Thyroid cancer is one of the most common forms of cancer, representing 3.6% of all new cancer cases each year (according to the National Cancer Institute). It occurs in 5-10 percent of thyroid nodules and has increased in prevalence over the last 30 years. Thyroid cancer occurs more commonly in woman than in men and can occur at any age. Risk factors for thyroid cancer include radiation exposure and a family history of thyroid cancer.
With thyroid cancer, there are generally no symptoms other than a lump in the neck area. This lump may represent a thyroid nodule or an enlarged lymph node that contains thyroid cancer. Some thyroid nodules with cancer cannot be felt on exam and are diagnosed via needle biopsy. Cancerous thyroid nodules can sometimes invade surrounding structures, which can lead to changes in the voice, such as hoarseness, or problems with swallowing.
The prognosis of thyroid cancer is generally favorable, with surgery to remove the thyroid gland and any involved lymph nodes usually recommended. Lymph node metastasis in thyroid cancer is common and is present in over 30% of patients presenting with the most common type of thyroid cancer, papillary thyroid cancer. More aggressive thyroid cancers with variable prognoses include follicular, medullary, poorly differentiated and anaplastic thyroid cancers.
Management of thyroid cancer begins with preoperative evaluation. This begins with a full head, neck and laryngeal exam at the first visit. Typically patients with thyroid cancer are initially diagnosed with a fine needle biopsy of the thyroid nodule, which is performed either by the surgeon or by a radiologist with ultrasound-guided biopsy. When a diagnosis of thyroid cancer is made, subsequent evaluation includes radiographic studies that include both high-resolution ultrasound of the thyroid and neck and/or fine cut CT scanning of the thyroid and entire neck area.
Thyroid cancer presents certain unique challenges at surgery. It has traditionally been associated with higher rates of complication, including recurrent laryngeal nerve injury, as compared with surgery for benign thyroid conditions. With expertise in head and neck surgical techniques and extensive knowledge of the anatomy of the recurrent laryngeal nerve, parathyroid glands, and surrounding lymph nodes, surgeons in the Division of Thyroid and Parathyroid Surgery at Mass. Eye and Ear are well prepared for these challenging cases. Our extensive experience and use of recurrent laryngeal nerve monitoring has allowed us to perform these complex procedures with a low risk of complications. Close pre- and postoperative communication and collaboration with the patient’s medical endocrinologist allows for coordinated care. They are joined in this multidisciplinary effort to treat thyroid malignancy by collaborators from the departments of radiology, oncology, radiation oncology, pathology and cytopathology, speech and swallowing therapy and laryngology.
For known thyroid cancer, typically the surgery involves removing the entire thyroid gland and sometimes also removing the lymph nodes. Because of the extent of surgery, it can take anywhere from about 2 hours for routine cases to 4 hours for more complex cases, with an overnight hospital stay needed. Any pain after the surgery is limited and usually alleviated with prescription and over-the-counter mild pain medication. Patients can generally speak, eat and breathe normally right after surgery.
Following surgery, the physician will review the pathologists report and make further recommendations in conjunction with the medical endocrinologist. This may include treatment with radioactive iodine therapy under the direction of the endocrinologist. This is a limited therapy with little to no post-treatment side effects. Standard external beam radiation therapy and chemotherapy are rarely needed and generally only in cases of more aggressive cancers. Physicians in the Thyroid and Parathyroid Surgery Division are well versed not only with the surgical treatment of thyroid cancer but are also experts in post-surgical treatment. They will help guide you through this process in order to achieve the most favorable outcome that is possible and involve other specialists as needed. Although the prognosis for most thyroid cancers is extremely favorable, long-term follow up is needed with thyroid cancer with both your surgeon and your endocrinologist.
Physicians in the Division of Thyroid and Parathyroid Surgery also have much experience with revision surgery for thyroid cancer, with a 0% rate of nerve paralysis in a study of 117 surgeries for recurrent thyroid cancer. Click here for more about revision thyroid cancer surgery.
Below are articles and studies relating to the discovery, care, and treatment of this condition. They are written for a physician audience but you may find these helpful in your own treatment course. Please contact your physician for questions and concerns.
Drs. Lesnik and Randolph published a radiographic algorithm that supports accurate definition of lymph node metastasis for patients with the most common type of thyroid cancer, papillary thyroid cancer both in patients first presenting with their cancers and in patients with recurrent cancers.
Dr. Randolph published a review paper on behalf of the American Thyroid Association that outlines the importance of recognition of macroscopic nodal disease.
Physicians in the Division of Thyroid and Parathyroid Surgery have published an article on the evidence based approach treatment of high-thyroid cancers such as poorly differentiated thyroid cancer.
Drs. Randolph and Kamani have done extensive work on the importance of laryngeal exam prior to thyroid surgery.
Dr. Randolph recently published a study of 117 surgeries for recurrent thyroid cancer in patients who underwent a second, third, fourth, fifth, sixth or seventh cancer surgery at Mass. Eye and Ear. The studied showed a 0% rate of neural complications.