Thyroid Cancer Symptoms and Information

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Thyroid Cancer Symptoms & Treatments

By the National Health Institute

The Thyroid
Understanding Thyroid Cancer
Thyroid Cancer: Who's at Risk?
Thyroid Cancer Symptoms
Diagnosis
Staging
Treatment
Getting a Second Opinion

The Thyroid

The thyroid is a gland in the neck. It has two kinds of cells that make hormones. Follicular cells make thyroid hormone, which affects heart rate, body temperature, and energy level. C cells make calcitonin, a hormone that helps control the level of calcium in the blood.

The thyroid is shaped like a butterfly and lies at the front of the neck, beneath the voice box (larynx). It has two parts, or lobes. The two lobes are separated by a thin section called the isthmus.

A healthy thyroid is a little larger than a quarter. It usually cannot be felt through the skin. A swollen lobe might look or feel like a lump in the front of the neck. A swollen thyroid is called a goiter. Most goiters are caused by not enough iodine in the diet. Iodine is a substance found in shellfish and iodized salt.

Understanding Thyroid Cancer

Cancer is a group of many related diseases. All cancers begin in cells, the body's basic unit of life. Cells make up tissues, and tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old and die, new cells take their place.

Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor. Growths on the thyroid are usually called nodules.

Thyroid nodules can be benign or malignant:

• Benign nodules are not cancer. Cells from benign nodules do not spread to other parts of the body. They are usually not a threat to life. Most thyroid nodules (more than 90 percent) are benign.

• Malignant nodules are cancer. They are generally more serious and may sometimes be life threatening. Cancer cells can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant nodule and enter the bloodstream or the lymphatic system. That is how cancer spreads from the original cancer (primary tumor) to form new tumors in other organs. The spread of cancer is called metastasis.

The following are the major types of thyroid cancer:

• Papillary and follicular thyroid cancers account for 80 to 90 percent of all thyroid cancers. Both types begin in the follicular cells of the thyroid. Most papillary and follicular thyroid cancers tend to grow slowly. If they are detected early, most can be treated successfully.

• Medullary thyroid cancer accounts for 5 to 10 percent of thyroid cancer cases. It arises in C cells, not follicular cells. Medullary thyroid cancer is easier to control if it is found and treated before it spreads to other parts of the body.

• Anaplastic thyroid cancer is the least common type of thyroid cancer (only 1 to 2 percent of cases). It arises in the follicular cells. The cancer cells are highly abnormal and difficult to recognize. This type of cancer is usually very hard to control because the cancer cells tend to grow and spread very quickly.

If thyroid cancer spreads (metastasizes) outside the thyroid, cancer cells are often found in nearby lymph nodes, nerves, or blood vessels. If the cancer has reached these lymph nodes, cancer cells may have also spread to other lymph nodes or to other organs, such as the lungs or bones.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if thyroid cancer spreads to the lungs, the cancer cells in the lungs are thyroid cancer cells. The disease is metastatic thyroid cancer, not lung cancer. It is treated as thyroid cancer, not as lung cancer. Doctors sometimes call the new tumor "distant" or metastatic disease.

Thyroid Cancer: Who's at Risk?

No one knows the exact causes of thyroid cancer. Doctors can seldom explain why one person gets this disease and another does not. However, it is clear that thyroid cancer is not contagious. No one can "catch" cancer from another person.

Research has shown that people with certain risk factors are more likely than others to develop thyroid cancer. A risk factor is anything that increases a person's chance of developing a disease.

The following risk factors are associated with an increased chance of developing thyroid cancer:

• Radiation. People exposed to high levels of radiation are much more likely than others to develop papillary or follicular thyroid cancer.

  One important source of radiation exposure is treatment with x-rays. Between the 1920s and the 1950s, doctors used high-dose x-rays to treat children who had enlarged tonsils, acne, and other problems affecting the head and neck. Later, scientists found that some people who had received this kind of treatment developed thyroid cancer. (Routine diagnostic x-rays -- such as dental x-rays or chest x-rays -- use very small doses of radiation. Their benefits nearly always outweigh their risks. However, repeated exposure could be harmful, so it is a good idea for people to talk with their dentist and doctor about the need for each x-ray and to ask about the use of shields to protect other parts of the body.)

  Another source of radiation is radioactive fallout. This includes fallout from atomic weapons testing (such as the testing in the United States and elsewhere in the world, mainly in the 1950s and 1960s), nuclear power plant accidents (such as the Chornobyl [also called Chernobyl] accident in 1986), and releases from atomic weapons production plants (such as the Hanford facility in Washington state in the late 1940s). Such radioactive fallout contains radioactive iodine (I-131). People who were exposed to one or more sources of I-131, especially if they were children at the time of their exposure, may have an increased risk for thyroid diseases.

  People who are concerned about their exposure to radiation from medical treatments or radioactive fallout may wish to ask the Cancer Information Service at 1-800-4-CANCER about additional sources of information.

• Family history. Medullary thyroid cancer can be caused by a change, or alteration, in a gene called RET. The altered RET gene can be passed from parent to child. Nearly everyone with the altered RET gene will develop medullary thyroid cancer. A blood test can detect an altered RET gene. If the abnormal gene is found in a person with medullary thyroid cancer, the doctor may suggest that family members be tested. For those found to carry the altered RET gene, the doctor may recommend frequent lab tests or surgery to remove the thyroid before cancer develops. When medullary thyroid cancer runs in a family, the doctor may call this "familial medullary thyroid cancer" or "multiple endocrine neoplasia (MEN) syndrome." People with the MEN syndrome tend to develop certain other types of cancer.

  A small number of people with a family history of goiter or certain precancerous polyps in the colon are at risk for developing papillary thyroid cancer.

• Being female. In the United States, women are two to three times more likely than men to develop thyroid cancer.

• Age. Most patients with thyroid cancer are more than 40 years old. People with anaplastic thyroid cancer are usually more than 65 years old.

• Race. In the United States, white people are more likely than African Americans to be diagnosed with thyroid cancer.

• Not enough iodine in the diet. The thyroid needs iodine to make thyroid hormone. In the United States, iodine is added to salt to protect people from thyroid problems. Thyroid cancer seems to be less common in the United States than in countries where iodine is not part of the diet.

Most people who have known risk factors do not get thyroid cancer. On the other hand, many who do get the disease have none of these risk factors. People who think they may be at risk for thyroid cancer should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

Thyroid Cancer Symptoms

• A lump, or nodule, in the front of the neck near the Adam's apple;
• Hoarseness or difficulty speaking in a normal voice;
• Swollen lymph nodes, especially in the neck;
• Difficulty swallowing or breathing; or
• Pain in the throat or neck.

These symptoms are not sure signs of thyroid cancer. An infection, a benign goiter, or another problem also could cause these symptoms. Anyone with these symptoms should see a doctor as soon as possible. Only a doctor can diagnose and treat the problem.

Thyroid Cancer Diagnosis

If a person has symptoms that suggest thyroid cancer, the doctor may perform a physical exam and ask about the patient's personal and family medical history. The doctor also may order laboratory tests and imaging tests to produce pictures of the thyroid and other areas.
The exams and tests may include the following:

Physical exam -- The doctor will feel the neck, thyroid, voice box, and lymph nodes in the neck for unusual growths (nodules) or swelling.

Blood tests -- The doctor may test for abnormal levels (too low or too high) of thyroid-stimulating hormone (TSH) in the blood. TSH is made by the pituitary gland in the brain. It stimulates the release of thyroid hormone. TSH also controls how fast thyroid follicular cells grow.
If medullary thyroid cancer is suspected, the doctor may check for abnormally high levels of calcium in the blood. The doctor also may order blood tests to detect an altered RET gene or to look for a high level of calcitonin.

Ultrasonography -- The ultrasound device uses sound waves that people cannot hear. The waves bounce off the thyroid, and a computer uses the echoes to create a picture called a sonogram. From the picture, the doctor can see how many nodules are present, how big they are, and whether they are solid or filled with fluid.

Radionuclide scanning -- The doctor may order a nuclear medicine scan that uses a very small amount of radioactive material to make thyroid nodules show up on a picture. Nodules that absorb less radioactive material than the surrounding thyroid tissue are called cold nodules. Cold nodules may be benign or malignant. Hot nodules take up more radioactive material than surrounding thyroid tissue and are usually benign.

Biopsy -- The removal of tissue to look for cancer cells is called a biopsy. A biopsy can show cancer, tissue changes that may lead to cancer, and other conditions. A biopsy is the only sure way to know whether a nodule is cancerous.
The doctor may remove tissue through a needle or during surgery:

Fine-needle aspiration: For most patients, the doctor removes a sample of tissue from a thyroid nodule with a thin needle. A pathologist looks at the cells under a microscope to check for cancer. Sometimes, the doctor uses an ultrasound device to guide the needle through the nodule.

Surgical biopsy: If a diagnosis cannot be made from the fine-needle aspiration, the doctor may operate to remove the nodule. A pathologist then checks the tissue for cancer cells.

A person who needs a biopsy may want to ask the doctor the following questions:

What kind of biopsy will I have?

How long will the procedure take? Will I be awake? Will it hurt?

Will I have a scar on my neck after the biopsy?

How soon will you have the results? Who will explain them to me?

If I do have cancer, who will talk to me about treatment? When?

Staging

If the diagnosis is thyroid cancer, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to learn whether the cancer has spread and, if so, to what parts of the body.

The doctor may use ultrasonography, magnetic resonance imaging (MRI), or computed tomography (CT) to find out whether the cancer has spread to the lymph nodes or other areas within the neck. The doctor may use a nuclear medicine scan of the entire body, such as a radionuclide scan known as the "diagnostic I-131 whole body scan," or other imaging tests to learn whether thyroid cancer has spread to distant sites.

Treatment

People with thyroid cancer often want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, the shock and stress that people may feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some also want to have a family member or friend with them when they talk to the doctor -- to take part in the discussion, to take notes, or just to listen.

The doctor may refer patients to doctors (oncologists) who specialize in treating cancer, or patients may ask for a referral. Specialists who treat thyroid cancer include surgeons, endocrinologists (some of whom are called thyroidologists because they specialize in thyroid diseases), medical oncologists, and radiation oncologists. Treatment generally begins within a few weeks after the diagnosis. There will be time for patients to talk with the doctor about treatment choices, get a second opinion, and learn more about thyroid cancer.

Getting a Second Opinion

Before starting treatment, the patient might want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient or doctor requests it. Gathering medical records and arranging to see another doctor may take a little time. In most cases, a brief delay does not make treatment less effective.

There are a number of ways to find a doctor for a second opinion:

• The patient's doctor may refer the patient to one or more specialists. At cancer centers, several specialists often work together as a team.
• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
• A local medical society, a nearby hospital, or a medical school can usually provide the name of specialists.
• The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at http://www.abms.org. (Click on "Who's Certified.")

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Selenium is involved in Thyroid hormone metabolism

By Dr. Wendy Wells, NMD

In addition to to its antioxidant function, Selenium is involved in Thyroid hormone metabolism. Most traditional physicians are not aware of this fact. Treating hypothyroidism can sometimes be as easy as adding this one nutrient. Many patients who are taking the drug Levothyroxine or T4, continue to have symptoms of low thyroid function (fatigue, weight gain, depression, constipation, hair loss, cold sensitivity, high cholesterol). This could be because they have a deficiency in Selenium and are not converting their T4 to T3 (active form). Iodothyronine deiodinase is an enzyme involved in thyroid hormone metabolism, specifically in the conversion of T4 to T3. There is a correlation between low Selenium levels and low T3 (active thyroid hormone) levels. Studies show there may be decreased T4 levels following selenium administration, suggesting that T4 is converted to T3 at a higher rate, hence, increasing one's metabolism. A quick way to tell if you have enought T3 is to take your Basal Body Temperature. This is done upon first awakening, before you get out of bed, place a thermometer under your arm for 3 minutes. Do this for 3 days in a row. If your temperature on average is less than 97.6, you may need more thyroid support. Other deficiencies implicated are glutathione, vitamine D, riboflavin and cobalt. Testing can be done to determine exactly which nutrient deficiencies may be present.

Get 15 minutes of free consultation with Dr. Wendy Wells, NMD.

Call 480-607-9999 to schedule an appointment.

Thyroid Education Materials

Thyroid Disease Manager, by De Groot, Hennemann, et al.
www.thyroidmanager.org

ThyroidToday.com
www.thyroidtoday.com
Complementary CME program available on CD-ROM

International Thyroid Societies

Asia and Oceania Thyroid Association
www.aota.or.kr

European Thyroid Association
www.eurothyroid.com

Latin American Thyroid Society
www.lats.org

Iodine Deficiency

International Council for the Control of Iodine Deficiency Disorders
www.iccidd.org

Endocrine-related Associations

American Association of Clinical Endocrinologists
www.aace.com

American Diabetes Association
www.diabetes.org

The Endocrine Society
www.endo-society.org

Endocrine Surgeons
www.endocrinesurgeons.org

Follow-Up to the Chornobyl (Chernobyl) Nuclear Accident

Newly Independent States Chernobyl Tissue Bank
www.swansea.ac.uk/nisctb

Government

Clinical Center, National Institutes of Health
www.cc.nih.gov

National Institutes of Health
www.nih.gov

National Cancer Institute
I-131 Thyroid Dose/Risk Calculator for NTS Fallout
http://ntsi131.nci.nih.gov/

Internet Resources for Patients

American Association of Clinical Endocrinologists
www.aace.com

Hormone Foundation (promoting understanding of hormones and disease)
www.hormone.org

Magic Foundation (support and education to families of children with growth disorders)
www.magicfoundation.org

Thyroid-Cancer.net (Johns Hopkins Thyroid Tumor Center)
www.thyroid-cancer.net

Patient Support Organizations

Thyroid Foundation of America, Inc.
One Longfellow Place
Suite 1518
Boston, MA 02114
phone (toll-free) 800 832-8321
phone 617 534-1500
fax 617 534-1515
e-mail info@allthyroid.org
web www.allthyroid.org

Founded in 1985, the Thyroid Foundation of America (TFA) was the first national association to support and educate patients with thyroid disease.

Light of Life Foundation (for patients with thyroid cancer)
PO Box 163
Manalapan, NJ 07726
phone (toll free) 1-877-LOL-NECK (565-6325)
phone 732 972-0461
fax 732 536-4824
email info@checkyourneck.com
web www.checkyourneck.com

The Light of Life Foundation, founded in 1997, strives to improve the quality of life for thyroid cancer patients, educate the public and professionals about thyroid cancer, and promote research and development to improve thyroid cancer care.

National Graves' Disease Foundation
P.O. Box 1969
Brevard, NC 28712
phone 828 877-5251
fax 828 877-5250
e-mail ngdf@citcom.net
web www.ngdf.org

Founded in 1990, the National Graves' Disease Foundation (NGDF) offers support and resources to Graves' disease patients, their families, and health care professionals. Patient members of the Foundation have contributed generously to ATA's Campaign for Thyroid Discovery. The web site features a monitored bulletin board.

ThyCa: Thyroid Cancer Survivors' Association, Inc.
P.O. Box 1545
New York, NY 10159-1545
phone (toll-free) 877 588-7904
fax 630 604-6078
e-mail thyca@thyca.org
web www.thyca.org

ThyCa: Thyroid Cancer Survivors' Association, Inc., founded in 1995, is an all-volunteer nonprofit organization, guided by a medical advisory council of renowned thyroid cancer specialists, offering support and information to thyroid cancer survivors, families, and health care professionals worldwide.

Thyroid Foundation of Canada
797 Princess Street, Ste 304
Kingston, Ontario, Canada, K7L 1G1
phone (613) 544-8364
1-800-267-8822 (IN CANADA)
fax 613 544-9731
web www.thyroid.ca

The Thyroid Foundation of Canada/La Fondation canadienne de la Thyroïde was founded in 1980 in Kingston, Ontario, Canada. Its goals are to promote awareness and education about thyroid disease and raise funds for thyroid disease research. The web site offers patient education materials in both English and French.