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Thyroid Cancer: Diagnosis and Treatment

The thyroid is a small butterfly-shaped gland located in the neck. According to Dr. Peter Tate of Lexington Surgeons, it is a general metabolic facilitator.

“The thyroid seems to have some function in all the body’s metabolic processes,” he said. Common problems associated with the gland include hyperthyroidism and hypothyroidism. Patients with hyperthyroidism, where the thyroid functions too much, present as jittery, with high heart rates and arrhythmias of the heart. Patients with hypothyroidism may be sluggish, tired and retain water.

“When a patient comes in complaining of tiredness or fatigue, the thyroid is always one thing to check,” Tate said.

Palpating the thyroid should be a routine part of every physical examination by primary care providers, he emphasized. This is one way to diagnose thyroid cancer. “Most of the time there aren’t many symptoms of thyroid cancer in the way of discomfort,” Tate said. “The usual way of diagnosing it is when it’s felt by the patient or the examining doctor upon a physical examination. You can feel a mass or lump there.” Tate said it is a misconception that thyroid cancer interferes with swallowing.

In addition to fatigue and lethargy, another symptom of thyroid cancer is swelling in the neck. When a mass or lump is detected, an ultrasound should be performed. “The ultrasound can tell you if the mass is solid or a cyst,” Tate said. “If it’s a cyst, we aren’t really as concerned about it being malignant.” If a solid mass is 1 centimeter or larger in size, the physician should immediately recommend a needle-directed biopsy.

Depending on the results of the biopsy, all or part of the thyroid may be removed. “Sometimes we take out half the gland to diagnosis a tumor,” Tate said. The tissue is sent for frozen section. If it is benign, the other portion of the gland does not need to be removed.

It is possible to live without the thyroid. When a thyroidectomy is performed, the patient is given thyroid hormone replacement medication that he or she will have to take for the rest of his or her life.

“It’s very easy to give thyroid hormone replacement as an oral pill,” Tate said. “That way the patient will maintain good thyroid function.”

Thyroid cancer is more common in women than men and can occur at almost any age. The etiology is unknown. One very rare type of thyroid cancer may be familial, but for the most part it is not an inherited problem. Thyroid cancer can metastasize, but this is not very common and does not cause a lot of difficulty for the patient.

Treatment for thyroid cancer is surgical, requiring a relatively small incision in the neck. “It’s not particularly painful and recovery is quick,” Tate said. “Overall the prognosis is very good except for a few rare types, and it’s fairly easy to treat.”

Following surgery, the patient is treated with radioactive iodine. This oral medication can cause suppression of all the thyroid tissue in the body. Usually it is a one-time treatment. Follow-up includes physical examination, laboratory evaluation of thyroid function and occasionally an ultrasound scan or X-ray.

By Tanya J. Tyler, Associate Editor




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