2. ThyroidCancer:
• Thyroid cancer is a cancer originating from
follicular or parafollicular thyroid cells. These
cells give rise to both well-differentiated
cancers (i.e., papillary and follicular) and
anaplastic thyroid cancer. The second cell type,
the C or parafollicular cell, produces the
hormone calcitonin and is the cell of origin for
medullary thyroid carcinoma (MTC).
3. Signs and Symptoms:
• A lump or swelling in your neck. This is the most
common symptom.
• Pain in your neck and sometimes in your ears.
• Difficulty swallowing.
• Difficulty breathing or constant wheezing.
• Hoarseness that is not related to a cold.
• A cough that continues and is not related to a cold.
• Some people may not have any symptoms. Their
doctors may find a lump or nodule in the neck during a
routine physical exam.
4. • Thyroid cancer is usually found in a euthyroid patient, but
symptoms of hyperthyroidism or hypothyroidism may be
associated with a large or metastatic well-differentiated
tumor.
• Thyroid nodules are of particular concern when they are
found in those under the age of 20. The presentation of
benign nodules at this age is less likely, and thus the
potential for malignancy is far greater.
5. Causes:
• Thyroid cancers are thought to be related to a number of environmental
and genetic predisposing factors, but significant uncertainty remains
regarding its causes.
• Environmental exposure to ionizing radiation from both natural
background sources and artificial sources is suspected to play a
significant role, and there are significant increased rates of thyroid
cancer in those exposed to mantlefield radiation for lymphoma, and
those exposed to iodine-131 following the Chernobyl and Fukushima
nuclear disasters.Thyroiditis and other thyroid diseases also predispose
to thyroid cancer.
• Genetic causes include multiple endocrine neoplasia type 2 which
markedly increases rates, particularly of the rarer medullary form of the
disease.
6. Diagnosis
• After a thyroid nodule is found during a physical
examination, a referral to an endocrinologist or a
thyroidologist may occur.
Most commonly an ultrasound is performed to confirm
the presence of a nodule and assess the status of the
whole gland.
Measurement of thyroid stimulating hormone and anti-
thyroid antibodies will help decide if there is a functional
thyroid disease such as Hashimoto's thyroiditis present, a
known cause of a benign nodular goiter.
M easurement of calcitonin is necessary to exclude the
presence of medullary thyroid cancer.
7. • Finally, to achieve a definitive diagnosis before
deciding on treatment, a fine needle
aspiration cytology test is usually performed
and reported according to the Bethesda
system.
8. Classification:
Thyroid cancers can be classified according to their
histopathological characteristics.
The following variants can be distinguished (distribution over
various subtypes may show regional variation):
• Papillary thyroid cancer (75% to 85% of cases – often in
young females – excellent prognosis. May occur in women
with familial adenomatous polyposis and in patients with
Cowden syndrome.
• Follicular thyroid cancer (10% to 20% of cases occasionally
seen in patients with Cowden syndrome
• Medullary thyroid cancer (5%to 8% of cases)- cancer of the
parafollicular cells, often part of multiple endocrine neoplasia
type 2
9. Poorly differentiated thyroid cancer
• Anaplastic thyroid cancer (less than 5% of cases[12]) is not
responsive to treatment and can cause pressure symptoms.
• Others Thyroid lymphoma
• Squamous cell thyroid carcinoma
• Sarcoma of thyroid
10. • Anaplastic thyroid cancer (less than 5% of
cases[12]) is not responsive to treatment and
can cause pressure symptoms.
• Others Thyroid lymphoma
• Squamous cell thyroid carcinoma
• Sarcoma of thyroid
11. Goal Of Treatment
• The goal of treatment for thyroid cancer is to get rid of the cancer
cells in your body. How this is done depends on your age, the type
of thyroid cancer you have, the stage of your cancer, and your
general health.
• Sometimes a suspicious lump or nodule has to be surgically
removed before you will know if you have cancer or not.
• After surgery, you may need treatment with radioactive iodine to
destroy any remaining thyroid tissue.
• When you no longer have all or part of your thyroid gland, you will
probably need to take thyroid hormone medicines for the rest of
your life. These medicines replace necessary hormones that are
normally made by the thyroid gland and prevent you from having
hypothyroidism-too little thyroid hormone.
12. Treatment
• Surgery to remove the part of the thyroid gland that contains
cancer. Removing one part (lobe) is called a lobectomy.
Removing both lobes is called a total thyroidectomy.
Removing all but a very small part of the thyroid is called a
near-total thyroidectomy. Lymph
nodes may also be removed during surgery.
• Radioactive iodine, which is used after surgery to destroy any
remaining thyroid tissue.
After you have your thyroid surgically removed, you may have
to wait several weeks before having radioactive iodine
treatment to destroy any remaining thyroid tissue.
13. • During the waiting period, you may have symptoms of
hypothyroidism such as fatigue, weakness, weight gain,
depression, memory problems, or constipation.
• Thyroid-stimulating hormone (TSH) suppression therapy. TSH
suppression therapy reduces the TSH in your body, which may
help prevent the growth of any remaining cancer cells.
• If thyroid cancer is advanced when it is diagnosed, initial
treatment may also include chemotherapy or radiation therapy.
14. Ongoing treatment
• After treatment for thyroid cancer, you may need to take
thyroid hormone medicine for the rest of your life to replace
the hormones that your body no longer makes. You will also
need follow-up visits with your doctor every 6 to 12 months.
In addition to scheduling regular visits, be sure to call your
doctor if you notice another lump in your neck or if you have
trouble breathing or swallowing.
• At your follow-up visits, your doctor may order a blood test to
measure your thyroid-stimulating hormone (TSH) level.
15. • This test helps your doctor know if you are
taking the right amount of thyroid hormone
medicine. Your doctor may order other tests,
such as a radioiodine scan, X-rays, or a CT
scan.
16. • THYROID HORMONE THERAPY: After thyroid
cancer surgery, thyroid hormone medication
levothyroxine is given for life. This pill has two
benefits: It supplies the missing hormone that
thyroid would normally produce, and it
suppresses the production of thyroid stimulating
hormone from pitutiary gland. High TSH levels
could stimulate any remaining cancer cells to
grow.
• Check thyroid hormone levels for proper dosing.
17. • RADIOACTIVE IODINE THERAPY:
• Radioactive iodine treatment uses large doses of
radioactive iodine. It is often after thyroidectomy to destroy
any remaining healthy thyroid tissue, as well as microscopic
areas of thyroid cancer that weren’t removed during
surgery. This treatment may also be used to treat thyroid
cancer that reoccurs after treatment or that spreads to
other areas of the body.
• Side effects: Nausea, dry mouth, dry eyes, altered sense of
taste or smell, plan where thyroid cancer cells have spread,
such as neck or chest.
• Precautions: Temporarily avoid close contact with people,
especially children and pregnant women
18. • External radiation therapy:
• Radiation therapy is given externally using a
machine that aims high-energy beams at
precise points on the body. This treatment is
typically administered a few minutes at a
time, five days a week, for about six weeks.
This is generally used to treat thyroid cancer
that has spread to the bones.
19. CHEMOTHERAPY:
• The tyrosine kinase inhibitors (TKIs),
vandetanib and cabozantinib, have been
approved by the FDA for thyroid cancer.
• Vandetanil:300mg PO daily
• Cabozantir: 140mg PO daily
• Dosage adjustment for TKIs may be required
depending on toxicity and coadministered
drugs.
20. Side effects of treatment
• The side effects of surgery for thyroid cancer are usually
mild and last a couple of days.
Your doctor will talk to you about medicine you can take
if you are having pain.
You will likely need to take thyroid hormone medicine for
the rest of your life to replace the hormones that your
body no longer makes.
• Taking high doses of thyroid hormone may cause a rapid
or irregular heartbeat. High doses taken over time may
also cause weakness in your bones (osteoporosis).
