Most thyroid cancers do not produce any symptoms. However, if large enough in size (and this is different for everyone), it most commonly causing pressure in front of the neck, difficult or uncomfortable swallowing, problems breathing when lying flat, a new persistent cough, or visible protrusion in the neck. More advanced cancers may also cause a permanent change in your voice.
Most types of thyroid cancer are very treatable and patients go on to live long, healthy, normal lives.
The only risk factors for thyroid cancer are a history of radiation to the head and neck and a personal or family history of an endocrine tumor syndrome, specifically Multiple Endocrine Neoplasia types 2A and 2B. Thyroid cancer can rarely be a part of other cancer syndromes.
Most patients should undergo thyroid surgery to remove the thyroid cancer. The extent of your surgery (thyroid lobectomy vs total thyroidectomy) will depend on the size of your cancer, if the thyroid cancer is extending outside of the thyroid gland, and if you have nodules in your other thyroid lobe.
After a total thyroidectomy, some intermediate-high risk patients with more aggressive cancers (not medullary) will be recommended to additional treatment with radioactive iodine.
This strategy is being offered to select patients (mostly ‘older’) with small, 1cm or less tumors. Saint Johns does have an active surveillance program and if you think you may be a candidate, you can discuss with your doctor
All thyroid cancer patients that have had a total thyroidectomy will be put on brand name thyroid medication. Very high risk patients will be given larger, suppressive doses of thyroid hormone replacement. This will help prevent any remaining thyroid tissue or cells from growing back at all or in the form of cancer. Your TSH levels will be monitored by your endocrinologists to obtain your optimum dose.
PTC is the most common type of thyroid cancer.
Garden variety papillary cancer is usually very slow growing and can be removed surgically. Though the cancer often metastasizes to the surrounding lymph nodes, this generally does not affect prognosis and most patients do very well.
Follicular (FTC) and Hurthle cell thyroid cancer are two different types of cancer but discussed together make up 5-10% of all cancers.
The only way to have a definitive diagnosis for these types of thyroid cancers is to remove the nodule and examine the capsule under the microscope for invasion. Follicular thyroid cancer tends to spread through the blood stream to the lungs and bone and not to the lymph nodes. Hurthle Cell thyroid cancer can spread to either the lymph nodes or organs. It is slightly more aggressive than PTC.
Rare (3-10%) type of thyroid cancer.
This is the type of thyroid cancer in patients with hereditary endocrine tumor syndromes and is more aggressive than PTC and FTC. Surgery is the only form of treatment, so a good first operation is important. All patients should have a total thyroidectomy (their entire thyroid removed) as part of their treatment.
Accounts for about 1% of all thyroid cancers and is the most aggressive type of thyroid cancer.
It usually occurs in older patients that present with a very rapidly growing hard neck mass and has a poor prognosis.
- NIFTP – Noninvasive Follicular Variant of Papillary thyroid cancer: this is a newer classification. These tumors still need to be removed surgically, but as the ‘cancer’ has not yet spread, a limited surgical approach (thyroid lobectomy with no additional treatment is more than sufficient.
- Minimally Invasive FTC: can be thought of as a ‘contained’ FTC. These tumors still need to be removed surgically, but as the ‘cancer’ has not yet spread, a limited surgical approach (thyroid lobectomy with no additional treatment is more than sufficient.