Hashimoto's Thyroiditis |
Hyperthyroidism |
Hypothyroidism |
Cancer |
Nodules
Thyroid Carcinoma...............................................................................................................See a Real Story
What is thyroid cancer?
The thyroid gland is located in the lower front of the neck, below the voicebox (larynx) located in the upper part of the neck, and above the collarbones. Thyroid cancer (carcinoma) usually appears as a painless lump in this area. In most cases, the lump affects only one side, and the results of thyroid function tests (blood tests) are usually normal.
There are four main types of thyroid cancer (papillary, follicular, medullary and anaplastic). Since the vast majority are either papillary or follicular, and these are the only two types treatable with radioiodine, this brochure will focus on these two types.
What are the features of thyroid cancer?
Many patients with thyroid cancer have no symptoms whatsoever, and are found by chance to have a lump in the thyroid gland on a routine physical exam or an imaging study of the neck done for unrelated reasons (CT or MRI scan of spine or chest, carotid ultrasound, etc). Some patients with thyroid cancer become aware of a gradually enlarging lump in the front portion of the neck, which usually moves with swallowing. Occasionally, the lump may cause a feeling of pressure. Obviously, finding a lump in the neck should be brought to the attention of your physician, even in the absence of symptoms.
What are the causes of thyroid cancer?
As with many types of cancer, the specific reason for developing thyroid cancer remains a mystery in the vast majority of patients. Major risk factors are:
• External radiation to the head or neck, especially during childhood
• Genetic predisposition (the influence of heredity), particularly for the medullary type of thyroid cancer
How is thyroid cancer diagnosed?
First, your physician takes a detailed history and performs a careful physical examination, especially of the thyroid gland. The best diagnostic approach for a specific patient will be determined by your physician after careful consideration of all the facts. The tests available to your physician for evaluation of the thyroid lump include, but are not limited to, the following:
• Fine-needle aspiration biopsy– this is usually done first and, if positive, significantly reduces the need for more
elaborate and expensive testing
• Ultrasonography– this may be required for guidance of the fine needle biopsy if the nodule is difficult to feel
• Thyroid scan – this can be done to see if the mass is capable of concentrating radioiodine, particularly in those rare patients with associated hyperthyroidism
• Blood studies
How is thyroid cancer treated?
Fortunately, most types of thyroid cancer can be diagnosed early and cured completely, but a thoughtful and comprehensive investigation is necessary. If thyroid cancer is suspected after review of all the information, referral to an experienced thyroid surgeon is recommended.
The usual approach is to remove the side of the thyroid containing the lump. If cancer is confirmed, further consultation with the endocrinologist is appropriate. Additional surgery to remove the remaining tissue and radioactive iodine treatment are usually recommended in order to destroy any remaining malignant thyroid cells and to reduce the risk of recurrence of this disease.
Radioactive iodine treatment should never be given to a pregnant woman! Small amounts of radioactive iodine will also be excreted in breast milk. Since radioiodine could permanently damage the infant’s thyroid, breast-feeding is not allowed. If radioiodine is inadvertently administered to a woman who is subsequently discovered to be pregnant, the advisability of terminating the pregnancy should be discussed with the patient’s obstetrician and endocrinologist. Therefore, prior to administering diagnostic or therapeutic radioiodine treatment, pregnancy testing is mandatory whenever pregnancy is possible.
After radioiodine therapy, thyroid medication (levothyroxine) should be started and dosed to replace the function of the thyroid and to decrease the likelihood of cancer recurrence. Periodic monitoring is supervised by the endocrinologist, and may include ultrasound examinations, radioiodine body scans, and periodic testing of a blood protein called thyroglobulin, which is found in normal thyroid cells but can also be produced by thyroid cancer cells.
The optimal frequency of further monitoring studies to be certain that the cancer has not recurred will be determined by your physician. Fortunately, most types of thyroid cancer have a very good prognosis when diagnosed early and treated by a physician who is familiar with its management.
Real Story - Nicole Buffa
A tri-athlete. An English teacher. A wife. An actress. A thyroid cancer survivor. An expectant mother of twins. A model. A
New Yorker. A counselor for those diagnosed with thyroid cancer.
Nicole Buffa, 37, wears many different hats (lazy isn’t one of them) and the one closest to her heart is the role that thyroid cancer played in her life.
It began in 2005. Nicole was experiencing a pain in her ear. While having it examined, the ENT doctor noticed a lump in her throat and, based on the blood work he did, recommended a biopsy.
“It was total luck that he noticed it, considering that the pain in my ear isn’t typically a symptom for a thyroid problem nor did I have a particularly enlarged thyroid gland,” Nicole said. “I decided to heed his advice.”
“An ultrasound found calcifications,” Nicole said. “Several samples of my lump, which were taken with a thin needle, quickly determined that I had papillary thyroid cancer.” In 2006, it is estimated that 30,000 patients were diagnosed with thyroid cancer. Roughly 75 to 80 percent were papillary, which tends to grow slowly and is easy to treat when diagnosed early.
Nicole underwent treatment at Beth Israel Medical Center in New York City. In one five-hour surgery, her head and neck surgeon performed a thyroidectomy to completely remove her thyroid. He also performed a left-neck dissection, removing 78 lymph nodes of which not all were infected.
A month after the surgery, Nicole underwent radioactive iodine (RAI) therapy. This process is recommended in order to destroy any remaining malignant thyroid cells and to reduce the risk of recurrence of thyroid cancer.
“The radioactive iodine experience was a bit like being in a Star Wars movie,” Nicole said. “Doctors in radiation suits administering a pill. It felt like pure science fiction.”
One of her major concerns was the amount of RAI she was receiving. “Before surgery, the cancer was quite extensive, and my concern was the level of RAI treatment I received could compromise my egg supply,” Nicole said. “I believe Dr. Urken’s microscopic surgical precision in removing the cancer allowed me to receive a lesser dose of RAI.
After the RAI treatment, Nicole began taking a synthetic thyroid hormone to replace missing thyroid hormone and treat 
thyroid cancer.
“Stabilizing my thyroid was one of the more difficult aspects of this whole process since one’s thyroid controls their metabolism. Initially, endocrinologists look to suppress cancer growth by putting you on a higher dose of thyroid medication than normal. Patients tend to like this idea as a higher metabolism usually equates to weight loss. However, it is a misconception since your body is working so hard it actually starts breaking down muscle tissue and this makes you flabby. I even gained weight. Upon trying to become pregnant my dose was lowered by a significant amount and I ended up losing weight. The antithesis of what I would have expected. I now feel great”
Nicole ran her first triathlon, raising roughly $4,000 for Leukemia and Lymphoma Society’s event in September, 2006.
“I also volunteer to help women diagnosed with thyroid cancer,” Nicole said. “Many people hear the “C” word and start freaking out, without realizing how treatable the condition is. I share my experiences to give them strength.”
Recently, Nicole found out she was pregnant with twins. An “amazing” event she believes is possible thanks to the great care she had from her doctors and surgeons when she battled thyroid cancer in addition to medical technology in the field of fertility.
Motherhood is a chapter in her life she’s eager to take on, citing that it’s not quite like training for a triathlon, “I anticipate it’s going to be far more exhausting.”
