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Thyroid cancer

Thyroid cancer is a common cancer, and the outlook for people with it is usually excellent. Most thyroid cancer is easily cured with surgery, and it seldom causes pain or disability. Simple, effective and well-tolerated treatment is available for the most common forms.

What are the symptoms of thyroid cancer?

The first sign of thyroid cancer is usually a lump (nodule) in your thyroid.

Many people don't have any other symptoms. A few people with thyroid cancer complain of pain in the neck, jaw or ear. If the cancer is large enough, it may cause difficulty breathing, choking, or shortness of breath if it is pressing on your windpipe. Occasionally it can cause a hoarse voice if it affects the nerve to your voice box.

What causes thyroid cancer?

We don't know what causes most thyroid cancer. It is more common in people whose thyroid gland has been exposed to radiation, who have a family history of thyroid cancer and are older than 45. Routine X-rays (such as dental X-rays, chest X-rays and mammograms) don't cause thyroid cancer.

How is it diagnosed?

We diagnose thyroid cancer by taking a sample of the thyroid nodule (called a fine needle aspirate, or FNA), or after removing the nodule during surgery. Thyroid nodules are very common, but less than one in 10 are thyroid cancer.

What are the types of thyroid cancer?

Papillary thyroid cancer is the most common type, making up about 80% of all thyroid cancers. It can happen at any age and tends to grow slowly, spreading first to the lymph glands in your neck. It usually has an excellent outlook (prognosis), even after it has spread to the lymph nodes.

Follicular thyroid cancer makes up about 15% of all thyroid cancers. It tends to happen in slightly older people. Follicular thyroid cancer can grow into the lymph nodes in the neck. It may also grow into blood vessels and then spread to other parts of the body, such as the lungs and bones.

Medullary thyroid cancer accounts for about 5% of all thyroid cancers. It is more likely to run in families and may be associated with other endocrine (hormone) problems. It may also be associated with a faulty gene. In these cases, a blood test can screen family members for the gene defect (called a RET mutation).

Poorly differentiated thyroid cancer is uncommon and is more difficult to treat.

Anaplastic thyroid cancer is the most severe and aggressive form of thyroid cancer and the hardest to treat. Fortunately, it is rare.

What is the treatment for thyroid cancer?

Surgery is the main treatment for all thyroid cancer.

Usually the surgeon removes all the thyroid gland, or as much of it as possible. After surgery, you will need to take thyroid hormone for the rest of your life.

Surgery often cures the thyroid cancer, especially if the tumour is small. If the cancer is large, if it has spread to lymph nodes, or there is a high risk your cancer will come back, you might also have radioiodine to destroy any thyroid or thyroid cancer cells that are left.

Radioiodine therapy is one reason why papillary and follicular thyroid cancers usually have an excellent outcome. It can seek out and destroy thyroid cancer cells, without damaging other tissues in your body.

If your doctor recommends radioiodine therapy, you will be made hypothyroid for a short time, because you need high levels of TSH (thyroid stimulating hormone) for it to work. (You will either not start thyroid hormone pills after your thyroid gland is removed or stop your thyroid hormone pills, if you are already on medication.) You will also go on a low-iodine diet for three weeks before the treatment.

Your doctor might prescribe T3 thyroid hormone to take while you are becoming hypothyroid, to decrease your symptoms. After you have had the radioiodine, you can start the thyroid pills again.

Radioiodine is safe, has few side effects, and has cured cases of thyroid cancer that had spread to the lungs. Depending on how much radioiodine you have, you may need to spend time in isolation in hospital, so you don't expose others to radiation.

What follow-up can I expect?

You will need regular follow-up, because thyroid cancer returns in 10 to 20% of patients (sometimes many years after treatment). These follow-up visits will include physical examination as well as blood tests. You will have blood tests for your thyroid hormone levels and to measure thyroglobulin, as this can show if the cancer has returned.

Your doctor might also arrange an ultrasound of your neck, to look for any sign the cancer is returning.

What is the outlook (prognosis) of thyroid cancer?

The outlook is usually very good. In general, it is better in younger people than in those over 45. People with papillary thyroid cancer whose tumour hasn't spread outside the thyroid gland have an excellent outlook – 25 years later, only 1% of them will have died as a result of the cancer. The outlook is not quite as good for patients over 45 or who have tumours larger than 4 cm in diameter. Still, even people who can't be cured can live a long time and feel well despite their cancer.

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Written by the Department of Endocrinology, Christchurch Hospital. Adapted by HealthInfo clinical advisers. Last reviewed January 2015.

See also:

Radioiodine for thyroid cancer

Preparing for your operation

Having an anaesthetic

Radioiodine image courtesy of digitalart at Neck examination © Can Stock Photo Inc. / justmeyo.

Page reference: 227101

Review key: HITHC-70792