Thyroid Cancer: Symptoms, Causes, and Treatment in Chicago
Your thyroid gland may be small, but its impact on the entire body is substantial. This tiny gland that sits at the front of your neck plays a major role in regulating your metabolism. Learning that you have thyroid cancer can be scary. Thankfully, most thyroid cancers are treatable with excellent results. We at Oral Cancer Institute (OCI) want to be with you on this journey. Let’s learn more about this mighty gland and how thyroid cancer can be treated today.
What is the Thyroid Gland?
Often called butterfly shaped, the thyroid gland sits in the front of your neck, under the larynx. It has two lobes to the left and right of the trachea (windpipe). The thyroid gland controls your metabolism and is a vital part of the endocrine system. This is the system that controls the entire body with the release of hormones that are critical for life itself. It uses the iodine that we get from food to make these thyroid hormones. Regulating body metabolism, temperature, heart rate, calcium balance, weight and energy levels are just some of the functions of the thyroid gland. The pituitary gland, adrenal glands, pancreas, ovaries and mammary glands are some other examples of the different types of glands in the body.
What is a Thyroid Nodule
A thyroid nodule is an unusual lump on your thyroid gland. Anyone can develop these nodules and they are very common. It may be discovered during a physical checkup, or you may feel the nodule yourself. Sometimes, they can be very hard to detect because they are so tiny. More than 90% of thyroid nodules in adults are benign (non-cancerous). A small percentage of these nodules can develop into cancer, so any unusual or new lump in your thyroid area should be reported to your physician.
What is Thyroid Cancer?
When there is an increase in thyroid gland cell growth, it can lead to thyroid cancer. Experts are not sure why these cells develop into cancer. Women are more likely to be diagnosed with thyroid cancer, but men and even children can develop this disease. Treatments are very effective with a high cure rate.
Types of Thyroid Cancer
The types of thyroid cancer are categorized by the type of cell that has turned into cancer. These include:
- Papillary: This is the most common and accounts for 80% of all thyroid cancers. It is slow-growing. It often spreads to the lymph nodes but because it responds so favorably to treatment, it can be curable. Papillary tumor cells absorb iodine
- Follicular: This type accounts for about 15% of thyroid cancers. This type of cancer can be metastasize (spread), to other parts of the body, like the lungs. Follicular cancer cells also absorb iodine.
- Medullary: This type accounts for about 2% of thyroid cancers. Family history and genetics could be a factor in the cause of this form of cancer. Medullary cancer cells do not absorb iodine.
- Anaplastic: This rare type also accounts for 2% of thyroid cancers. It is aggressive, meaning it grows quickly and spreads to the surrounding area and can metastasize to other organs and regions of the body. This type of thyroid cancer is the hardest to treat. Anaplastic cancer cells do not absorb iodine.
Risk Factors for Thyroid Cancer
- Sex: Thyroid cancer is 3 times more likely to be diagnosed in women.
- Age: Thyroid cancer can be diagnosed at any age but more commonly will occur at ages 30-60.
- Family: Most people diagnosed with thyroid cancer do not have a family history of it, but there is an increased risk of developing it if you have a close relative that has had thyroid cancer.
- Hereditary: There are some genetic conditions that can lead to a greater risk of thyroid cancer.
- Radiation: Exposure to radiation can increase your risk of thyroid cancer. It could be from medical imaging tests (x-rays/CT scans etc.) or from fallout from a nuclear plant or war zone related.
- Body weight: People with excess body weight have a higher risk of thyroid cancer.
- Iodine: Populations that have diets low in iodine have an increased risk of follicular thyroid cancer. This is more common in countries that don’t have added iodine in their salt. Having a diet high in iodine may increase the risk of papillary thyroid cancer.
Having a risk factor does not mean that you will get thyroid cancer. Many people who do have thyroid cancer have no risk factors.
Symptoms and Early Signs
Thyroid cancer can go unnoticed because there may not be any obvious symptoms. Some signs of thyroid cancer are:
- A lump in front of the neck
- Swollen thyroid or swelling in the neck or lymph nodes
- Pain in the thyroid area of the neck
- Hoarseness
- Persistent cough
- Difficulty swallowing or breathing
Having one or more of these symptoms should be reported to your doctor.
Symptoms that may be an indication that thyroid cancer has spread:
- Fatigue
- Loss of appetite
- Nausea or vomiting
- Unexpected weight loss
If you have any of these symptoms, please call OCI for an initial appointment or a second opinion. We are committed to providing compassionate, evidence-based care with the highest standards of excellence. Our surgeons are academically trained and experts in the treatment of thyroid and head and neck cancers. All patients are presented at our multidisciplinary tumor board which consists of head and neck surgical oncologists, medical oncologists, radiation oncologists, radiologists and pathologists allowing for a comprehensive treatment plan. We want to partner with you from diagnosis, through treatment and recovery.
Diagnosis and Testing
Your doctor will do a physical examination, including taking a medical history. The provider will feel your neck for any lumps or nodules and ask about any family history of cancer. Then appropriate testing will be recommended.
- Blood tests: Your thyroid secretes hormones that regulate your metabolism (T3 and T4) and calcitonin, which regulates your calcium levels. These results can indicate the health of your thyroid gland.
- Ultrasound Imaging: These images will show any nodules and their borders. Cancerous nodules can be irregularly shaped or have calcium deposits.
- Biopsy: A sample of the nodule is taken with a very thin needle. This is called a fine needle aspiration biopsy (FNAB). This procedure can be done while using ultrasound, to precisely guide the doctor to the exact location. These samples will be sent to a pathologist for testing.
- Radioiodine Scan: This test is a nuclear medicine test using radioactive iodine. You are given this iodine and then the amount of iodine that is absorbed into the thyroid gland is measured with a thyroid scan at different intervals to determine the condition of your thyroid. A computer will create a picture of your thyroid in detail.
- Additional Imaging: CT scans and PET scans can be recommended to detect whether any cancer has spread.
Genetic Testing: For medullary thyroid cancers, genetic testing and counseling may be advised. Learning your inherited genetics can be helpful for your entire family.
Thyroid Cancer Treatment
Considerations for treatment will depend on how large the tumor is and if it has spread.
- Surgery: This is the most common treatment for thyroid cancer. The surgeon will either remove part of the thyroid gland (lobectomy) or the total gland (thyroidectomy). This will depend on the size and location of the tumor. Lymph nodes can also be removed if appropriate.
- Thyroid replacement therapy– When the thyroid gland is removed, you will need to replace the hormones that are no longer being produced. You will need to take these supplements for the rest of your life.
- Parathyroid glands-These 4 little glands that sit next to the thyroid secrete an important hormone that regulates our calcium levels. Sometimes during thyroid surgery, the parathyroid glands can be bruised, resulting in low calcium levels. This usually resolves within a few days or even weeks. Vitamin D helps the body absorb calcium, so taking a calcium supplement with vitamin D may be necessary. Watch for signs of low calcium, and be sure to report any of these symptoms to your doctor:
- Muscle cramping
- Muscle twitching
- Tingling sensation in the lips, tongue, fingers or feet.
- Abnormal heartbeat
- Radioactive iodine (RAI) therapy: This treatment can be used alone or after surgery to destroy any remaining cancer cells. It can also be used for hyperthyroidism and thyroid cancer that has spread. RAI therapy will only work on the types of cancer that can absorb iodine (Papillary and Follicular).
- A brief overview of this well tolerated process:
- You will receive the RAI either by mouth or IV injection
- Because your thyroid absorbs the iodine, there is little exposure to the rest of your body. However, you still will have to take precautions as there is some exposure to radiation that could affect others.
- The radiation will destroy your remaining thyroid cells or the cells that have spread. You will need to take thyroid hormones after this procedure.
- The radioactive iodine stays in your system for a short time and your body will excrete it mostly through the urine. There may also be a small amount in your other body fluids.
- Your care givers will give detailed instructions to you on how to care for yourself and others. Make sure you follow these instructions carefully. These will include:
- Avoid pregnant women and children and keep at least three feet away from the public after treatment.
- Sleep alone and no intimate contact. Casual contact is ok after doctor’s approval.
- Use your own bathroom. Sitting during urination will decrease the chance of urine splashing. Flush twice after urination for designated time given to you by your doctor.
- Drink plenty of water to flush out radiation.
- Use good hand hygiene, washing hands frequently.
- Daily bath or shower.
- Wash your clothes and linens daily and separately.
- Don’t share any eating utensils and wash them separately.
- Avoid public transportation or any long trips with anyone.
- Women should avoid pregnancy, and men avoid conception for 6-12 months
- These times may vary because of the dosage of radiation. Prescribed isolation may be longer than the typical 3-4 days. Following your doctor’s specific orders is imperative.
- External beam radiation therapy: A radiation machine is used to deliver rays or particles aimed directly at the cancer cells. This treatment would be used for medullary or anaplastic thyroid cancer.
- Brachytherapy: This treatment involves placing radioactive seeds directly into or next to the tumor.
- Chemotherapy: These are oral or intravenous medications that kill cancer cells.
- Hormone Therapy: This treatment can stop the release of any hormones that may cause cancer recurrence.
- Ethanol Ablation: Alcohol can be injected into very small cancer areas causing those cells to shrink. This procedure, which is done with ultrasound can be used in people that are poor candidates for surgery.
- Targeted Drug Therapy: There are different types of targeted drugs. Some of these therapies would target the cells that feed the cancer cells. Other types focus on cell genetics. You would have to have your cells tested to see which type of therapy would be beneficial to you.
- Hot and Cold Therapies: These treatments would be used for smaller areas and possibly cancer that has spread. Radiofrequency ablation (RFA) kills cancer cells with heat by using radio waves. Cryoablation uses a gas that freezes and kills cancer cells.
Recovery and Prognosis
Thyroid cancer can be curable, especially if the cancer has not spread. Most thyroid cancers (80%) are the papillary type and are extremely responsive to treatment.
The American Cancer Society uses a database maintained by the National Cancer Institute (NCI) and provides these 5-year survival rates for thyroid cancer. It groups these cancers in stages defined as follows.
Localized: No sign cancer has spread outside of thyroid
Regional: The cancer has spread but only to nearby areas.
Distant: The cancer has spread to other parts of the body, like the lungs.
Papillary | Follicular | Medullary | Anaplastic | |
Stage |
5 year survival rate | 5 year survival rate | 5 year survival rate | 5 year survival rate |
Localized | >99.5% | >99.5% | >99.5% | 39% |
Regional | 99% | 98% | 92% | 11% |
Distant | 74% | 67% | 43% | 4% |
Stages Combined | >99.5% | 98% | 91% | 8% |
Can Thyroid Cancer Be Prevented?
Most people that get thyroid cancer do not have any risk factors, so it is impossible to prevent these cancers. Any risk factors should be reported to your doctor.
- Family History-Having a close relative with thyroid cancer, especially if they have the inherited form (Medullary) can put you at a higher risk. You may want to have genetic testing.
- These cancers can be prevented by removing the thyroid gland.
- Radiation-Unusual exposure to radiation should also be reported to your doctor.
- Limit exposure to radiation, especially for children.
- Adequate Iodine
- Weight Management-There is a link between obesity and thyroid cancer
- Eat a healthy diet with plenty of fruits, vegetables and lean protein.
- Limit processed foods, especially those high in sugar.
- Regular yearly appointments with your doctor
- Be sure to report any lumps or swelling in your neck area.
- Report any signs or symptoms
Follow-Up Care After Thyroid Treatment
Your doctor will want to see you for follow-up appointments to make sure your cancer has not returned. You may have to have blood work or additional imaging tests like ultrasound, CT or MRI.
We at the Oral Cancer Institute will customize a treatment plan based on your specific needs. You will always be included in all decisions made and questions are always welcome. Our team has a strong dedication to helping patients maintain the best possible quality of life during and after treatment.
Please contact us to make an appointment for a consultation with one of our OCI providers.