Thyroid cancer

Thyroid cancer is a type of cancer that originates from abnormal cell growth in the thyroid gland. The thyroid gland plays a crucial role in producing hormones that regulate metabolism and the functioning of various organs in the body. This cancer often manifests as a rapidly growing lump under the skin in the neck, which can be a single lump or multiple lumps.

Patients with thyroid cancer may experience symptoms such as:

Hoarseness
Difficulty breathing or swallowing
Throat pain

This type of cancer may be detected incidentally when patients undergo diagnostic tests for other abnormalities, such as examinations of the neck or chest. In such cases, the cancer may be found before the patient experiences clear symptoms.

The incidence of thyroid cancer has been steadily increasing, which may be due to improved screening methods and increased awareness of abnormalities in recent times. Timely diagnosis and treatment can significantly improve the chances of recovery and enhance overall health outcomes.

The types of thyroid cancer can be categorized as follows:

Papillary Thyroid Cancer
This is the most common type and the least aggressive.
It originates from the follicular cells of the thyroid.
The cancer cells resemble normal cells and grow slowly.
It is most commonly found in women of reproductive age or individuals aged 30-50 years.

Follicular Thyroid Cancer
This is the second most common type of thyroid cancer.
It also arises from the follicular cells of the thyroid.
It is more common in individuals over the age of 50.

Medullary Thyroid Cancer
This type is associated with genetic conditions.
It originates from the C cells of the thyroid, which produce the hormone calcitonin.
Elevated levels of calcitonin in the blood may indicate the presence of this cancer in its early stages.

Anaplastic Thyroid Cancer
This is a rare type, characterized by rapidly growing cancer cells.
It is difficult to treat and typically occurs in individuals over the age of 60.

Thyroid Lymphoma
This is another rare type, most often occurring in older individuals.
It originates from immune cells in the thyroid, and the cancer cells tend to grow rapidly.
Each type of thyroid cancer has different growth characteristics and severity. Proper diagnosis and treatment can significantly improve the chances of recovery and health outcomes.
 

How to treat Thyroid Cancer (CA thyroid)

The treatment for Thyroid Cancer (CA thyroid) depends on the type, stage, and individual characteristics of the cancer, as well as the overall health of the patient. Here’s an overview of the general treatment approaches:

1. Surgical Treatment
Total Thyroidectomy: The most common surgery for thyroid cancer is the removal of the entire thyroid gland, known as a total thyroidectomy. This is usually the treatment of choice for most types of thyroid cancer (like papillary and follicular thyroid cancers).
Lobectomy: In some cases, especially for smaller, low-risk cancers, only part of the thyroid (the affected lobe) may be removed (called a lobectomy or hemithyroidectomy).
Lymph Node Dissection: If cancer has spread to nearby lymph nodes in the neck, they may also be removed during surgery.

2. Radioactive Iodine (RAI) Therapy
After surgery, patients often receive radioactive iodine (I-131) therapy to destroy any remaining thyroid tissue, including cancerous cells. This is particularly effective for papillary and follicular thyroid cancers because these cancers absorb iodine.
RAI treatment is typically done after thyroidectomy, especially if there's concern that cancerous cells might remain in the body.

3. Thyroid Hormone Replacement
After the thyroid is removed, the body can no longer produce thyroid hormones. Therefore, patients will need to take synthetic thyroid hormone (levothyroxine) to maintain normal metabolism and bodily functions.
In some cases, the dosage of thyroid hormone is adjusted to suppress the production of thyroid-stimulating hormone (TSH), which could stimulate any remaining cancer cells.

4. External Radiation Therapy (Radiotherapy)
External radiation therapy may be used in cases where the cancer is more advanced or if it recurs after surgery.
This therapy may also be considered for certain types of thyroid cancer that do not take up iodine (like anaplastic thyroid cancer or poorly differentiated thyroid cancer).

5. Chemotherapy
Chemotherapy is rarely used in thyroid cancer and is generally reserved for more aggressive, advanced forms of thyroid cancer, like anaplastic thyroid cancer, which does not respond to RAI or hormone therapy.

6. Targeted Therapy and Immunotherapy
For aggressive or metastatic thyroid cancers, such as medullary thyroid cancer (MTC) or some cases of poorly differentiated thyroid cancer, targeted therapies (such as tyrosine kinase inhibitors) or immunotherapies may be considered.
Targeted therapies work by blocking the molecular pathways that promote cancer cell growth.
Immunotherapy can help the body's immune system recognize and destroy cancer cells.

7. Observation and Monitoring
After initial treatment, regular monitoring is essential. This includes:
Thyroglobulin (Tg) levels: This protein, produced by thyroid cells, can be measured to track recurrence or metastasis in patients who had a thyroidectomy.
Neck Ultrasound: A regular ultrasound is typically performed to check for any recurrence of cancer in the lymph nodes or other nearby tissues.
Whole-body scan with radioactive iodine: In some cases, this scan is done to check for any remaining cancer cells that may have taken up iodine.
Specific Considerations for Types of Thyroid Cancer

Papillary and Follicular Thyroid Cancer (Differentiated Thyroid Cancer)
These are the most common forms of thyroid cancer, and they typically have a good prognosis with appropriate treatment (surgery and RAI therapy).
Long-term survival rates are high, especially for small, localized tumors.
Medullary Thyroid Cancer (MTC)
This cancer arises from the C cells of the thyroid that produce calcitonin.
Treatment often involves total thyroidectomy, and there is a role for genetic testing, as MTC can be part of genetic syndromes (e.g., MEN2).
Medullary thyroid cancer does not typically take up radioactive iodine, so RAI therapy is not effective.
Anaplastic Thyroid Cancer
This is a rare, highly aggressive form of thyroid cancer that typically requires aggressive treatment.
It often does not respond to RAI therapy, so treatment may involve a combination of surgery (if possible), external radiation, chemotherapy, and newer targeted therapies or immunotherapies.
Prognosis

The prognosis for thyroid cancer depends on several factors:
Type of thyroid cancer: Papillary and follicular cancers tend to have a very good prognosis, while anaplastic thyroid cancer has a poor prognosis.
Stage: Early-stage cancers (localized to the thyroid) have a higher cure rate.
Age: Younger patients typically have a better prognosis than older individuals.
Response to treatment: How well the cancer responds to surgery, RAI therapy, and other treatments can influence long-term outcomes.
Conclusion

Treatment for thyroid cancer often involves a combination of surgery, radioactive iodine therapy, and thyroid hormone replacement. For aggressive or advanced cancers, additional treatments like radiation, chemotherapy, or targeted therapies may be used. Regular follow-up and monitoring are essential to ensure that the cancer is under control and to detect any recurrences early.

It's important to have a personalized treatment plan developed by a multidisciplinary team, including an endocrinologist, oncologist, and surgeon, who can assess the best options based on the specifics of the cancer and the patient's overall health.

 

Dr.Maytee  Uengarporn ,MD

Sepeciality Otolaryngology Head and Neck Surgery

1996 – 2001: Doctor of Medicine (M.D.), Faculty of Medicine, Ramathibodi Hospital
2007 – 2009: Residency: Board Certification in Otorhinolaryngology, Faculty of Medicine, Ramathibodi Hospital"