J. Gary Evans
The thyroid is a butterfly-shaped gland at the front of your neck just below the Adam?s apple. A healthy thyroid is a little larger than a quarter and usually can?t be felt through the skin.
It might be small, but it?s important.
The thyroid, part of the endocrine system, makes hormones that affect heart rate, blood pressure, metabolism, body temperature and weight.
Many people have benign growths or nodules in their thyroids. But the nodules can also be malignant. Thyroid cancer is the ninth most common type of cancer in the U.S., but it is the fastest increasing cancer in men and women. Here are some facts to know about thyroid cancer:
How common is thyroid cancer?
Thyroid cancer accounts for 1 percent of malignancies diagnosed in the United States each year. The American Cancer Society estimates 56,460 new cases of thyroid cancer and 1,780 deaths from thyroid cancer in the United States for 2012. Although the incidence of thyroid cancer has more than doubled over the past 30 years, part of the increase is related to earlier diagnoses now made possible with readily available diagnostic imaging, such as thyroid ultrasonography.
Who is at risk for thyroid cancer?
Thyroid cancer can affect any age group, but appears to be more common in young and middle adulthood. Two-thirds of those diagnosed with thyroid cancer are between 20 and 55 years old. Women are affected three times as often as men. People with a family history of thyroid cancer or a prior history of radiation treatment or exposure (particularly to the head and neck) are also at a higher risk for thyroid cancer.
What are the symptoms of thyroid cancer?
Thyroid cancer may not cause any symptoms at all in its early development. As the cancer grows in size, however, it is likely to cause symptoms, typically developing into a growing nodule or lump, which increases in size over time. The nodules may be seen or felt at the front of the neck. Enlargement or swelling of the neck, enlarged lymph nodes, hoarseness, difficulty swallowing, difficulty breathing and pain in the neck or throat can be prominent symptoms.
What do nodules have to do with cancer?
A thyroid nodule is a lump or growth within the thyroid gland. Thyroid nodules are very common; they are found in 4 to 8 percent of adults on physical examination, and can be seen in 20 to 40 percent of patients via ultrasound. Sometimes thyroid nodules are found incidentally by other tests such as carotid dopplers, CAT scans or MRI?s of the neck and chest. The risk of a thyroid nodule being a thyroid cancer is about 5 percent, though the risk of cancer can be higher if other risk factors and symptoms are present.
How is thyroid cancer diagnosed?
Patients with thyroid nodules that are palpable or approach 1 centimeter in size or larger should undergo a thyroid fine needle aspiration (FNA), which is generally performed with ultrasound guidance. Smaller nodules can also be sampled by FNA depending on location, or are often simply monitored for any size change by a follow-up thyroid ultrasound.
The thyroid FNA uses a very small needle and does not require any sedation or pain medication. A pathologist looks at the specimen under the microscope and determines if the nodule is benign or malignant (cancerous). If the FNA is not able to establish the diagnosis, some patients may need to undergo a surgical biopsy, where part of the thyroid containing the nodule is removed.
How is thyroid cancer treated?
When thyroid cancer has been diagnosed patients are referred to an experienced thyroid surgeon for surgical removal of the gland. During surgery, lymph nodes in the neck may also be removed and tested for cancer cells. Most patients undergo radioactive iodine treatment after surgery to reduce the likelihood of cancer recurrence.
The survival/cure rate for the most common forms of thyroid cancer is excellent and approaches 95 percent with appropriate care.
J. Gary Evans, who has been in private practice in Jacksonville since 1993, is director of research with Northeast Florida Endocrine and Diabetes Associates, chief of section of endocrinology at St. Vincent?s Medical Center and the director and editor of www.DiabetesWellnessCenter.com, a website posting daily health tips to help people minimize or prevent diabetes through diet and exercise. He is a member of the Duval County Medical Society.
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