Thyroid Cancer: A Brief Guide to Diagnosis and Treatment

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Until you find what works for you, consider trying to:. If you have signs and symptoms that worry you, start by seeing your family doctor. If your doctor suspects you may have a thyroid problem, you may be referred to a doctor who specializes in diseases of the endocrine system endocrinologist. Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared.

GUIDELINES Pocketcards

Here's some information to help you get ready, and what to expect from your doctor. Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For thyroid cancer, some basic questions to ask your doctor include:. Your doctor is likely to ask you a number of questions.

Being ready to answer them may reserve time to go over points you want to talk about in-depth. Your doctor may ask:. Thyroid cancer care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version.

Thyroid biopsy During a thyroid biopsy, your doctor uses a needle to remove a small amount of suspicious tissue from your thyroid gland. Parathyroid glands The parathyroid glands, which lie behind the thyroid, manufacture the parathyroid hormone, which plays a role in regulating your body's levels of the minerals calcium and phosphorus. Request an Appointment at Mayo Clinic.

Thyroid Cancer Diagnosis on the Rise HD

Share on: Facebook Twitter. References AskMayoExpert. Anaplastic thyroid cancer. Rochester, Minn. Differentiated thyroid cancers. Medullary thyroid cancer. Melmed S, et al. Nontoxic diffuse goiter, nodular thyroid disorders and thyroid malignancies. In: Williams Textbook of Endocrinology. Philadelphia, Pa. Accessed Dec. Thyroid carcinoma. Fort Washington, Pa.

Thyroid Cancer: A Brief Guide To Diagnosis And Treatment

Niederhuber JE, et al. Histologic differentiation between Hurthle cell adenoma and carcinoma can be definitely made only after the evaluation of resection specimen by the presence or absence of vascular or capsular invasion, which is the hallmark of HCC [ 72 ]. Patients with minimally invasive carcinomas usually experience a better prognosis [ 73 ]. Overall, older patients and those with larger tumor size, extrathyroidal extension, and not undergoing surgery have reduced survival [ 74 ].

As other differentiated thyroid cancers, the main treatment for HCC is surgery. Since the preoperative diagnosis of HCC is impossible by cytology, determining the initial extent of surgery and whether further surgical resection completion thyroidectomy involves post-operative histological evaluation [ 70 ]. So, the first step is a thyroid lobectomy in the primary surgery unless the pathological features guide us to total thyroidectomy. Presence of dominant contralateral nodule, nodule size greater than 4 cm or preexisting diminished thyroid hormone production requiring thyroid hormone therapy are another indication for total thyroidectomy [ 51 ].

Completely resected minimally invasive HCC is categorized as low risk and then does not require TSH suppression therapy. Patients with incomplete response to therapy should have TSH levels less than 0. Patients with incomplete biochemical response to therapy or high-risk HCC and an excellent or indeterminate response to therapy should have TSH levels between 0. Generally, RAI Tx is not routinely recommended for patients at low risk of recurrence. External beam radiation therapy EBRT : In patients with clinically evident gross extrathyroidal extension that is incompletely resected, external beam radiation therapy EBRT can be considered as a treatment option.

However, potential benefit of radiation should be weighed against potential complications, such as dental decay, tracheal stenosis, esophageal stricture, osteonecrosis, fibrosis, and xerostomia [ 76 ]. Introduced by Sakamoto et al. PDTCs have a high recurrence rate despite appropriate treatment. These types of cancers have more aggressive pattern than typical papillary thyroid cancer. The most challenging issue in diagnosis of PDTC is lack of a precise definition.

PDTCs are usually at an advanced stage, usually extrathyroidal extension and extensive local invasion, at the time of diagnosis [ 85 ]. Survival rates are remarkably lower than in patients with WDTC [ 85 , 87 , 88 ].

Background

Patients more than 45 years of age and those with cervical lymph node invasion, tumor necrosis, local recurrence, mitotic index greater than 3 per 10 high-power fields, tumor size greater than 4 cm, and distant metastasis at the time of diagnosis have poorer prognosis [ 89 — 92 ][ 13 , 31 — 34 ]. Since PDTC is rare, the best treatment option for treatment remains inconclusive. Most previous studies are agreed with total thyroidectomy with lymph node dissection because of aggressive nature of these tumors.

Anaplastic thyroid cancer ATC is a rare and lethal form of thyroid cancer, which is responsible for 1. Geographical prevalence of ATC has a wide range from 1. ATC is considered to be originally derived from follicular cells resulted from dedifferentiation. In most of the cases, ATC usually presents with a rapidly enlarging neck mass and local symptoms such as neck pain, dysphagia, dyspnea, and hoarseness [ 97 ]. A variety of previous studies have evaluated prognostic factors of ATC [ 99 — ].

Ages more than 70, acute onset of symptoms, white blood cell count WBC more than , tumor size more than 5 cm, T4b and distant metastasis are associated with increased mortality and poor prognosis [ ].

ATA Professional Guidelines | American Thyroid Association

A majority of patients will finally die from ATC and should be aware of the prognosis by a thorough discussion in order to have information on the impact of disease on their quality of life and also the potential benefit of participating in clinical trials [ 97 ]. ATC raises both diagnostic and therapeutic challenges. This is because of rarity of the disease and also lack of expression of thyroid and epithelial cell markers in anaplastic cancer cells [ ]. In addition, ATC cells present in a variety of histology and morphology abnormalities which causes delay in diagnosis and consequently in treatment.

As the diagnosis is established, staging should be done as well as the assessment of airway by fiberoptic laryngoscopy. Referring the patient to a center with experience with anaplastic thyroid cancer is highly recommended. An expert head and neck surgeon should assess the patient to determine if the primary tumor is resectable. Early after resection, external beam radiation with radiosensitizing drugs, like taxanes with or without platin or anthracycline chemoradiation.

Palliative chemoradiation is suggested for patients with unresectable primary tumors but without distant metastases. Patients with advanced disease stage IVC are the most challenging ones. Treating physician should balance local control of primary tumor and treatment of distant metastases. If the airway is at risk, the chemoradiation should be started. Patients in whom the airway is not at risk or is stabilized by tracheostomy should preferably be enrolled in a clinical trial or undergo systemic chemotherapy by cytotoxic drugs [ 1 ]. Dabrafenib, which is a selective BRAF inhibitor, trametinib, lenvatinib, rapamycin, and microtubule inhibitors are among the drugs being evaluated in ATC patients.

Patients and their family members should be informed of poor prognosis of the disease. Some patients should be transferred to a sanatorium if they do not wish to be treated or their performance is poor. Medullary thyroid cancer MTC is originated from parafollicular neuroendocrine cells, in contrast with differentiated thyroid cancer. As most of the thyroid cancers, MTC usually presents as a solitary thyroid nodule in patients in fourth or sixth decade of life [ ]. Since it metastasizes frequently, neck lymphadenopathy is usually the first manifestation.

A classic thyroid nodule associated with flushing and diarrhea is suggestive of widespread metastatic disease. T2, N0, M0: the tumor is more than 2 cm but is not larger than 4 cm across and has not grown outside the thyroid T2. T3, N0, M0: the tumor is larger than 4 cm or has grown slightly outside the thyroid T3 , but it has not spread to nearby lymph nodes N0 or distant sites M0. T1—T3, N1b, M0: the tumor is of any size and might have grown slightly outside the thyroid gland T1—T3. As other thyroid cancers, surgery is the mainstay for MTC management; however, imaging and diagnosis before surgery are necessary for determining the best surgical intervention [ 1 ].


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As the diagnosis of MTC is made, the patient should undergo neck ultrasonography and tumor markers calcitonin and carcinoembryonic antigen evaluation. In addition, it should be determined if the disease is sporadic or associated with MEN 2 syndrome, because patients with MEN 2 may have pheochromocytoma or primary hyperparathyroidism or both.

So, biochemical testing should be considered for ruling out pheochromocytoma or primary hyperparathyroidism in MTC patients with unknown status of germline RET mutation. If the patient has primary hyperparathyroidism, a total thyroidectomy should be done including parathyroidectomy. For patients with pheochromocytoma, adrenalectomy should be prioritized to thyroidectomy.


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  • Patients with hereditary MTC should be referred to a genetic counselor so that only necessary family members undergo testing for lowering related costs [ 1 ]. Family members with germline RET mutation benefit from prophylactic thyroidectomy [ ]. Axial skeleton MRI is suggested for bone metastasis.

    Total thyroidectomy with bilateral central neck dissection is preferred for patients with no distant metastasis. Lateral neck dissection is recommended only if metastatic disease is suspected by neck ultrasound and confirmed by FNA cytology. After surgery, patients need thyroid hormone replacement therapy but not TSH suppression as in high risk differentiated thyroid cancers. Calcitonin and carcinoembryonic antigen CEA should be checked not earlier than 3 months after surgery for determining if the patient has persistent disease.

    External Beam radiation therapy EBRT should be limited in MTC patients, because it can limit further surgical interventions due to fibrosis as well as affecting the quality of life of patients. Patients should be managed with active surveillance by both ultrasonography and serial evaluation of tumor markers to guide further surgical treatment. Your doctor can tell you more about the kind you have. Most thyroid cancers are found when patients see a doctor because of new neck lumps called nodules.

    Sometimes doctors find neck lumps during a physical exam. Yet other times thyroid cancer may be found during an ultrasound test for other health problems. If signs are pointing to thyroid cancer, more tests will be done. But they can help show if the thyroid is working the way it should. Ultrasound: For this test, a small wand is moved over the skin in front of your neck. It gives off sound waves and picks up the echoes as they bounce off the thyroid gland.

    The echoes are made into a picture on a computer screen. Radioiodine scan: For this test, a low dose of radioactive iodine called I is swallowed or put into a vein. Over time, the iodine is absorbed by the thyroid gland. A special camera is then used to see the radioactivity. Nodules that have less iodine than the rest of the thyroid can sometimes be cancer. MRI scan: This test uses radio waves and strong magnets instead of x-rays to take pictures. MRI scans can be used to look for cancer in the thyroid, or cancer that has spread. PET scan: In this test, you are given a special type of sugar that can be seen inside your body with a camera.

    In a biopsy, the doctor takes out a small piece of tissue to check it for cancer cells. A biopsy is the only way to tell for sure if you have cancer. The most common kind of thyroid biopsy is a fine needle aspiration FNA. To do this, the doctor will put a thin, hollow needle right into the nodule to take out some cells and a few drops of fluid to test for cancer.

    If the diagnosis is not clear after an FNA biopsy, you might need another kind of biopsy to get more cells to test. If you have thyroid cancer, the doctor will want to find out how far it has spread. This is called staging. The stage describes the spread of the cancer through the thyroid gland.

    It also tells if the cancer has spread to other organs of your body that are close by or far away. Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside of the thyroid gland. Be sure to ask the doctor about the cancer stage and what it means for you. There are many ways to treat thyroid cancer but surgery is the main treatment.

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