Thyroid Cancer and monitoring

Thyroid cancer is an uncommon cancer. It usually presents as an asymmetrical swelling in the neck, which slowly increases in size and can occur at any age from about 20.

The commonest type of thyroid cancer is the so called differentiated type - either papillary or follicular. Well-differentiated thyroid cancers account for about 90% of all thyroid malignancies and usually they are associated with an excellent outlook. Although we do not know exactly what causes these well-differentiated cancers to grow, they are more likely to develop in patients who have received x-ray treatments in childhood for enlarged tonsils, enlarged thymus glands, acne, and occasionally for other malignancies such as Hodgkin’s disease or tuberculosis. Routine diagnostic x-rays (like chest x-rays, dental x-rays, or thyroid scans) do NOT cause such thyroid cancer.

The primary therapy for all forms of thyroid cancer is surgery. For more aggressive papillary and follicular cancers, the generally accepted approach is to remove the entire thyroid gland, or as much of it as can be safely removed. For intrathyroidal papillary cancer and minimally invasive follicular thyroid cancer, a debate continues as to the merits of total thyroid removal versus the removal of just one lobe and the tissue connecting the two thyroid lobes, known as the isthmus. Since the outlook is so good for intrathyroidal papillary cancer and minimally invasive follicular cancer, a clear policy has yet to be reached nationally whether to remove the whole gland (called total thyroidectomy) or the side of the thyroid gland that contains the cancer (called a thyroid lobectomy). Therefore there are no absolute rules for the management of these less aggressive cancers and your surgeon will discuss this with you so that you are fully informed and take part in the decision process.

Following surgery, the patient usually requires to receive radio-active iodine. These tumours, like normal thyroid tissue, can concentrate iodine. If radioactive iodine is given, scanning by a gamma camera will show any normal thyroid tissue, or in its absence any residual thyroid cancer. A higher dose of radioactive iodine will eradicate any residual thyroid tissue (an "ablative radioiodine" dose) and any residual cancer. Thus patients are usually scanned after surgery then proceed to treatment will radioactive iodine. The latter is administered as a capsule, but the radioactivity is absorbed throughout the body, and excreted mostly in the urine, but also in sweat and faeces. Patients are admitted for therapy (usually for 2-3 days), largely for radiation protection, so that the radiation is safely contained. The treatment is usually well tolerated, the commonest side effects being fatigue, transient neck swelling and a sore throat. Since the radioactivity destroys the normal thyroid tissue, patients need to take thyroid replacement therapy for life.

Follow up is by a combination of clinical examination for further lumps in the neck, repeat iodine scans and measurement, in the blood, of a substance called thyroglobulin. Thyroglobulin is a protein found in the blood, whose level increases if there is regrowth of the cancer.

The outlook for patients following treatment is usually very good and the vast majority of patients have no further problems.

There is a patient organisation called the British Thyroid Foundation: if you are interested, please ask for a leaflet at your next hospital visit or contact British Thyroid Foundation, PO Box 97, Clifford, Wetherby, West Yorkshire  LS23 6XD. http://www.btf-thyroid.org

The British Thyroid Foundation has recently joined Thyroid Federation International, 96 Mack Street, Kingston, Ontario, Canada K7L 1N9.  The website can be found at   http://www.thyroid-fed.org

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Ó NHS Tayside; 2006; version 1.0

Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a person’s health provider.