two weeks
• Swelling in the neck that is not painful
• Difficulty breathing or swallowing (less common but important)

Symptoms in older adults

• A fast-growing neck mass
• Trouble swallowing or a feeling of pressure
• A hoarse voice that gets worse
• Fatigue or unexplained weight loss (these can be signs of more advanced disease)

Causes

Main causes

• The exact cause is not known in most cases.
• Changes (mutations) in the DNA of thyroid cells can cause them to grow too fast and form a tumor.
• Some genetic conditions, like familial medullary thyroid cancer, can run in families.

Risk factors

• Being female
• Being between 30 and 60 years old (though it can happen at any age)
• Exposure to high levels of radiation to the head or neck, especially in childhood
• A family history of thyroid cancer
• Certain inherited genetic syndromes, such as multiple endocrine neoplasia type 2 (MEN2)
• A diet very low in iodine (though this is rare in developed countries)

When to see a doctor

See a doctor urgently if:

• You find a new lump or swelling in your neck that does not go away after two weeks
• Your voice is hoarse for more than three weeks
• You have trouble swallowing or breathing
• Your neck hurts, and you also have a fever or difficulty opening your mouth

Book a routine appointment if:

• You notice a small, painless lump in the neck that feels smooth
• You have risk factors for thyroid cancer and want to talk about them
• You have a family history of thyroid cancer and want to know about monitoring

Diagnosis

To diagnose thyroid cancer, a doctor will ask about your symptoms, feel your neck, and usually order imaging tests. If a suspicious lump is found, the first step is an ultrasound. Doctors may then take a tiny sample of cells from the lump with a needle. This is called a biopsy, and it is the main way to confirm cancer.

Tests that may be done

• Physical exam of the neck to check for lumps or swelling
• Thyroid function blood tests to check hormone levels (they do not diagnose cancer but help see how the gland is working)
• Ultrasound of the neck, which creates images of the thyroid and can show if a lump looks suspicious
• Fine needle aspiration biopsy (FNA): a thin needle is used to remove a small sample of cells for testing
• CT scan or MRI if the cancer has spread or if more detail is needed

What to expect at your appointment

The biopsy is usually done in the doctor's office or clinic. It feels like a small pinch and takes only a few minutes. After that, you may have a small bruise or soreness for a day or two. If the biopsy shows cancer, your doctor will talk with you about what comes next and may refer you to a specialist who treats thyroid conditions.

Treatment

Treatment for thyroid cancer depends on the type, the size of the tumor, whether it has spread, and your overall health. Most people with thyroid cancer need surgery to remove all or part of the thyroid. After surgery, you may need additional treatment to lower the chance of the cancer coming back. Your care team will tailor a plan just for you.

Self-care at home

• Keep all follow-up appointments so that your doctor can check for signs of recurrence.
• After thyroid removal, take your thyroid hormone medicine exactly as prescribed — it is not a choice medicine; it replaces the hormone your body needs.
• Tell your doctor about any new symptoms, especially a new lump, neck pain, or trouble swallowing.
• Wear a medical alert bracelet or card if you have had your thyroid removed, so emergency workers know your medical history.

Medical treatments

The main treatment is surgery to remove part or all of the thyroid gland. After surgery, some people may need radioactive iodine therapy, which is given as a liquid or capsule to destroy any remaining thyroid tissue or cancer cells that may be left. Other treatments include external beam radiation, and in some cases, targeted therapy or chemotherapy for advanced disease. Hormone replacement tablets are needed after thyroid removal to keep your body's hormone levels normal and to slow down any remaining thyroid tissue. Your doctor will talk with you about the most appropriate options for your situation.

When is surgery considered?

Surgery is the most common treatment for thyroid cancer. The surgeon may remove half or all of the thyroid gland, depending on the tumor size and type. If the cancer has spread to lymph nodes in the neck, those nodes may also be removed.

Living with this condition

After treatment, many people feel fine and live normal, active lives. You will need regular check-ups to watch your hormone levels and make sure the cancer does not come back. It may take a few months to adjust your thyroid hormone dose properly, so expect some blood tests along the way. Fatigue, changes in mood, and minor skin issues can happen, but these usually improve with time and support.

Lifestyle tips

• Do not try to lose weight or change your thyroid medicine dose on your own — talk to your doctor first.
• If you smoke, ask your doctor for help quitting; smoking can raise the risk of complications.
• Get enough rest and do not push yourself too hard, especially in the first few months after treatment.
• Keep a list of your medicines and appointments, and share it with family or friends who can help you.

Diet and exercise

There is no special diet that cures thyroid cancer, but eating a balanced diet with plenty of vegetables, fruits, and whole grains can help you feel energized. If your doctor tells you that you need to follow a low-iodine diet before radioactive iodine therapy, they will give you specific instructions. After that, a normal diet is fine. Gentle exercise, like walking, can improve your mood and boost your energy during and after treatment.

Mental health and emotional wellbeing

A cancer diagnosis can be frightening, and treatment can affect your emotions. You may feel anxious, sad, or stressed. These feelings are normal. It is important to talk with your care team about what you are feeling. Many people find counseling, relaxation exercises, or joining a support group helpful. If you feel overwhelmed, do not go through it alone — reach out to a doctor or a mental health professional. If you are ever in crisis, contact your local emergency services or a crisis helpline right away.

Prevention

There is no sure way to prevent thyroid cancer. But you can lower your risk by limiting unnecessary radiation exposure, especially for children. If you have a family history of thyroid cancer or an inherited syndrome, you can talk to a genetic counselor about screening options. For most people, the focus should be on noticing symptoms and getting a prompt diagnosis.

Screening programmes

There is no national screening program for thyroid cancer in the general population. People with a high risk due to family history or genetic conditions may have regular neck examinations, ultrasound scans, or blood tests to check for early signs. Ask your doctor what is right for you.

Complications

If left untreated

• Thyroid cancer can grow into nearby structures in the neck, such as the windpipe or voice box, which can make breathing and speaking difficult.
• Cancer can spread to lymph nodes in the neck, and in more advanced cases, to distant organs like the lungs or bones.
• Voice changes and swallowing problems may become permanent if the tumor presses on nerves.
• Without treatment, some types of thyroid cancer can become life-threatening.

Long-term outlook

The outlook for thyroid cancer is generally very good. Most thyroid cancers are slow-growing and respond well to treatment. The five-year survival rate for the most common types is over 95 percent, and many people are completely cured. Even if cancer returns or spreads, treatment can often control it for many years. Your doctor will explain your specific situation, but there is every reason to be hopeful.

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