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Thyroid cancer is a
disease that you get when abnormal cells begin to grow in your
thyroid gland. The thyroid gland is shaped like a butterfly and is located in
the front of your neck. It makes hormones that regulate the way your body uses
energy and that help your body work normally.
Thyroid cancer is an
uncommon type of cancer. Most people who have it do very well, because the
cancer is usually found early and the treatments work well. After it is
treated, thyroid cancer may come back, sometimes many years after
Experts don't know what causes thyroid cancer. But like other cancers, changes in the DNA of your cells seem to play a role. These DNA changes may include changes that are inherited as well as those that happen as you get older.
People who have been
exposed to a lot of radiation have a greater chance of getting thyroid cancer.
dental X-ray now and then will not increase your chance of getting thyroid
cancer. But past
radiation treatment of your head, neck, or chest
(especially during childhood) can put you at risk of getting thyroid cancer.
Thyroid cancer can cause
Some people may not have any symptoms. Their doctors may
find a lump or
nodule in the neck during a routine physical
If you have a
lump in your neck that could be thyroid cancer, your doctor may do a
biopsy of your thyroid gland to check for cancer
cells. A biopsy is a simple procedure in which a small piece of the thyroid
tissue is removed, usually with a needle, and then checked.
Sometimes the results of a biopsy are not clear. In this case, you may
need surgery to remove all or part of your thyroid gland before you find out if
you have thyroid cancer.
Thyroid cancer is treated with
surgery and often with radioactive iodine. It rarely needs
radiation therapy or
chemotherapy. What treatment you need depends on your
age, the type of thyroid cancer you have, and the
stage of your disease. Stage refers to how severe the
disease is and how far, if at all, the cancer has spread.
Finding out that you have cancer can be overwhelming. It's common to feel scared, sad, or even angry. Talking to others who have had thyroid cancer may help. Ask your doctor about cancer support groups in your area.
Most thyroid cancer cannot
One rare type of thyroid cancer, called
medullary thyroid cancer (MTC), runs in families. A genetic test can tell you
if you have a greater chance of getting MTC. If this test shows that you have
an increased risk, you can have your thyroid gland removed to reduce your risk for thyroid
cancer later in life.
Learning about thyroid cancer:
Living with thyroid cancer:
Experts don't know what causes thyroid cancer. Like other cancers, changes in the DNA of your cells seem to play a role. These DNA changes may include changes that are inherited as well as those that happen as you get older.
Thyroid cancer can cause many symptoms,
Some people may not have any symptoms. Their doctors may
find a lump or nodule in the neck during a routine physical exam.
is a disease that occurs when abnormal cells begin to grow in the
thyroid gland. You may notice a lump in your neck and
then go to your doctor. Or your doctor may notice a lump during a routine
physical exam or on an imaging test that you are having for another health
Thyroid cancer is usually found before the cancer has
spread very far. This means that most people who are treated for thyroid cancer
do very well. After it is treated, thyroid cancer may come back, sometimes many
years after treatment.
Before starting your treatment, your
doctor needs to find out which type of thyroid cancer you have. A
biopsy can identify your type of cancer. During a
biopsy, a small piece of thyroid tissue is removed, usually with a fine needle. The
thyroid tissue cells are then examined under a microscope.
also important to find out the
stage of your cancer. Staging is a way for your doctor
to tell how far, if at all, the cancer has spread. It also helps your doctor
decide what kind of treatment you need. Staging generally depends on the results of your radioactive iodine scan.
If you have your thyroid
gland surgically removed, you will probably need to take thyroid hormone medicine for the rest of your life to replace the hormones that were made by your thyroid. Taking it will help regulate your
metabolism and other body functions.
A risk factor for thyroid cancer is something that increases your chance of getting this cancer. Having one or more of these risk factors can make it more likely that you will get thyroid cancer. But it doesn't mean that you will definitely get it. And many people who get thyroid cancer don't have any of these risk factors.
The most common risk factors for thyroid cancer include:
One rare type of thyroid cancer, which is called
medullary thyroid cancer (MTC), runs in families. You
can inherit a specific
gene that increases your risk for
Call your doctor if you have any
of the following symptoms:
Health professionals who can evaluate your symptoms
and help determine your risk for thyroid cancer include:
Thyroid cancer is usually treated by endocrinologists,
nuclear medicine specialists,
medical oncologists, and
To prepare for your appointment, see the topic Making the Most of Your Appointment.
In order to diagnose
thyroid cancer, your doctor will ask about your
medical history and do a
Your doctor may check your vocal cords using a thin tube-like instrument that has a light (laryngoscope).
Your doctor may order a
CT scan or an
ultrasound to get a better look at your thyroid. If
your doctor thinks that the lump or nodule could be cancerous, he or she may
fine needle biopsy of the thyroid gland.
You may also
have blood tests to check the levels of your thyroid-stimulating hormone (TSH), serum calcitonin, or carcinoembryonic antigen (CEA).
Other tests may be done before, during, or after your
treatment for thyroid cancer.
In some cases, an MRI, a chest X-ray, a CT scan, or a
PET scan may be done.
If you have
medullary thyroid cancer (MTC), a
CT scan of the chest and belly and a
bone scan may also be needed.
At this time there are not any screening tests for thyroid cancer that work well for people at average risk. Talk to your doctor about whether you need
to be screened for thyroid cancer.
People who have a family
history of medullary thyroid cancer (MTC) may want to have a
genetic test to look for a gene change called an RET
mutation. Before you have the test, it is a good idea to talk with a
genetic counselor. He or she can help you understand
what your test results may mean.
The goal of treatment
for thyroid cancer is to get rid of the cancer cells in your body. How this is
done depends on your age, the
type of thyroid cancer you have, the
stage of your cancer, and your general health.
Most people have surgery to remove part or all of the thyroid gland.
Sometimes a suspicious lump or
nodule has to be surgically removed before you will
know if you have cancer or not.
After surgery, you may need
treatment with radioactive iodine to destroy any remaining thyroid tissue. When
you no longer have all or part of your thyroid gland, you will probably need to
take thyroid hormone medicines for the rest of your life. These medicines
replace necessary hormones that are normally made by the thyroid gland and
prevent you from having
hypothyroidism—too little thyroid hormone.
information on hypothyroidism, see the topic
Your treatment for
thyroid cancer may include:
If thyroid cancer is
advanced when it is diagnosed, initial treatment may also include
After treatment for
thyroid cancer, you may need to take
thyroid hormone medicine for the rest of your life to
replace the hormones that your body no longer makes. You will also need
follow-up visits with your doctor every 6 to 12 months. In addition to
scheduling regular visits, be sure to call your doctor if you notice another
lump in your neck or if you have trouble breathing or swallowing.
At your follow-up visits, your doctor may order a blood test to measure your
thyroid-stimulating hormone (TSH) level. This test
helps your doctor know if you are taking the right amount of thyroid hormone
medicine. Your doctor may order other tests, such as a
radioiodine scan, X-rays,
or a CT scan.
The side effects of surgery for thyroid cancer are usually mild and last a couple of days. Your doctor will talk to you about medicine you can take if you are having pain. You will likely need to take
thyroid hormone medicine for the rest of your life to
replace the hormones that your body no longer makes.
The most important side effect of radioactive iodine therapy (RAI) is that you will become radioactive for a period of time. Your doctor will give you written instructions to follow to prevent exposing others to radiation. For more information, see Radioactive Iodine.
Thyroid hormone therapy rarely causes side effects when you have the right dose. Too much or too little thyroid hormone can cause side effects.
Taking high doses of thyroid hormone may cause a rapid or irregular heartbeat. High doses taken over time may also cause weakness in your bones (osteoporosis).
Home treatment may help you manage your side effects.
Thyroid cancer may come back (recur). If thyroid
cancer does recur, it may be found during a physical exam, on an ultrasound, or
as a result of increasing
thyroglobulin levels. Unlike other types of recurrent
cancer, recurrent thyroid cancer is often cured, especially if it has spread
only to the
lymph nodes in the neck.
Recurrent thyroid cancer or
thyroid cancer that has spread (metastasized) to other parts of the body may be treated with surgery, radioactive iodine, radiation, or chemotherapy.
Your doctor may talk to you about being in a clinical trial. For some people with thyroid cancer, taking part in a clinical trial may be the best treatment choice. Clinical trials for thyroid cancer are looking at targeted therapy with tyrosine kinase inhibitors.
Your doctor may talk to you about palliative care. This is medical care that provides an extra layer of support for people with serious and chronic illnesses. With palliative care, you have the help of a medical team to manage your symptoms, pain, and stress. For more information, see the topic Palliative Care.
Additional information about thyroid cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/thyroid.
Most cases of thyroid cancer cannot be prevented.
You may be much more likely to get medullary thyroid cancer (MTC) if you have a gene carried by some families. A
genetic test can show if you carry this gene. If your test is positive for the gene, you may want to talk with your doctor about having your thyroid removed to prevent getting thyroid cancer later in life.
There are certain things you can do to
feel better or to reduce the side effects of your treatment for
thyroid cancer. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. If you have chemotherapy, your doctor may also give you medicines to control and prevent nausea and vomiting.
You can try home treatments:
Having cancer can be very stressful, and it may feel overwhelming to face the challenges in front of you. Finding new ways of coping with the symptoms of stress may improve your overall quality of life. These ideas may help:
Having cancer can change your life in many ways. For support in managing these changes, see the topic
Getting Support When You Have Cancer.
thyroid cancer is generally treated with surgery,
medicines may also be needed to treat the cancer and to replace thyroid
Medicines to treat thyroid cancer include:
After you have your thyroid
surgically removed, you may have to wait several weeks before you have
radioactive iodine treatment to destroy any remaining thyroid tissue. During
the waiting period, you may have symptoms of hypothyroidism such as fatigue,
weakness, weight gain, depression, memory problems, or constipation.
doctor may also put you on a low-iodine diet before treating you with radioactive iodine. If you are
on a low-iodine diet, you cannot eat foods that contain a lot of iodine, such
as iodized salt, seafood, and baked goods. Depleting your body of iodine may make radioactive
iodine treatment more effective, because your cells become "hungry" for
After surgery, you may need to take thyroid hormone replacement pills for the rest of your life. Taking these pills rarely causes side effects if you are taking the right amount. But too much thyroid hormone can cause you to feel hot and sweaty. It can also cause weight loss, a fast heart rate, chest pain, cramps, or diarrhea. And too little thyroid hormone can cause you to feel cold and tired. It can also cause weight gain, dry skin, or dry hair.1
Most people with thyroid cancer have surgery to remove the cancer. You may have part or all of your thyroid removed.
The kind of surgery you have may depend on your age, the type of cancer you have, how much the cancer has spread, and your general health.
During surgery, lymph nodes in the neck may also be
removed and tested for cancer cells (lymphadenectomy). If thyroid cancer has spread to the lymph
radioactive iodine will be used to destroy the
remaining cancer cells.
Most thyroid cancers grow and
spread so slowly that you can delay surgery for a short time if you need to. If
you choose to postpone surgery, your thyroid cancer should be watched closely
Surgery to remove only
the part of the thyroid gland that contains cancer (lobectomy) is less
complicated than total thyroidectomy and less likely to lead to hypothyroidism.
But thyroid cancer comes back (recurs) after lobectomy more often than it does
after total thyroidectomy.
If you and your doctor decide that you need surgery, it is important to have the procedure done by a highly skilled surgeon at a hospital that has a good success rate. There are fewer problems from surgery when a person has a skilled and experienced surgeon.2
Radiation treatment uses high-energy X-rays to kill cancer cells and shrink tumors. It is rarely used for thyroid cancer.
People sometimes use complementary therapies
along with medical treatment to help relieve symptoms and side effects of
cancer treatments. Some of the complementary therapies that may be helpful
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free number have information about services and activities
in local areas and can provide referrals to local ACS divisions.
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
National Cancer Institute (2012). What You Need to Know About Thyroid Cancer. Available online: http://www.cancer.gov/cancertopics/wyntk/thyroid.
National Comprehensive Cancer Network (2013). Thyroid carcinoma. NCCN Clinical Practice Guidelines in Oncology, version 1.2013. Available online: http://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf.
Other Works Consulted
American Cancer Society (2013). Cancer Facts and Figures 2013. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2013.
American Thyroid Association Guidelines Taskforce (2009). Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 19(11): 1167–1214. Also available online: http://thyroidguidelines.net/revised/taskforce.
Carling T, Udelsman R (2011). Thyroid tumors. In VT DeVita Jr et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., pp. 1457–1472. Philadephia: Lippincott Williams and Wilkins.
Cooper DS, et al. (2007). The thyroid gland. In DG
Gardner, D Shoback, eds., Greenspan's Basic and Clinical Endocrinology, 8th ed., pp. 209–280. New York: McGraw-Hill.
National Cancer Institute (2013). Thyroid Cancer Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/thyroid/HealthProfessional.
National Cancer Institute (2013). Thyroid Cancer Treatment (PDQ)—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/thyroid/Patient.
July 12, 2013
E. Gregory Thompson, MD - Internal Medicine & Matthew I. Kim, MD - Endocrinology
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