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Thyroid Endocrine Disorders Sarasota Florida
Papillary Thyroid Cancer in Lymph Node
Papillary Thyroid Cancer in Lymph Node

Thyroid cancer is one of the fastest growing cancers in America and one of the most curable. Thyroid cancer (carcinoma) usually appears as a painless lump the lower front of the neck, below the Adam's apple and above the collarbone. In most cases, the lump affects only one side of the neck and results of thyroid function blood tests usually appear normal.

There are four main types of thyroid cancer: papillary (the most common, making up 70%-80% of all thyroid cancers), follicular (10%-15% of all thyroid cancers), medullary (5%-10% of all thyroid cancers) and anaplastic (less than 5% of thyroid cancers and the most aggressive). Since the vast majority of cases are either papillary or follicular, and these are the only two types treatable with radioiodine, the following information will focus on these two types.

As with many types of cancer, the specific reason for developing thyroid cancer remains a mystery in most patient cases, though several known risk factors have been identified including external radiation to the head or neck (especially during childhood), genetic predisposition (particularly for medullary thyroid cancer), and gender (a lump in a man's neck is more likely to be cancerous than one in a woman's neck).
Signs and Symptoms
Many patients with thyroid cancer have no symptoms whatsoever, and are found by chance to have a lump in the thyroid gland during a routine physical exam or an imaging study (CT or MRI) done for unrelated reasons. Other patients with thyroid cancer become aware of a gradually enlarging lump in the front portion of the neck which usually moves with swallowing. Occasionally, the lump may cause a feeling of pressure. Obviously, finding a lump in the neck should be brought to the attention of your physician, even in the absence of other symptoms.
Detection and Diagnosis
Your physician will first take a detailed history and perform a careful physical examination, especially of the thyroid gland. The best diagnostic approach for a specific patient will be determined by the physician after careful consideration of all the facts. The tests available to your physician for evaluation of the thyroid lump include, but are not limited to, the following:
  • Ultrasound - This is done to determine the characteristics of the nodule as well as to look for other, non-palpable nodules and to evaluate for any suspicious lymph nodes in the neck. It is also used to guide needle biopsy.
  • Fine needle aspiration biopsy (FNA) - This is the next step and, if positive, significantly reduces the need for more elaborate and expensive testing.
  • Thyroid scan - A scan can be performed to determine if the mass is capable of concentrating radioiodine, particularly in those rare cases with associated hyperthyroidism.
  • Blood studies - There is no specific blood test to detect thyroid cancer and, in most cases, the usual thyroid function tests are completely normal.
  • Molecular Markers

Fortunately, most types of thyroid cancer can be diagnosed early and cured completely, but a thorough and comprehensive investigation is necessary. If thyroid cancer is suspected after review of all the information, referral to an experienced thyroid surgeon is recommended.

The usual approach to thyroid cancer is to remove the portion of the thyroid containing the lump, along with most of the remaining thyroid gland and any abnormal lymph nodes. Pre-operative ultrasound by a skilled physician is critical in planning the extent of surgery. If cancer is confirmed, further treatment with radioactive iodine may be necessary.

Radioactive iodine treatment is usually recommended in order to destroy any remaining malignant thyroid cells as well as the "remnant" of normal thyroid tissue that usually remains after surgery. It is also recommended to reduce the risk of recurrence for this disease.

After surgery, thyroid medication (levothyroxine) should be started and the dose carefully adjusted to each patient's unique requirements. This will prevent the development of persistent hypothyroidism and decrease the likelihood of cancer recurrence. Periodic monitoring is supervised by the endocrinologist and should include ultrasound examinations of the neck and testing of a blood protein called thyroglobulin, which is found in normal thyroid cells but can also be produced by thyroid cancer cells. Radioiodine scans have a limited role in long-term follow-up care.

The optimal frequency of additional monitoring studies to be certain the cancer does not recur will be determined by your physician. Fortunately, most types of thyroid cancer are associated with a very good prognosis when diagnosed early and treated by a physician who is familiar with the management of this disease.

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