Thyroid cancer

  • Definition
    • Thyroid cancer is a cancer that starts in the thyroid gland. The thyroid gland is located inside the front of your lower neck.

  • Alternative Names
    • Tumor - thyroid; Cancer - thyroid; Nodule - thyroid cancer; Papillary thyroid carcinoma; Medullary thyroid carcinoma; Anaplastic thyroid carcinoma; Follicular thyroid cancer

  • Causes
    • Thyroid cancer can occur in people of any age.

      Radiation increases the risk of developing thyroid cancer. Exposure may occur from:

      • Radiation therapy to the neck (especially in childhood)
      • Radiation exposure from nuclear plant disasters

      Other risk factors are a family history of thyroid cancer and chronic goiter (enlarged thyroid).

      There are several types of thyroid cancer:

      • Anaplastic carcinoma (also called giant and spindle cell cancer) is the most dangerous form of thyroid cancer. It is rare, and spreads quickly.
      • Follicular tumor is more likely to come back and spread.
      • Medullary carcinoma is a cancer of non-thyroid cells that are normally present in the thyroid gland. This form of thyroid cancer tends to occur in families.
      • Papillary carcinoma is the most common type, and it usually affects women of childbearing age. It spreads slowly and is the least dangerous type of thyroid cancer.
  • Symptoms
    • Symptoms vary depending on the type of thyroid cancer, but may include:

      • Cough
      • Difficulty swallowing
      • Enlargement of the thyroid gland
      • Hoarseness or changing voice
      • Neck swelling
      • Thyroid lump (nodule)
  • Exams and Tests
    • Your health care provider will perform a physical exam. This may reveal a lump in the thyroid, or swollen lymph nodes in the neck.

      The following tests may be done:

  • Treatment
    • Treatment depends on the type of thyroid cancer.

      Surgery is most often done. The entire thyroid gland is usually removed. If the doctor suspects that the cancer has spread to lymph nodes in the neck, these will also be removed.

      Radiation therapy may be done with or without surgery. It may be performed by:

      • Aiming external beam (x-ray) radiation at the thyroid
      • Taking radioactive iodine by mouth

      After treatment for thyroid cancer, you must take thyroid hormone pills for the rest of your life. The dosage is usually slightly higher than what your body needs. This helps keep the cancer from coming back. The pills also replace the thyroid hormone your body needs to function normally.

      If the cancer does not respond to surgery or radiation, and has spread to other parts of the body, chemotherapy or targeted therapy may be used. These are only effective for a small number of people.

  • Support Groups
    • You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

  • Possible Complications
    • Complications of thyroid cancer may include:

      • Injury to the voice box and hoarseness after thyroid surgery
      • Low calcium level from accidental removal of the parathyroid glands during surgery
      • Spread of the cancer to the lungs, bones, or other parts of the body
  • When to Contact a Medical Professional
    • Call your provider if you notice a lump in your neck.

  • Prevention
    • There is no known prevention. Awareness of risk (such as previous radiation therapy to the neck) can allow earlier diagnosis and treatment.

      Sometimes, people with family histories and genetic mutations related to thyroid cancer will have their thyroid gland removed to prevent cancer.

  • References
    • Lai SY, Mandel SJ, Weber RS. Management of thyroid neoplasms. In: Flint PW, Haughey BH, Lund VJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 123.

      National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: thyroid carcinoma. Updated 2016. Accessed March 17, 2016.

      PDQ thyroid cancer treatment. National Cancer Institute Web site. Updated February 4, 2016. Accessed March 17, 2016.

      Schneider DF, Mazeh H, Lubner SJ, et al. Cancer of the endocrine system. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 71.