Thyroid tumor

The thyroid tumor consists of abnormal thyroid tissue that grows faster than the normal one due to excessive cell division. Growth continues even after the impulses for cell proliferation have been interrupted.
Each body organ (thyroid, lungs, kidneys, etc.) contains cells of different types to perform different functions.
When they are formed, the cells are immature and cannot take over the tasks of mature cells.
Over time, these cells grow and mature, changing their structure and specializing to perform the specific functions of the organ to which they belong, i.e. they differentiate themselves from those of the rest of the body.

Tumor differentiation:

Well-differentiated tumor means that the cells have the appearance, size and shape of the organ with the tumor.

  • An undifferentiated tumor contains immature cells that are unable to perform the function of the organ with the tumor.

Contents

Anatomy of the thyroid gland

The thyroid gland is a gland located at the bottom of the front of the neck. Thyroid tumors are:

  • benign (benign or non-cancerous) tissues
  • or malignant (malignant or carcinogenic) growths.

Examples of benign tumors are the adenomas that produce thyroid hormones.
Malignant tumors are less common, the frequency is higher in women than in men.

Thyroid adenomas grow from the cell layer that covers the inner surface of the thyroid gland. The adenoma secretes thyroid hormones and if it creates too many of them, it can cause hyperthyroidism.

Tumor types of the thyroid gland

National Cancer Institute (NCI) classification:

Benign:

  • Follicular thyroid adenoma
    • the most common thyroid tumor;
    • occurs mainly in adults.
  • Hyalinizing trabecular adenoma
    • occurs in the follicular cells.

Malignant:

  • Papillary thyroid carcinoma
    • the most common form of thyroid cancer,
      accounts for about 80% of all thyroid cancers;
    • is often diagnosed between the ages of 30 and 60, but can occur at any age;
    • is more aggressive in elderly patients;
    • is more common in women.
  • Follicular thyroid carcinoma
    • accounts for about 10 – 15% of all thyroid cancers;
    • is more common in adults between the ages of 40 and 60;
    • is more common in women;
    • is more aggressive in elderly patients.
  • Hürthle cell cancer
    • is a variant of follicular thyroid carcinoma;
    • is rather rare;
    • is one of the most aggressive thyroid carcinomas.
  • Medullary thyroid carcinoma: There are two types of medullary thyroid cancer: sporadic medullary carcinoma and familial medullary carcinoma.
    • represents 5 – 10% of all thyroid cancers;
    • begins in the C cells;
    • Since familial medullary thyroid carcinoma is hereditary, an examination may be performed to detect genetic abnormalities in the blood cells.
  • Undifferentiated or anaplastic thyroid cancer
    • is very rare: represents about 1% of all thyroid cancers;
    • anaplastic thyroid carcinoma begins in the follicular cells and tends to grow and spread very quickly;
    • often encounters patients from the age of 65;
    • is extremely aggressive and invasive;
    • responds less to the therapies.
  • Clear cell tumors
  • Squamous or mucinous tumors
  • Low-differentiated or insular carcinoma

Symptoms of thyroid cancer

The first sign of a cancerous lump in the thyroid gland is usually a painless and visible lump on the neck.
Other symptoms include:

  • difficulty speaking (dysphonia), hoarseness or loss of voice because the cancer presses on the nerves of the vocal cords;
  • difficulty swallowing due to the pressure of the cancer on the throat;
  • anterior and posterior cervical pains that do not pass;
  • breathing disorders;
  • swelling at the front of the neck (corresponds to the mass of the tumor);
  • in rare cases, the patient develops hyper- or hypothyroidism.

In the advanced phases, emaciation or unexplained weight loss may be observed.
However, the symptoms of thyroid cancer may be similar to those of other conditions and health problems.

Risk factors for thyroid tumor

The four main risk factors for developing a thyroid tumor are:

1. Radiation exposure Radiation exposure
during childhood is an identified risk factor for thyroid cancer.

2. Hereditary abnormalities
Several hereditary 
diseases increase the risk of thyroid tumors, but most people who develop thyroid cancer do not suffer from an inherited condition and have no relatives who suffer from this problem.
Hereditary diseases include:

  • Some hereditary syndromes increase the risk of thyroid cancer. These include: familial medullary thyroid cancer, multiple endocrine neoplasia, and familial adenomatous polyposis.
  • The patient or a family member suffers from genetic syndromes such as Cowden’s syndrome (a condition characterized by the formation of benign tumor cells on the skin and mucous membranes called hamartomas).
  • Familial adenomatous polyposis (FAP): People with this syndrome develop many polyps in the intestine and have a very high risk of developing colorectal cancer. They also have an increased risk of other cancers, including papillary thyroid cancer.
  • Carney complex type I: causes abnormalities in the PRKAR1A gene.
  • Medullary thyroid cancer: About 8 out of 10 cases of medullary thyroid cancer (MTC) are caused by an abnormal gene.

3. Nutrition
If the diet contains little iodine, the risk of developing thyroid carcinoma increases.
Radiation-exposed individuals or people with a history of benign thyroid disease are more likely to have low iodine levels.

According to the natural medicine recommended by hygienists, the risk of developing a thyroid tumor can be increased by abundant consumption of the following foods:

  • Butter
  • Cheese
  • meat and other foodstuffs of animal origin,
  • processed and canned foods.

To reduce the risk, one should include plenty of fresh fruits and vegetables in the diet.

According to the blood type diet, the cause of the thyroid tumor is a diet rich in carbohydrates and starch, due to:

  • the blood sugar level rises,
  • the metabolism is negatively affected.

Thus, the following foods must be reduced or avoided:

  • Sweets,
  • Cereal
  • Potatoes
  • Fruit
  • sweeteners and sugar,
  • sugared drinks.

Obese people have a higher risk of developing thyroid cancer.

4. Gender
Women are about 250% more likely to develop thyroid cancer.

Diagnosis of thyroid cancer

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

  • Blood tests. The levels of thyroid hormones (T3 and T4) in the blood are normal in most patients with thyroid cancer, they are considered to be of little help for diagnosis. An elevated calcitonin level can be caused by medullary thyroid carcinoma and is therefore useful for diagnosis.
  • Ultrasound. This examination helps determine whether a thyroid nodule is solid or liquid. Fixed nodules have a greater chance of being malignant, but an ultrasound is not enough to determine malignancy. Furthermore, the number and size of the nodes can be determined with this examination.
    If the nodules are very small, ultrasound can be used to insert the needle for puncture of the node for laboratory analysis. However, even if the lump is large, most doctors use ultrasound to perform fine needle puncture.
    Ultrasound can also be used to determine whether nearby lymph nodes may be enlarged because the thyroid cancer has spread.
  • Fine needle puncture of the thyroid gland: Cells are removed from the node for microscopic examination using a thin needle.
    If Hürthle cells are found in the biopsy, this does not mean that it is cancer; they are special thyroid cells (with a larger amount of mitochondria), but these are not always carcinogenic.
  • Thyroid scintigraphy (rarely performed).

Sign

  • If the patient drinks a sip of water, it can be observed whether the thyroid gland shifts when swallowing.
  • Pay attention to enlargement or asymmetry.
  • Stand behind the seated patient and use the 2nd and 3rd fingers of both hands to examine the gland when swallowing.
  • Look for swelling, pay attention to size and stiffness.
  • Note any enlargements of the lymph nodes in this area.

Examination results that increase the likelihood of malignancy are:

  • knots with a size of more than 4 cm;
  • solidity and hardness;
  • fixation of the nodes to the surrounding tissues;
  • cervical lymphadenopathy, initially metastases of thyroid carcinoma are found in the cervical lymph nodes;
  • Reduction or loss of mobility of the vocal cords.

Differential diagnosis of thyroid cancer

The doctor must exclude the following diseases:

  • Non-toxic goiter – non-active thyroid nodules.
  • Toxic goiter – normofunctional nodules.
  • Graves’ disease – diffuse hyperactivity of the thyroid gland.
  • Hashimoto’s thyroiditis – autoimmune destruction of the thyroid gland.
  • Isolated thyroid nodules – 15-25% are cysts that can be sucked off.
  • Quervain’s thyroiditis – pain in the throat, fever and lethargy after an upper respiratory tract infection or viral disease.
  • Acute, purulent thyroiditis – as a result of a bacterial or fungal infection leading to an abscess.

Therapy for thyroid tumor

There are treatment options for all patients with thyroid cancer.
Four types of treatment are used:

  • surgery (removal of carcinoma);
  • radiation therapy (is performed with high-dose X-rays or other high-energy rays to kill the tumor cells), in the thyroid gland, radioiodine therapy is usually performed, with the iodine administered orally in capsule form;
  • hormone therapy (hormonal drugs are administered to stop the growth of tumor cells);
  • Chemotherapy (drugs are taken to kill the tumor cells), usually this therapy is not performed unless the cancer is advanced and has formed distant metastases.

Surgery is the most commonly used treatment for thyroid cancer.

Testimonial of a patient whose thyroid gland was removed due to a malignant tumor

Malignant lump in a thyroid lobe

Before the operation
Previously, I had already had an ultrasound done on my own, in which a slightly calcified lump was detected.
I was referred to an endocrinology department where a fine needle aspiration was performed.
After a month, I was told that the lump was malignant.
In my case, it belonged to category T4. A genetic test was also performed to confirm the malignancy. This is a new procedure.
I met with the endocrinologist and an otolaryngologist, because the otolaryngologist operates on the thyroid gland.
Together we decided to remove the entire thyroid gland, because you can only take out half of it.
If part of the organ remains in the body, it can become difficult to dose the euthyrox because the remaining thyroid continues to produce these hormones. In addition, therapy with radioactive iodine would not be possible.
Should metastases or further nodules appear in the following years, further intervention would be required to remove the rest of the thyroid gland.
Then they called me and told me the day for the operation.
A few days before the operation, you have to go to the hospital to perform the preoperative examinations, such as blood tests.

Hospitalization and surgery
I was in the hospital for 3 nights. After the operation, the calcium level must be checked and the drains must be clean.
As long as the drains are not clean and the calcium level does not have the right values, you will not be discharged.
The risks of the procedure are damage to the vocal cords, the voice may never sound the same again. Then you should also frequent a speech therapist.
Another possible side effect is damage to the parathyroid glands, which are associated with calcium metabolism.
In case of problems, you have to take calcium supplements forever.
The operation takes about 1 hour. However, I came to the operating room at 7:30 in the morning and was not back in my room until 11:30/12:00.
The operation is performed under general anesthesia.

Postoperative
It takes a few days to overcome the effects of anesthesia. As soon as you wake up again, however, the immediate effects of anesthesia quickly wear off.
The first night you can not sleep due to the pain, which does not subside despite the administration of morphine and other painkillers.
You can feel pain in the neck, where the drains are attached, and in the jaw arch, as it is irritated by the spreader placed in the mouth for ventilation.
After 3 nights I was released.
After 1 month I returned to work and felt a constant improvement.
It is necessary to determine the correct dosage for the Euthyrox.

Therapy with radioactive iodine
After four months, I was advised to undergo therapy with radioactive iodine.
You go to the hospital and receive a tablet that has been individually put together based on various factors.
I was in a room with another woman, but in isolation. Due to the risk of radiation exposure, no one was allowed to enter the room.
The nurses were communicated using a telephone.
As soon as you have broken down the radioactive iodine, i.e. the values fall below certain safety values, you are dismissed.
For the next 12 days you have to stay away from other people, direct proximity of others should only be allowed for a short time.
Clothes must also be washed separately. We have been advised to use disposable plastic plates so as not to endanger other people.
I was alone in my apartment and my husband is currently driving to his mother.
Of course, I didn’t go to work.

Treatment for each stage of the thyroid tumor

Treatment for thyroid cancer depends on:

  • Type
  • stage of the disease,
  • Age
  • general state of health of the patient.

Papillary carcinoma and follicular thyroid cancer in the first stage
Possible forms of treatment:
1. Surgical intervention to remove a thyroid lobe (lobectomy), followed by hormone therapy. Radioiodine therapy can also be done after surgery.
2. Surgery to remove the thyroid gland (total thyroidectomy).
In some cases, pregnant women can also be operated, but the doctor should perform local anesthesia.

Papillary thyroid carcinoma and follicular carcinoma in stage
two 
The treatment options are:
1. surgery to remove a thyroid lobe and the lymph nodes containing cancer cells, followed by hormone therapy. Subsequently, the doctor may order radioiodine therapy, but if the patient is a pregnant woman, this therapy cannot be performed.
2. Surgery to remove the thyroid gland.

Papillary thyroid carcinoma in the third stage
Therapy is chosen among the following options:

1. Surgery to remove the entire thyroid gland (total thyroidectomy) and the lymph nodes to which the cancer has spread.
2. Total thyroidectomy followed by radioiodine therapy or external radiation therapy.

Follicular thyroid carcinoma in the third stage
Possible forms of therapy:
1. Surgery to remove the entire thyroid gland (total thyroidectomy) and the lymph nodes or other tissues around the thyroid gland into which the tumor has spread.
2. Total thyroidectomy followed by radioiodine therapy or external radiation therapy.

Papillary or follicular carcinoma in stage
four 
Treatment is one of the following options:
1. Radioactive iodine.
2. External radiation treatment.
3. Hormone therapy.
4. Chemotherapy.

Medullary thyroid carcinoma
The method chosen will probably be surgery to remove the entire thyroid gland (total thyroidectomy), unless there are metastases in other areas of the body.
If the cervical lymph nodes contain cancer cells, the surgeon removes the cervical lymph nodes (lymph node dissection).
If the cancer has spread to other areas of the body, the doctor may order chemotherapy.
Metastases usually form in:

  • Bone
  • Lungs
  • Liver.

Anaplastic thyroid carcinoma
Treatment can be one of the following:
1. Surgery to remove the thyroid gland and surrounding tissues.
Since this cancer usually penetrates the surrounding tissue very quickly, the doctor will likely need to remove part of the trachea.
The doctor must then create an airway in the throat so that the patient can breathe. This procedure is called tracheostomy.
2. Complete thyroidectomy is used to reduce symptoms if the disease is located in the thyroid gland.
3. External radiotherapy.
4. Chemotherapy.
5. Clinical trials are underway on new treatments for thyroid cancer.

Recurrent thyroid cancer
The choice of therapy depends on:

  • type of thyroid cancer,
  • the nature of the previous treatment,
  • Area where the cancer has returned.

The therapy can be one of the following:
1. Surgery with and without radioactive iodine.
2. External radiation therapy to relieve symptoms caused by the cancer.
3. Chemotherapy.
4. Radioactive iodine.
5. Radiotherapy, administered during surgery.

Prognosis

Anaplastic carcinoma can lead to death if not treated in time.
In other cases, the prognosis for thyroid tumors is excellent because the 5-year survival rate from diagnosis in the case of differentiated carcinoma is more than 90%.

Read more:

Loading...