Thyroid cancer is an abnormal thyroid tissue that grows faster than normal for excessive cell division and proliferation.
Growth continues even when the stimulus for cell multiplication stops.

Each organ of the body (thyroid, lung, kidney, etc.) contains different types of cells to perform different functions.

When cells are born they are immature and unable to perform the task of the mature.
Over time, these cells grow and mature by changing structure and specialize to perform specific functions of the organ to which they belong, so the cell differs from other cells in the body.
Cancer:

  • Well differentiated means that the cells have the appearance, size and shape as those of the organ with the cancer.
  • Undifferentiated cells contain immature cells that are unable to perform organ functions with cancer.

 

Anatomy of the Thyroid

The thyroid is a gland located at the front of the neck at the base of the throat.
Thyroid tumors can be:

  1. Benign masses (noncancerous),
  2. Malignant (cancerous) formations.

Examples of benign cancer are adenomas that hide the thyroid hormones.
Malignant tumors are more rare, the frequency is higher in women than in men.
The thyroid adenoma grows from the layer of cells lining the inner surface of the thyroid gland.
The adenoma secretes thyroid hormones, if secreted too much can cause hyperthyroidism.

 

Types of Thyroid Cancer

National Cancer Institute (NCI) classification:

Benign tumors

  • Follicular thyroid adenoma – is:
    • The most common thyroid cancer,
    • More frequent in adults.
  • Hyalinizing trabecular tumor Origins
    in follicular cells.

Malignant tumors or cancers

  • Papillary thyroid carcinoma – is
    • The most common type of thyroid cancer, accounts for about 80% of all thyroid cancers
    • Often diagnosed between 30-60 years, but it can happen at any age,
    • More aggressive in older patients,
    • More common in women.
  • Thyroid follicular carcinoma
    • It accounts for approximately 10-15% of all thyroid cancers,
    • It is most common in adults between the ages of 40 and 60,
    • It is more common in women,
    • It is more aggressive in older patients.
  • Hürthle cell tumor
    • It is a variant of follicular carcinoma,
    • It’s very rare,
    • It is among the most aggressive thyroid cancers.
  • Medullary thyroid carcinoma:

    • There are two types of medullary thyroid cancer: sporadic spinal carcinoma and medullary thyroid carcinoma.
    • It accounts for about 5-10% of all thyroid carcinomas.
    • It starts in C cells.
    • Since familial spinal cord cancer is hereditary, genetic abnormalities can be tested in blood cells.
  • Undifferentiated anaplastic thyroid carcinoma
    • It is very rare and accounts for about 1% of all thyroid carcinomas.
    • Anaplastic thyroid carcinoma begins in the follicular cells and tends to grow and spread very rapidly.
    • This often affects patients over the age of 65,
    • It is very aggressive and invasive,
    • Respond less to treatment.
  • Clear cell tumors
  • Scamosous and mucinous tumors
  • Little differentiated or insular carcinoma

 

Symptoms of thyroid cancer

The first sign of a cancerous nodule in the thyroid gland is usually a painless and visible nodule in the neck.

Other symptoms may include:

  • Difficulty speaking (dysphonia), hoarseness or loss of voice because cancer presses the nerves of the vocal chords,
  • Difficulty swallowing by throat cancer pressure,
  • Cervical pain  in the front and back that does not pass,
  • Respiratory disorders,
  • Swelling in the front of the neck (corresponds to the tumor)
    Rarely the patient develops hyperthyroidism or hypothyroidism .

In advanced stages one may notice an unexplained weight loss or weight loss.
However, thyroid cancer symptoms may resemble other conditions or medical problems.

 

Risk Factors for Thyroid Cancer

The four main risk factors for the development of thyroid cancer are:

1. Exposure to radiation
Exposure to radiation during childhood is an identified risk factor for thyroid cancer.

2. Hereditary genetic abnormalities
Several hereditary diseases increase the risk of thyroid cancer, but most people who develop thyroid cancer do not have an inherited disease or relatives with this problem.
Among the hereditary diseases are:

  • Some inherited genetic syndromes increase the risk of thyroid cancer, including: familial medullary thyroid carcinoma, multiple endocrine neoplasia, and familial adenomatous polyposis.
  • The patient or family member suffers from genetic syndromes such as Cowden’s syndrome (a benign disease characterized by the formation of tumors on the skin and mucous membranes called hamartomas).
  • Familial adenomatous polyposis (PAF): People with this syndrome develop many colon polyps and are at a very high risk of colon cancer. They also have an increased risk of some other cancers, including papillary thyroid cancer.
  • Carney complex type I: PRKAR1A causes abnormalities in the gene.
  • Medullary thyroid carcinoma: About 8 cases of medullary thyroid carcinoma (CMT) in 10 are caused by an abnormal gene.

3. Diet for thyroid cancer
If the diet contains low levels of iodine, it increases the risk of developing thyroid cancer.
People exposed to radiation or those with a history of benign thyroid disease are more likely to have low levels of iodine.

According to the natural medicine recommended by hygienists, the risk of developing thyroid cancer can increase by eating too much:

  • Butter,
  • Cheese,
  • Meat and other food of animal origin,
  • Food processed and preserved.

To help reduce the risk, many fresh fruits and vegetables need to be inserted into the diet.

Depending on the blood type diet , the cause of thyroid cancer is a diet with a lot of carbohydrates and starches that:

  • It increases the level of sugar in the blood,
  • Affect metabolism negatively.

So you have to reduce or avoid:

  • Sweets,
  • Cereals,
  • Potatoes,
  • Fruits,
  • Sweeteners and sugar in beverages,
  • Sugary drinks.

Obese people have an increased risk of developing thyroid cancer.

4. Gender (male or female)
Women are more likely about 250% to have a thyroid cancer  .

 

Diagnosis of thyroid cancer

In addition to a complete clinical history and physical examination, the diagnostic tests for thyroid cancer are:

  • Ultrasonography  This test can help determine if a thyroid nodule is solid or liquid. Solid nodules are more likely to undergo malignant degeneration, but ultrasound is not sufficient to understand if the tumor is malignant. This test also serves to control the number and size of thyroid nodules.
    If the thyroid nodules are too small, ultrasound may be helpful for guiding the nodule biopsy needle. Even if the lump is large, most doctors use this instrument to guide the biopsy needle.
    Ultrasound can also help determine if nearby lymph nodes are enlarged because thyroid cancer has spread.
  • Fine needle aspiration : Collect a sample of the nodule with a needle for examination under a microscope.
    It is the most appropriate examination because it allows to determine with certainty if the nodule is malignant.
    If in the biopsy are found Hurthle cells does not mean that there is a cancer, it is a particular thyroid cell (with a greater amount of mitochondria) but it is not always cancerous.
  • Thyroid scintigraphy (Rarely used).

 


Signs of thyroid cancer

  • Instruct the patient to drink water and look if the thyroid moves when it swallows.
  • Notice an enlargement or asymmetry.
  • Stand behind the seated patient and use the 2nd and 3rd finger of both hands to examine the gland when swallowing.
  • Look for lumps, size and stiffness.
  • Check for lymph nodes in the area.

The results of the test that increase the probability of being malignant are:

  • Nodules larger than 4 cm,
  • Strength and hardness,
  • Fixation of the nodule to adjacent tissues,
  • Cervical lymphadenopathy, metastases from thyroid cancer to onset can be found in the lymph nodes of the neck.
  • Reduction or loss of vocal cord mobility.

 

Differential diagnosis  of thyroid cancer

The doctor should exclude:

  • Non-toxic goiter – Thyroid nodules that do not work.
  • Toxic nodular goiter – nodules that function normally.
  • Basedow’s disease – generalized hyperactivity of the thyroid gland.
  • Hashimoto’s Thyroiditis – autoimmune destruction of the gland.
  • Solitary thyroid nodule – 15-25% are cysts and can be aspirated.
  • De Quervain’s thyroiditis – neck pain , fever and fatigue  after a upper respiratory infection or viral illness.
  • Acute suppurative thyroiditis – is the consequence of bacterial or fungal infections that cause an abscess.

 

Treatment for thyroid cancer

There are treatments for all patients with thyroid cancer.
If you complete four types of treatment:

  • Surgery (removal of cancer),
  • Radiation therapy (using high doses of x-rays or other high energy rays to kill cancer cells), for the thyroid is usually done with radioactive iodine treatment, which consists of capsules to ingest.
  • Hormone therapy (taking medications with hormones to stop the growth of cancer cells),
  • Chemotherapy (taking drugs to kill cancer cells), usually this treatment is not done, except in cases of advanced cancer with distant metastases.

Surgery is the most common treatment for thyroid cancer.

 

Testimony of a patient undergoing thyroid removal with cancer

Malignant nodule in a thyroid lobe

Preoperative
Before I did an ultrasound that showed a slightly calcified nodule. I was sent to the department of endocrinology to do needle aspiration.

After a month, I was told that the lump was a malignant tumor. And my case was classified as T4, also made a genetic test to confirm the malignancy, is a new test.

I had a meeting with the endocrinologist and the otolaryngologist because the otorhinolaryngologist does the thyroid surgery. We decided to take it all together, because it is also possible to take half the thyroid.

If a part of the organ remains, it can be complicated to establish the dose of Etirox because the remaining part still produces thyroid hormones, so you can not do the treatment with radioactive iodine. If in the following years metastases or other nodules were formed you have to do another surgery to remove the remaining part of the thyroid. They called me to report the day of surgery. A few days before the operation, I went to the hospital to do the preoperative exams, for example  blood tests .

Hospitalization and surgery
I was hospitalized three nights, in the post-intervention period one needs to control the dosages of calcium, there are drains that need to be cleaned. While the drains are not cleaned and calcium does not have the correct values, the patient is not discharged.
The risks of surgery are damage to the vocal cords, the voice could not go back as before, so you have to go to the speech-language pathologist. The other possible side effect is the lesion of the parathyroid glands that are linked to the calcium metabolism. In case of problems you have to take the calcium supplements forever.

The surgery lasted about 1 hour but I went in at 7:30 and went back in the room at 11:30 a.m. to 12:00 p.m. The surgery is performed under general anesthesia.

Postoperative
The duration of the anesthesia is a few days, after waking up the effects of anesthesia pass quickly.
The first night I could not sleep because of the pain despite taking morphine and other painkillers.
He felt pain in the neck , where they attacked the drains and in the dental arcade because the retractor they put in the mouth to breathe causes discomfort.
After 3 nights I was discharged from the hospital.
Return to work occurred after a month, I gradually improved.
You have to find the right dose of Eutirox.

Treatment with radioactive iodine
After four months, I was advised to do radioactive iodine therapy.
The treatment consists of  hospital admission to take the capsule customized based on several factors.
I was sharing a room with another lady, but in isolation, no one could enter the risk of radiation.
We  communicated with the nurses over the phone.
By eliminating radioactive iodine, that is, when the values ​​dropped below a safe level, I was discharged from the hospital.
For 12 days I had to stay away from other people, it is possible to stay close to others just for a very limited time.
Even clothes should be washed separately, the use of plastic dishes is recommended by the doctor  to avoid injury to other people.
I was in the apartment alone and my wife went to live with her mother.
Obviously, I could not go to work.

 

Treatment for all stages

The treatment of thyroid cancer depends on:

  • Of the type,
  • From the disease stage,
  • From age,
  • Of the general health of the patient.

Cancer papillary thyroid follicular and early – stage
treatment can be:
1. Surgery to remove a thyroid lobe (lobectomy), followed by hormonal therapy. Radioactive iodine can also be given after surgery.
2. Operation to remove the thyroid (total thyroidectomy).
In some cases it is possible to operate even pregnant women, but the surgeon should do the local anesthesia .

Papillary thyroid cancer and follicular cancer in the second stage
Possible therapies are as follows:
1. Surgery for the removal of a lobe from the thyroid gland and lymph nodes that contain the cancer cells, followed by hormone therapy. Then the doctor may prescribe radioactive iodine, but if the patient is a pregnant woman can not do this therapy.
2. Surgery to remove thyroid.

Papillary thyroid cancer in the third stage
Therapy is chosen from the following options:

Ultrasound of a thyroid carcinoma lymph node

1. Surgery to remove the entire thyroid (total thyroidectomy) and lymph nodes where the cancer has spread.
2. Total thyroidectomy followed by radiation therapy with radioactive iodine or external radiation therapy.

Follicular thyroid cancer in the third stage
The therapy can be:

1. Surgery to remove the entire thyroid (total thyroidectomy) and lymph nodes or other tissues around the thyroid where the tumor has spread.
2. Total thyroidectomy followed by radioactive iodine or external radiation therapy.

Papillary or follicular carcinoma in the fourth stage

The treatment may be one of the following:
1. Radioactive iodine.
2. External radiation therapy.
3. Hormonal therapy.
4. Chemotherapy.

Medullary thyroid cancer
The treatment chosen will likely be surgery to remove the entire thyroid (total thyroidectomy), unless the patient has metastases elsewhere in the body.
If the lymph nodes in the neck contain cancer cells, the surgeon removes the lymph nodes from the neck (lymph node dissection).
If the cancer has spread to other parts of the body, the doctor may prescribe chemotherapy.
Metastasis usually consists of:

  • In the bones,
  • In the lungs,
  • In the liver.

Anaplastic thyroid carcinoma
Treatment can be one of the following:
1. Surgery to remove the thyroid gland and surrounding tissue.
Since this type of cancer usually invades the surrounding tissues very quickly, the doctor will probably have to remove a part of the trachea.
The doctor should then create an airway in the throat so the patient can breathe. This surgery is called a tracheostomy.

2. Total thyroidectomy is used to reduce symptoms if the disease stays in the thyroid area.
3. Radiotherapy of external bundles
4. Chemotherapy.
5. Clinical studies are under way on new methods of treating thyroid cancer.

Recurrent thyroid cancer
The choice of treatment depends on:

  • From the current thyroid cancer type,
  • Of the type of treatment in the past,
  • From the area where the cancer came back.

The treatment can be one of the following:

1. Surgery with or without radioactive iodine.
2. External radiation therapy to relieve symptoms caused by cancer.
3. Chemotherapy.
4. Radioactive iodine .
5. Radiotherapy given during surgery.

Prognosis of thyroid cancer

Anaplastic carcinoma can cause death if not treated early.
In other cases, the prognosis for thyroid cancer is excellent because the 5-year survival of the diagnosis exceeds 90% in the case of differentiated cancer.

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