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Thyroid Cancer: Signs and Symptoms

Thyroid Cancer: Signs and Symptoms

September is Thyroid Cancer Awareness Month.  We are going to take a look at a few aspects about the thyroid.

Your thyroid gland makes hormones that help control the function of many of your body’s organs, including your brain, kidneys, skin, liver, and heart.  Producing too much (hyperthyroidism) or too little (hypothyroidism) thyroid hormone can cause problems with these organ systems and a wide range of symptoms that may require medical treatment.

In addition, your thyroid gland can develop nodules. A thyroid nodule is a growth within your gland.  Thyroid nodules are very common and occur in 5-10% of women and 1-5% of men. Over 60% of the population over the age of 60 will have thyroid nodules.  While the diagnosis of thyroid cancer is increasing, 95% of thyroid nodule are benign and do not require treatment. 

A personal history of exposure to head and neck radiation (especially in childhood) in addition to family history are two risk factors for developing thyroid cancer.  This radiation exposure is not related to routine CT scan, or x-rays performed but rather radiation treatment for an illness or exposure from your job.

What happens if a thyroid nodule is detected?  Your physician will perform a history and physical.  In addition, routine blood tests should include thyroid hormone levels. An ultrasound is the best study to evaluate the thyroid and may be ordered by your physician even if originally found on another radiologic test.  

Based on those findings biopsy may be performed. Usually the results will fall into one of four categories: benign (70-75% of cases), malignant (4-7%), inconclusive or indeterminate (10-15%), and unsatisfactory (1-10%).

Thyroid cancer is becoming increasingly common, rising to the 5th most common cancer in women.  Most patients with thyroid cancer do not have any associated symptoms.  Both Sofia Vergara and HGTV Flip-Flop’s Tarek El Moussa were diagnosed with thyroid cancer without apparent symptoms.  Larger nodules, even if not cancerous, may produce symptoms that can include difficulty swallowing solid food, and a sense of fullness in your neck. There are a number of other reasons these and other symptoms may be occurring so following up with your doctor is important.

Papillary thyroid cancer (PTC) is the most common of the four types of thyroid cancer, comprising 75-80% of cases.  Follicular thyroid cancer occurs in 10-15% of cases. Together, they are often referred to as differentiated thyroid cancer and have the best chance for cure.

So are we really overdiagnosing cancer?  A recent article published in the New England Journal of Medicine has suggested just that.  In the article they define overdiagnosis as,  “thyroid tumors that would not if left alone, result in symptoms or death.”  You must remember that although some low-risk cancers may be managed conservatively, and that all cancers are not created equal.  If diagnosed with cancer, the patient should evaluate and discuss their individual cancer risk allowing the treatment to be individualized to them.

If diagnosed with cancer, the best chance to cure is often surgical treatment.  Depending of type and size of thyroid cancer either a thyroid lobectomy (removal of half the thyroid) or total thyroidectomy (removal of the entire gland) may be recommended.  Also, depending on your risk profile, Radioactive Iodine treatment may be recommended following surgery.  The last portion of treatment includes Thyroid stimulating hormone (TSH) suppression.  The goal of TSH suppression is to suppress or remove any stimulus for remaining thyroid cells to grow.

What can you do? 

Perform a neck check. You'll need a handheld mirror and glass of water.  Your thyroid gland is found in the area below the larynx (Adam’s apple) and above the collarbone.

  1. Tip your head back
  2. Take a drink of water and swallow
  3. Look at the neck while swallowing noting any bulges
  4. If you see any bulges, see your physician.

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