THYROID NEOPLASMS

The thyroid is a gland in the neck that lies in front of and to the sides of the Adam's apple. The thyroid produces hormones that regulate your metabolism. The cells that make up the thyroid gland are called follicular and parafollicular cells. Thyroid cancers (neoplasms) are generally divided into those originating from the follicular cells (papillary, follicular, and anaplastic) and those originating from the parafollicular cells (medullary carcinoma of the thyroid). Approximately 10,000 new cases of thyroid cancer are diagnosed each year in the United States.

Thyroid cancer is not contagious. Radiation exposure poses a risk for this cancer, especially among children who undergo radiation therapy to the head, neck, or upper chest during infancy or childhood.

In most instances, a thyroid nodule or lump is the first sign of the cancer. For a definite diagnosis, cells are removed from the lump (fine needle aspiration) and examined with a microscope. Thyroid cancers if detected and diagnosed early, before they spread beyond the thyroid gland, can be cured. The anaplastic type of thyroid cancer, however, is aggressive and resistant to treatment.

A lump in the neck is the first sign. As thyroid cancers grow, they usually spread to nearby structures, causing hoarseness, difficulty swallowing, swollen lymph glands, and neck pain.

Sometimes the cells removed by fine needle aspiration can suggest cancer but the findings are not conclusive. In this case the physician orders a thyroid scan and an ultrasound scan of the thyroid. These two studies give clues about whether the lump is cancerous. Once the diagnosis of thyroid cancer is confirmed, treatment can be a surgical procedure, radiation therapy, or chemotherapy, depending on whether the cancer has spread beyond the thyroid gland.

Removal of the thyroid gland is called thyroidectomy. Surgical treatment is important because it helps determine the extent of the disease, whether the cancer has spread to nearby lymph nodes, and the type of thyroid cancer found. Complications of surgical treatment are injury to the vocal cords and removal of the small glands behind the thyroid gland called the parathyroid glands.

The nuclear material called radioactive iodine can be used after surgical treatment or to treat patients with known spread of the cancer to kill the cancer cells. A side effect of use of radioactive iodine is that it kills normal thyroid cells in addition to cancer cells.

Chemotherapy is used to treat patients who do not respond to surgical treatment or therapy with radioactive iodine. The side effects of chemotherapy are easy bruising, bleeding, infection, nausea, vomiting, and hair loss.

• Take the prescribed medication after surgical treatment. Because your thyroid gland is removed, you no longer produce thyroid hormones and must take thyroid supplements.
• Find a surgeon who is experienced in thyroid operations. Surgical treatment is important, and the procedure may vary depending on the size of the tumor.
• Understand the importance of nutrition and exercise after surgical treatment.
• Remember the earlier thyroid cancer is detected, the higher are the chances of cure with treatment. It is important to evaluate any lump in the neck to look for thyroid cancer.

• Do not miss follow-up appointments with your physicians. Careful neck examinations are performed to look for lumps that may have recurred. Blood tests and thyroid scans are performed to look for evidence that the cancer has returned.
• Do not forget there are different types of thyroid cancers. The papillary type is the most common and occurs among young persons. The follicular type occurs among an older group of patients. The medullary type can occur sporadically or in a hereditary form. The hereditary form tends to be associated with other diseases that produce excess hormones (adrenaline, parathyroid hormone) called pheochromocytoma and hyperparathyroidism. A blood test (calcitonin level) helps determine whether the medullary type of thyroid cancer has returned after surgical treatment.

• If you notice a lump in your neck.
• If you have hoarseness.
• If you have hand tremors (hands shaking), diarrhea, sweats, and palpitations. This may mean you are taking too much thyroid medication after surgical treatment.
• If you have an intolerance to cold, a raspy voice, constipation, loss of hair over the eyebrows along with weight gain. This may mean you are taking too little thyroid medication.
• If after an operation you notice numbness around your mouth, the tips of your fingers, and feet along with muscle spasms of your hands, legs, or face. This can indicate a low calcium level. This can happen when the parathyroid glands are removed with the thyroid gland.

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