ENDOCRINOLOGY THYROID RESEARCH

Diagnosis of Thyroid Cancer

By Dr Shahzad Ahmad on June 26, 2018

**Thyroid Cancer Treatment**

We individualize thyroid cancer treatment to your needs. We review the characteristics of the tumor, we take into account if the tumor has spread and at which locations, your overall health and preferences, and, when needed, we evaluate the genetic makeup of the tumor. We then provide you with treatment options based on those.

**Active Surveillance**

This is recommended for very small thyroid cancers, which are less than 1 cm in size. It is well known that 98-99% of these tumors will not get bigger or spread, so surgery is not needed. More recent evidence has shown that surveillance may be an option for larger tumors, up to 2 cm. However, more research is needed before this can be incorporated into practice, and we would only recommend this in select cases.

**Thyroidectomy**

The first line treatment for thyroid cancer is thyroidectomy (surgery to remove the thyroid). Recent data has shown that it is better to remove the whole thyroid (total thyroidectomy) for larger cancers, but it is ok to remove half the thyroid (hemithyroidectomy) for smaller non-aggressive cancers without evidence of lymph node spread on ultrasound. Lymph nodes have to be removed from the neck if they are suspicious for metastases. The decision making process is complex, and it is best made in association with a thyroid cancer specialist who performs and is experienced in in-office ultrasound, and with an experienced thyroid surgeon.

**Radioactive Iodine**

Radioactive iodine (RAI) is a very important and useful treatment option for patients with, or at high risk of recurrence. However, recent data indicate that less patient’s need radioactive iodine treatment, and increase expertise is required to identify which patient truly needs RAI, and what dose
**Call (801) 871 8366 to talk to our medical staff about your thyroid problem.**

• Papillary Thyroid Cancer. This is by far the most common type, and has many variants. It is usually (but not always) slow growing and curable.
• Follicular Thyroid Cancer. This is seen in much fewer people. It tends to be a little more aggressive than papillary thyroid cancer, but is is also usually slow growing and treatable.
• Hurthle Cell Carcinoma. This is rare, and can be harder to treat if not caught early.
• Medullary Thyroid Cancer. This is a unique type of thyroid cancer, as it comes from neuroendocrine cells that do not produce thyroid hormone. Many times, we see this cancer as part of genetic syndromes. It is less frequently curable, but usually treatable, if treated by a thyroid cancer specialist.
• Anaplastic Thyroid Cancer. This usually develops from a papillary or follicular thyroid cancer, and is extremely aggressive. It can lead to death in weeks to months, but recent advances have decreased the number of people dying from this. This diagnosis is an emergency, and treatment should not be delayed even for 1 day.

There is no such thing as a “good type of cancer”. If you are diagnosed with any of these types of thyroid cancer, or you are at high risk for thyroid cancer, it is imperative that you see a thyroid cancer specialist to receive appropriate care. We will work with you to identify the best treatment strategy.
Am I at risk for thyroid cancer? Should I get thyroid cancer screening? Each type of thyroid cancer has its own risk factors.
**Risk factor for Papillary Thyroid Cancer**

• Family history of papillary thyroid cancer, especially if more than 1 family member has been affected.
• Radiation exposure (radiation treatments at or close to the neck, exposure to nuclear fallout), especially during childhood
• Specific genetic syndromes, such as familial adenomatous polyposis, etc
• Gender (more common in women, but usually more aggressive in men)

**Risk factors for Follicular and Hurthle Cell Thyroid Cancer**

• Iodine deficiency, especially while growing up
• Specific genetic syndromes, such as Cowden’s syndrome, etc

**Risk factors for Medullary Thyroid Cancer**

• Family history of Medullary Thyroid Cancer, or a genetic syndrome called MEN2 (a or b), due to an inherited mutation in a gene called RET

If you have any of the above risk factors, you are at higher risk for thyroid cancer. The Endocrinology Center of Utah can help you diagnose and find the best treatment strategy.