By Dr. Joseph Valentino
University of Kentucky
Your thyroid gland may be small, but it plays a big role in keeping your body running. Located at the base of your neck where a bow tie would sit, this butterfly-shaped gland produces hormones that regulate your metabolism – acting like the throttle on an engine for your entire body.
When your thyroid isn’t working properly, you might experience fatigue, weight changes, hair loss, or bowel problems. However, when cancer develops in the thyroid, it typically doesn’t affect how the gland produces hormones. The rest of the healthy gland continues doing its job while the tumor grows in one area.
How thyroid cancer is discovered
Most thyroid cancers are found when patients or doctors notice a lump or growth in the neck. Sometimes these nodules are discovered incidentally during CT scans or ultrasounds performed for other reasons – a car accident, for example. Unlike other cancers, thyroid cancer rarely causes the classic symptoms we associate with the disease until it becomes quite advanced.
The vast majority of thyroid cancers are caught early as painless lumps. In advanced cases, large tumors might cause difficulty swallowing, breathing problems, or voice changes.
Signs and symptoms
Most thyroid cancers don’t affect how your thyroid functions, but they can cause noticeable changes in your neck area. Contact your doctor if you experience:
• A lump or mass in your neck that wasn’t there before
• One side of your neck feeling bigger than the other
• Tightness or fullness at the base of your neck
• Difficulty swallowing or feeling like food is “hanging up” in your throat
• Breathing difficulties, especially when lifting your arms above your head
• Persistent hoarseness or voice changes
• Coughing up blood (in advanced cases)
Many thyroid cancers are now discovered accidentally during scans for other reasons – like CT scans after car accidents or ultrasounds for other conditions.
Understanding your risk
Thyroid cancer represents about 3% of all adult cancers and affects people fairly evenly across all states. We’re seeing more cases diagnosed today than 20 years ago, but this increase is largely due to improved imaging technology that catches smaller tumors earlier.
Interestingly, research shows that about one in ten people who die from other causes actually have undetected thyroid cancer that never caused problems. Many thyroid cancers grow very slowly over years and may never require treatment.
Diagnosis and treatment
Today’s advanced diagnostic tools allow us to be smarter about treatment. Using ultrasound imaging and fine needle biopsies, we can examine the characteristics of thyroid nodules. We can even analyze the genetic makeup of cancer cells to predict how aggressive a tumor might be.
Treatment for thyroid cancer typically begins with surgery to remove all or part of the thyroid gland. Other treatment may be needed as well such as:
• Radioactive iodine therapy to identify and possibly destroy remaining cancer cells after surgery
• Thyroid hormone suppression therapy is helpful to slow the growth of many thyroid cancers
• Active surveillance: Repeating examinations and radiology studies periodically for very small, slow-growing cancers not removed, or for identifying recurrent cancer.
• Advanced treatments for recurrent or complex cases such as radiation therapy, and targeted systemic treatments.
Not every thyroid nodule needs immediate surgery. We consider many factors: the size and appearance of the nodule, genetic testing results, the patient’s overall health, and their personal concerns. Some small, slow-growing cancers can be monitored carefully, while others require prompt surgical treatment.
Dr. Joseph Valentino, M.D., is a surgeon at the University of Kentucky Markey Cancer Center.