Q & A with Dr. Clifford Gelman
National Health Review
Over the past 10 years, studies have shown that thyroid cancer has been increasing in the United States especially in women. Women are three times more likely to be diagnosed with thyroid cancer than men. Learning about thyroid cancer and its treatments can help you take an active part in your own care.
What is the function of the thyroid gland?
The thyroid is the butterfly shaped gland that is located just below the Adam’s apple in the throat. It has a right lobe, a left lobe, and a small piece of tissue that connects the two, called the isthmus. The thyroid acts like the body’s thermostat. It makes iodine containing hormones called T3 and T4 which circulate all over the body to regulate heart rate, blood pressure, and how cells use nutrients for energy.
What is thyroid cancer?
Thyroid cancer is the abnormal uncontrolled growth of cells in the thyroid gland, that have the potential to break away and spread to adjacent tissues or other parts of the body. Most growths or tumors of the thyroid (90%) are not cancer (benign). There are four types of thyroid cancer, papillary, follicular, medullary, and anaplastic.
What causes thyroid cancer?
Some forms of thyroid cancer can be hereditary, especially those associated with certain tumor syndromes like MEN2 and Familial Polyposis Syndrome. Certain thyroid conditions can be predisposing factors for thyroid cancer, such as thyroiditis and nodular goiters. The thyroid is especially sensitive to radiation and exposure to radiation is an increased risk factor for the most common types of thyroid cancer. Routine diagnostic x-rays, such as dental x-rays or chest x-rays use very low doses of radiation and their benefits usually outweigh their risks. Repeated exposure however, could be
harmful, so it’s a good idea to talk with your dentist and doctor about the need for each
x-ray and to ask about the use of shields such as a thyroid lead collar when getting x-rays. Protective thyroid collars are available for use during mammography at TEPAS Breast Center.
Having one or more risk factors does not mean that a person will get thyroid cancer. Most people who have risk factors never develop cancer. However, your doctor may use the risk factors obtained from your personal history to help determine what if any diagnostic tests may be recommended.
What are the symptoms of thyroid cancer?
Thyroid cancer often causes a lump or nodule that can be felt in the neck. Most nodules though (90%) are benign or not cancer. Difficulty swallowing, hoarseness, or swollen neck lymph nodes can be symptoms of thyroid cancer as well. However, most often these symptoms are not due to cancer. Anyone with symptoms that do not go away after a couple of weeks should see their doctor. Often, thyroid cancer is found incidentally when a thyroid nodule is seen on an x-ray done for another reason and there are no symptoms at all.
How is thyroid cancer diagnosed?
Diagnostic tests such as ultrasound can be used to visualize an abnormal thyroid nodule. Your doctor may also recommend a thyroid nuclear scan to help to help determine the risk that it might be cancer. The only way to tell for sure if a thyroid nodule is cancer is to do a biopsy. Ultrasounds and biopsies are regularly done at TEPAS Healthcare. Using local anesthesia, a needle is introduced into the nodule and a sample of the tissue is evaluated by the pathologist. The pathologist can tell whether the nodule is benign, a cancer, or whether more tissue is needed to make the diagnosis. Often, the nodule or portion of the thyroid containing the nodule must be removed surgically.
What is the treatment for thyroid cancer?
The treatment depends on the type of thyroid cancer, the size of the nodule, and patient risk factors such as increased age, history of radiation, or genetic factors. Surgical removal of all or part of the thyroid is the mainstay of treatment. It usually requires an overnight hospital stay but is sometimes done as an outpatient in selected patients. Experienced thyroid surgeons can use plastic surgery techniques to minimize the surgical scar. New technology using robotic surgery with no neck scar is currently being evaluated at research centers. Thyroid hormone is given to patients who have had their thyroid removed. It also is used to suppress the growth of cancer cells in patients with thyroid cancer. It is very well tolerated and requires one pill a day. Several weeks after beginning treatment, a blood test called TSH is required to determine the correct dose of thyroid hormone. Radioactive iodine treatment is given after surgery to reduce the risk of recurrence in all but very low risk patients. This involves an oral dose of radioactive iodine. The iodine is only taken up by thyroid cells and thyroid cancer cells and the radiation will attack any residual microscopic cancer cell left in the body after surgery.
What is the prognosis?
Papillary and follicular cancers are the most common types of thyroid cancer (75%) and have a very high cure rate if diagnosed early, greater than 90%. Medullary cancer of the thyroid can be very successfully treated and controlled if treated before it spreads. Unfortunately, anaplastic cancer of the thyroid which occurs most often in the over 60 age group is very aggressive and usually survival is low. This fortunately is the rarest form of thyroid cancer (1%).
What type of follow up is needed?
Your doctor can use certain blood tests such as T4 and thyroglobulin levels to determine if the cancer might be recurring. This is usually every three to six months initially. A nuclear thyroid scan is also used to for cancer recurrence after the thyroid has been removed. An annual chest x-ray is also recommended. It is important that thyroid cancer patients follow up regularly with their doctors.
Although thyroid cancer is increasing, it is one of the most treatable and curable cancers if diagnosed early. With use of ultrasound, which is quick and painless, it is very easy to diagnose abnormal thyroid nodules. Many thyroid surgeons have the ability to do ultrasound evaluations in their offices and can also perform biopsies if needed. Regular communication with your doctor is important in making informed decisions about your health care.
Clifford Gelman, MD, FACS, is a board-certified general, breast, thyroid and parathyroid surgeon. He has 16 years of surgery experience and is currently accepting new and established patients.
TEPAS Healthcare offers the high-quality medical expertise, cutting-edge technology, and compassionate care in a setting conducive to healing. Services include general and laparoscopic surgery, endoscopy and colonoscopy, digital mammography, breast cancer surgery, surgical oncology, thyroid, vascular and endovascular surgery, aneurysm screening and surgery, varicose and spider vein removal, Botox, IPL, and laser hair removal.
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