Q: My husband was diagnosed with thyroid cancer more than a year ago. This doctor is following him on a regular basis and he is on Synthroid but I wonder if he is making light of his condition and we should be more concerned than we are? Can you provide any insight?
A: I’ve written numerous times about thyroid abnormalities – generally hypo or hyperthyroid conditions, but haven’t covered thyroid cancer which occurs in the cells of the thyroid gland that undergo cancerous changes – sometimes because of genetics, but for other reasons, also. In some cancers, cells grow out of control. Thyroid cancer is a rather uncommon condition in our country but appears to be on the rise, perhaps because more sophisticated equipment and technology allows physicians to detect small cancers that may have been overlooked in the past.
There are several types of thyroid cancer, including papillary, follicular, anaplastic, medullary and thyroid lymphoma. Papillary cancer is the most common form and accounts for about 80% of all thyroid cancer diagnoses. Follicular thyroid cancer originates in follicular cells and is the second most common cancer of the thyroid. The medullary form may or may not be genetically inherited. Anaplastic thyroid cancer is very rare and even more difficult to treat. Lastly, a thyroid lymphoma, while also very rare, begins in the immune system of the thyroid. Those individuals at an increased risk for thyroid cancer include being exposed to high levels of radiation, having a goiter (a benign enlargement), and having specific genetic syndromes. Thyroid cancer may recur in the lymph nodes, as well as in other areas such as the lungs and bones. On the upside recurrences can be successfully treated.
Symptoms may not appear early on with the disorder but if the thyroid gland grows, the cancer can worsen. The individual may have swollen lymph nodes in the neck, dysphagia (difficulty swallowing), a detectable neck mass and pain.
Diagnosis may be accomplished through a physical examination and palpation of thyroid masses and lymph nodes, through lab testing, ultrasound, and biopsy to remove cells for analysis under a microscope.
Treatment options depend on the type and stage of cancer. Most forms can be treated and cured with medication. Should surgery be advised, the process will remove all or most of the gland. Some specialists prefer to allow a small amount of thyroid tissue to remain around the parathyroid glands so as to reduce the risk of parathyroid damage. The surgeon may also remove enlarged lymph nodes from the neck area to test them for cancer cells. Following surgery to remove a cancerous thyroid gland, a patient will likely be placed on medication such as Synthroid or Levothyroid for life. The medication will both supply the missing hormone the thyroid would normally produce, and will suppress the production of TSH from the pituitary gland. In some instances radioactive iodine in capsule or liquid form may be given to destroy any remaining thyroid tissue. This treatment may also be used to treat any thyroid cancer that may recur following treatment. Most radioactive iodine will be excreted by the body through urination within a few days of treatment. Radiation therapy may be used for thyroid cancer that has spread to the bones, and chemotherapy, still another option, is given as an intravenous infusion. The latter is not commonly used to treat thyroid cancer but it may be beneficial to some individuals who fail to respond to more traditional therapy treatment.
If your husband has confidence in his health care provider, he should remain on the prescribed medication and be diligent in reporting any abnormalities. His physician may be attempting to suppress thyroid growth with the Synthroid. Accompany your husband on his next visit and bring the list of questions you want answers to.
