The thyroid is small butterfly-shaped gland that sits on the trachea below the Adam’s apple. It helps control metabolism, heart rate and body temperature. Though there are other potential causes for the following symptoms, a thyroid cancer screening could be necessary if a person feels a lump in their neck, is experiencing changes in their voice or hoarseness, has difficulty swallowing or trouble breathing, has an unexplained cough, or notices pain in the front of their neck.
A goiter is simply an enlargement of the thyroid. A goiter can occur in a thyroid that is producing too much hormone (hyperthyroidism), too little hormone (hypothyroidism), or as a result from either cancerous or benign nodules on the thyroid gland. The most common cause of a goiter worldwide is a lack of iodine; however, this is infrequently the cause in the United States as most people have sufficient amounts in their diets. Though a goiter does not necessarily indicate thyroid cancer, it is extremely important for that to be ruled out through medical evaluation.
Some risk factors cannot be controlled or avoided. Women, for instance, are three times more likely to be diagnosed with thyroid cancer than men. Also, although it can occur at any age, women in their 40s and 50s and men in their 60s and 70s appear to be at a higher risk. Sometimes thyroid cancer can be because of genetics. Having a first-degree relative, for example, that has experienced thyroid cancer increases your chances of a diagnosis. Other risk factors can be controlled; things like exposure to radiation, being overweight or obese, and a lack of iodine in the diet.
There are numerous tools available in the diagnosis of thyroid cancer that are used in conjunction with one another according to the patient’s needs and symptoms. Blood tests are used to evaluate the function of the thyroid gland; an ultrasound allows us to visualize the nodule(s); fine needle sampling is used for biopsies, which are sent to pathology; and CT or MRI is used to plan for surgery and for follow-up. Genetic testing can be done as well to rule out, or confirm, an inherited syndrome. Though dependent on the type if thyroid cancer, it is overall very survivable. In fact, for the most common cases, there is a 100% survival rate after five years following treatment.
Treatment for thyroid cancer can include surgery, radioactive iodine, chemotherapy, external beam radiation therapy, or targeted drug therapy, among other options. If surgery is indicated, the number, location, and size of the nodule(s) will help determine if a patient receives a lobectomy, where only part of the thyroid gland is removed, or a total thyroidectomy. Three historical medical innovations are responsible for the success we are able to see with thyroid surgery today; anesthesia, antisepsis, and hemostasis. Previously, thyroid surgery saw high mortality and morbidity rates, meaning many patients died and others suffered significant side effects. Today the surgery is quite safe. Now surgeons are able to minimize side effects by using smaller incisions, keeping muscles intact, looking for and avoiding parathyroid glands, and identifying and avoiding the recurrent laryngeal nerve.
Potentially, even smaller surgical incisions may be necessary, leading to the possibility of scar-less thyroid surgery. Various new procedures are in development or testing such as approaching the thyroid laparoscopically, with robotic assistance, through the mouth (transoral), or even through the armpit (transaxillary).
Dr. Mehmet Marangoz of Concord Endocrinology and Dr. Melissa Hoyt of Concord Surgical Associates recently presented on thyroid cancer at the April Concord Hospital Trust “What’s Up Doc?” Donor Lecture Series. The monthly series, supported by the Walker Lecture Fund, features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Dr. Marangoz’s and Dr. Hoyt’s presentation on Concord Hospital’s YouTube channel at: youtube.com/concordhospital.