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Thyroid Cancer
Overview

Thyroid cancer is becoming increasingly common in people younger than 55 years old. There are 62,450 cases of thyroid cancer diagnosed each year in the United States. It can happen to anyone at any age, but the cases only amount to 2% in children. It is often symptomless in early stages, but easily treated and slow growing. There are different types of thyroid cancer and they are very treatable if caught early. This article will help you understand the symptoms, when to see a doctor, how it is diagnosed, treatment, and prognosis for thyroid cancer.

What is Thyroid Cancer?

Your thyroid is an endocrine gland just at the bottom front of the neck area. It secretes hormones that help to regulate your metabolism. It is involved with your body temperature, weight, heart rate, blood pressure, and energy levels.
Thyroid cancer usually starts out in a small cyst or nodule on the thyroid. Some of these are benign, but some nodules can continue to grow into cancer. The good news is most types of thyroid cancer are slow growing and very receptive to treatment with radiation. The key is recognizing suspicious cells and treating it early in the disease.

Causes of Thyroid Cancer

The exact cause of thyroid cancer is not completely understood. What they do know is the cells of the thyroid begin to change and grow too fast. They don’t die and slough off like normal cells and form masses on the gland. These abnormal cells can also grow into the nearby lymph nodes and spread throughout the body.
There are a few different types of thyroid cancer including:
Papillary. This is the most common type of thyroid cancer. It starts in the follicular cells of the thyroid. Their job is to make thyroid hormone and keep it for later use by the body. This type is common in people 30 to 50 years of age.
Follicular. This type of cancer is common in adults over 50 years of age. It starts in the follicular cells. Another sub-type of follicular cancer is Hurthle cell cancer, which is very rare.
Medullary – This type grows in the cells that make calcitonin, a hormone that helps regulate the calcium levels in your body. This type of thyroid cancer can possibly be diagnosed easily by checking calcitonin levels in the blood.
Anaplastic. This is a very rare type of thyroid cancer, but very aggressive. It is most common in people over 60 years old.
Thyroid Lymphoma. This is another very rare thyroid cancer. It affects the immune cells of the thyroid. It is fast growing and most common in older adult population.

Thyroid Cancer Symptoms

Early thyroid cancer often has no symptoms and may be discovered at an annual physical exam. It is important to see your doctor if you have any of the following 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 be caused by benign masses on the thyroid, but still need to be evaluated and watched by your doctor. Early diagnosis and treatment of thyroid cancer is crucial to prevent it from spreading.

How is Thyroid Cancer Diagnosed?

If you have a thyroid nodule and 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 well. It is important to understand that less than 1 in 10 thyroid nodules are cancerous.
Your doctor may order one or more of the following tests:
Blood Testing
TSH – Thyroid Stimulating Hormone to check if your hormones are high/low
Free T3 and Free T4 – Thyroid hormones
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 and checks how much the nodule absorbs. A nodule that is cold may need a biopsy, hot nodules are normal
Ultrasound – Ultrasound with Doppler flow studies can check to see if nodules are normal or abnormal

Biopsy
FNA – Fine Needle Aspiration. 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.

Thyroid Cancer Staging

Thyroid cancer is staged by type since the cells affected tend to act differently. Here are the stages by types:
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 that is 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 and blood vessels that supply the lungs, and the 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.

Thyroid Cancer Treatment

Thyroid Cancer Treatment
Treatment for thyroid cancer is by type and by stage. Your treatment plan will be decided by you and your treatment team what will be best for you. The treatments are as follows:
Papillary and Follicular Cancer
Stages I and II
Total Thyroidectomy or Partial Thyroidectomy
Possible Radioactive Iodine Treatment
Lobectomy
Lymph Node Removal
Thyroid Hormone Therapy – To suppress the gland and stall cancer growth

Stage III
At this stage, a total thyroidectomy is performed and removal of any and all lymph nodes that are affected. Radioactive iodine is given after surgery and possibly radiation treatments.
Stage IV
Thyroidectomy
Further surgery to remove cancer from areas it has spread to
Lymph Node Removal
Radioactive Iodine – only for tumors that show iodine uptake
Thyroid Hormone Treatment – To suppress the gland and stall cancer growth
Targeted Therapy – Attacks growth proteins in cancer cells
Radiation
Chemotherapy – kills off cancer cells throughout the body

Chances for a cure at this stage are low, but treatments can relieve symptoms and increase life span.
Medullary Thyroid Cancer
All stages – The doctor may use one or all of the following treatments:
Total Thyroidectomy
Lymph Node Removal
Radiation
Targeted Therapy – attacks growth proteins in cancer cells
Chemotherapy – kills off cancer cells throughout the body

Anaplastic Thyroid Cancer
All Stages – The doctor may use one or all of the following treatments to help with symptoms and increase the lifespan:
Total Thyroidectomy. To decrease the size of the mass and increase comfort.
Tracheostomy. To relieve symptoms.
Radiation
Chemotherapy

Alternative Medicine for Thyroid Cancer

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 like, vitamin C.
Try Asian Mushrooms. Maitake, shitake, and agaricus may boost the immune system to help fight cancer cells.

Thyroid Cancer Risk Factors

There are some risk factors for thyroid cancer. Just because you have a risk factor doesn’t mean you will get thyroid cancer, but it is important to have your thyroid checked at each yearly physical if you have any of the following:
Gender. Thyroid cancer is 3 times more common in women.
Age. The risk for thyroid cancer is highest in women ages 40 to 50 and men age 60 to 70.
Low Iodine Intake. There tends 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. This risk factor is proven to increase the chances of thyroid cancer. Exposure to radiation can be from nuclear accidents or medical radiation to the neck or head as a child.
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.

Lifestyle Changes for Thyroid Cancer

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, soy bean 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.

Thyroid Cancer Survival Rate

Papillary

Stage of Cancer
Stage I
Stage II
Stage III
Stage IV

5 Year Survival Rate
Around 100%
Around 100%
93%
51%

Follicular

Stage of Cancer
Stage I
Stage II
Stage III
Stage IV

5 Year Survival Rate
Around 100%
Around 100%
71%
50%

Medullary

Stage of Cancer
Stage I
Stage II
Stage III
Stage IV

5 Year Survival Rate
Around 100%
Around 98%
81%
28%

Anaplastic
Any anaplastic thyroid cancer is stage IV and the 5 year survival rate is only about 7%. This is a very aggressive and fast growing cancer.

Bibliography

American Cancer Society. (2014, February 24). What are the key statistics about thyroid cancer? Retrieved from American Cancer Society: https://www.cancer.org/cancer/thyroidcancer/detailedguide/thyroid-cancer-key-statistics
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/

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