White Coat Notes

7 common questions about thyroid cancer

Dr. Gregory W. Randolph is the Director of the General Otolaryngology Service and Director of the Thyroid and Parathyroid Surgical Service at Massachusetts Eye and Ear Infirmary.

Dr. Gregory W. RandolphMass. Eye and Ear

Having always been intrigued by endocrinology, Dr. Randolph became interested in the anatomy of the head and neck while he was in medical school at Cornell University. Thyroid and parathyroid surgery bring together his two greatest areas of interest.

In the post below, Dr. Randolph answers seven of the most common questions about thyroid cancer:

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1. What is the thyroid and what does it do?

The thyroid gland is a gland in the neck base that is shaped like a bow tie and positioned like one, too. It encircles the breathing tube (trachea) and swallowing tube (the esophagus). It secretes hormones, which regulate the body’s metabolism. The thyroid is commonly the source of benign and malignant growths, which can appear as neck masses and can affect the surrounding structures including the voice box and larynx. Laryngeal exam and voice assessment is critical in the evaluation of thyroid pathology.

2. What causes thyroid problems?

Masses and nodules within the thyroid are very common—about 50% of individuals have thyroid nodules as adults. The majority of these nodules are benign. Fine needle aspiration biopsy is necessary for many nodules to exclude cancer. Nodules can occur in certain families with greater frequency and may also occur in the setting of past-radiation exposure. An example of this is the Chernobyl accident in Russia—such radiation exposure increases the likelihood of those exposed developing nodules and the likelihood that the nodules are malignant.

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3. What signs and symptoms can occur if thyroid function is affected?

Most nodules of the thyroid and thyroid cancers are not associated with any abnormality in thyroid function. There are, unfortunately, few if any systemic symptoms associated with thyroid nodules and thyroid cancers. They often appear as a lump in the neck base and are detected by the patient while showering or men while shaving. They can also be detected through a physical exam in your primary care physician’s office or incidentally through x-rays done of the neck for other purposes such as MRI scans done for cervical whiplash, CT scanning of the chest and neck for chronic cough, or carotid arterial ultrasonography.

4. How is the diagnosis of thyroid disease made?

The diagnosis of thyroid nodularity—determining whether it is benign or malignant—is primarily based on ultrasonographic analysis of the thyroid gland and ultrasonographic guided fine illustration biopsy. This topic will be reviewed during the public forum at Mass. Eye and Ear on April 5.

5. What is the treatment for thyroid disease?

Many thyroid nodules can be followed with serial ultrasound once the biopsy is negative. When thyroid cancers are operated on, generally the prognosis is very favorable for patients with the vast majority of thyroid cancer types.

6. How do I know if I have thyroid cancer?

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The diagnosis of thyroid cancer can generally be made following a fine needle biopsy of the thyroid nodule. Once the diagnosis is made, typically additional imaging of the neck is performed to make sure there is no lymph node metastasis of thyroid cancer, which is relatively common occurring in up to a third of patients with thyroid cancer.

7. If thyroid surgery is recommended, how is my voice box—and voice— protected?

Electrophysiologic monitoring of the recurrent laryngeal nerves and nerves adjacent to the thyroid gland to bring electrical cavity to the muscles of the vocal cord can be performed during thyroid surgery. Mass. Eye and Ear researchers recently completed a review of over 3,000 monitored thyroidectomies and found that this electrical monitoring system is tremendously helpful in gaining optimal information regarding neural function and in protecting nerves during surgery.

Mass. Eye and Ear will host a public seminar entitled Understanding Thyroid Nodules and Thyroid Cancer on Saturday, April 5, 2014. Drs. Gregory W. Randolph, Paul M. Konowitz and Mary Elizabeth Cunnane will be the speakers at this event.

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