Doctor inspecting thyroid gland on woman's neck

Thyroid Cancer: What You Need to Know

Private: Erik K. Alexander, MD
Contributor Erik K. Alexander, MD

The thyroid is a butterfly-shaped gland located below the Adam’s apple. This gland regulates the metabolism through the production of thyroid hormone, which carries messages from the thyroid to the rest of the body through the bloodstream.

The formation of thyroid cancer

“Thyroid cancer usually appears as small lumps or nodules within the thyroid gland. The thyroid gland may also enlarge. Thyroid cancer can metastasize from the thyroid to other parts of the neck or body. Generally, the more cancer has spread, the more difficult it is to treat,” says Erik K. Alexander, MD, an endocrinologist in the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital.

There are four main types of thyroid cancer (also called thyroid carcinoma):

  • Papillary thyroid cancer (PTC): The most common form of thyroid cancer (approximately 85 percent of all cases). PTC affects more women than men. The prognosis for most patients with adequately treated papillary thyroid cancer is excellent. In many patients, this form of thyroid cancer can be cured.
  • Follicular thyroid cancer (FTC): Accounts for about 10 percent of thyroid cancer cases. It is slightly more aggressive than PTC, and can spread to other parts of the body. However, in most cases, the prognosis is excellent.
  • Medullary thyroid cancer (MTC): Accounts for roughly 2 to 4 percent of thyroid cancers. It can spread through the lymphatic system and bloodstream. In some cases, MTC may run in families and can be screened for with a blood test. This disease can be more aggressive than PTC and FTC. Surgery is the most important part of treatment.
  • Anaplastic thyroid cancer (ATC): Occurs most often among women and accounts for about 1 to 2 percent of thyroid cancer cases. This fast-growing cancer typically results in a large growth in the neck. It usually arises in previously undiagnosed cases of papillary thyroid cancer.

Symptoms of Thyroid Cancer

Symptoms of thyroid cancer may include:

  • Lump or swelling over the thyroid or fullness in the lower neck
  • Persistent cough for more than one month, without symptoms of a cold
  • Neck pain, especially in the front of the neck that can radiate up to the ears
  • Hoarseness or other changes in the voice that are persistent for more than one month
  • Swollen neck or lymph nodes that do not go away
  • Trouble breathing that feels like breathing through a straw
  • Trouble swallowing that is worsening

Risk Factors

Risk factors for thyroid cancer include:

  • Gender: Women have three times the risk of developing thyroid cancer than men.
  • Age: Thyroid cancer can occur at any age, but is more common in younger individuals who have thyroid nodules. However, nodules themselves (both benign and malignant) are more common with advanced age.
  • History of radiation exposure: Having radiation to the throat as a child increases risk.
  • Iodine deficiency: Your risk is higher if your diet is low in the mineral iodine.
  • Family history: Thyroid cancer can run in families.

“Individuals who are experiencing persistent symptoms in the front of their neck, or patients who have risk factors for thyroid carcinoma should undergo an examination of their neck by an experienced physician,” says Dr. Alexander.

Diagnosis of Thyroid Cancer

Once there is a suspicion of a mass or nodule in the thyroid, a patient is usually evaluated by an endocrinologist. This will usually lead to an ultrasound of the neck or thyroid area, which can identify if a nodule is present.

To diagnose thyroid cancer, a physician may conduct the following tests:

  • Neck exam
  • Ultrasound
  • Needle biopsy (fine needle aspiration)
  • Blood tests
  • Rarely, CT-scan or other imaging

“If a nodule is found, an ultrasound-guided fine needle aspiration is typically recommended. This is a simple, minimally invasive procedure that doesn’t cause much discomfort, but can provide a lot of valuable information, such as whether the nodule is benign or malignant, the latter of which is rare,” says Dr. Alexander.

Treatment options for thyroid cancer

If a patient has thyroid carcinoma, the first treatment approach is typically to remove all or part of the thyroid gland. A secondary treatment is often required, known as radioactive iodine therapy, which delivers radioactive iodine in pill form to destroy thyroid cancer cells. In some cases, hormone therapy may be used, an approach that blocks hormones that promote cancer growth.

In rare cases, external radiation therapy may be used. This approach directs rays of energy at a tumor to kill cancer cells. In rare cases, treatment may involve the use of chemotherapy. For advanced disease, a physician may recommend targeted therapy, which targets specific genes or proteins within cancer cells that control cancer growth and survival.

“You and your healthcare provider can discuss a treatment plan that is specific to your diagnosis. The goal is to understand the patient’s desires and needs, while proposing options that provide the optimal treatment,” says Dr. Alexander.

Treatment at Brigham and Women’s Hospital

The Thyroid Center at Brigham and Women’s Hospital is a comprehensive center for the detection and treatment of thyroid nodules and thyroid cancer. The interdisciplinary team of specialists are experts in treating recurrent and advanced thyroid cancers with the latest minimally invasive surgical approaches and advanced therapies.

– Dustin G.

Private: Erik K. Alexander, MD
Erik K. Alexander, MD

Erik K. Alexander, MD, is an endocrinologist with the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women's Hospital.

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