Health Chats
Thyroid Cancer: Causes, Symptoms, Treatments and Outcomes
Tuesday Sep 27, 2011, 07:00PM - 08:00PM (EST)
Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
, Sarasota, FL
There are four types of thyroid cancer, papillary, follicular, medullary and anaplastic. Papillary and follicular are the most common. Most thyroid cancers are treatable if found early. Dr. Lupo will answer your questions about Thyroid Cancer, including questions about causes, symptoms, treatment and outcomes. Mark A. Lupo, M.D. is board-certified in Endocrinology and has a subspecialty focus in thyroid and parathyroid disorders. Dr. Lupo is currently Secretary of the Academy of Clinical Thyroidologists and was President of the group from 2008-2009, member of the American Thyroid Association (ATA), American Association of Clinical Endocrinologist (AACE), AACE Nuclear Medicine Task Force, ATA Programming Committee, Endocrine Society, Florida Medical Association, and American Mensa Society. Dr. Lupo serves as the moderator for the patient-oriented MedHelp International Thyroid Disorders forum.
MLupoMD:
A CT of the chest would be reasonable.  PET scanning is not routinely used for thyroid cancer but can sometimes help.  At this point would plot out the trend in Tg-Ab levels over time to see if this is going up or down and also to determine the impact of the recent RAI on this trend
Pam:
Hi Dr. Lupo,  Thanks so much for taking time to answer our questions.  My cousin has just been diagnosed with something called anaplaxic thyroid cancer.  When I search for information on this, everything I find is VERY discouraging.  Are there new treatments?  What is the prognosis for her?  She is only 41 years old and has 2 children.
MLupoMD:
Anaplastic thyroid cancer is rare, but very aggressive usually with a poor prognosis (6 months average). She needs to get to a thyroid cancer treatment center (like MD Anderson, Sloan Kettering, Mayo Clinic, or a good local university) for a team-approach to treatment.  First the diagnosis needs to be confirmed...cont'd
MLupoMD:
Second, need to see if she is a surgical candidate -- sometimes needed just to "debulk" the tumor.  There are times where surgery is not likely to help and we go straight to radiation-chemo..combined....cont'd
MLupoMD:
The benefit of a specialty center would be clinical trials on ATC....the key is to move quickly and work with an experienced team even if that means travelling.  
SFmonsterdark:
What are the symptoms of Thyroid Cancer?  How do I do a neck check myself?
MLupoMD:
Usually, there are none.
MLupoMD:
But symptoms can be trouble swallowing, hoarseness, hard/fixed neck mass....cont'
MLupoMD:
you can check yourself by looking in the mirror, focus on lower neck and swallow (the thyroid moves when you swallow) and not any lack of symmetry or bump you may see. Also self-palpation every couple of months would be appropriate.
Brightlight06:
I am facing surgery to remove my thyroid and some of the surrounding lymph nodes.  I have heard that I may lose my voice completely and wondered how great the possibility is for that to happen due to surgery?
MLupoMD:
It depends on the surgeon -- high volume thyroid surgeons have a 1% complication rate of nerve (to vocal cords) injury.  Low volume surgeons (about 50% of thyroid surgery in this country is performed by surgeons doing <10 per year) -- about 5-8% (or higher) risk....cont'd
MLupoMD:
Sometimes the tumor encases the nerve, putting you at higher risk.  Even if the nerve is stunned, the voice can return in 6 months in most cases. If the nerve is severed or sacrificed, then they can do procedures to help the voice recover.  Find a surgeon that does at least 30 thyroidectomies per year.  Expect to have trouble "hitting the high notes" in many cases - even with very skilled surgeons.
pinkroses4me:
When I had some blood work done to check my cholestrol & thyroid the results came back noting my cholestrol level was high and alsomy thryroid wasn't working as it should.  Two years later, I had my blood work redone, my cholestrol level is still high, but.. my thryoid is back to normal?  What does that mean?  I was surprised that my thryoid corrected itself, without any medication :)  Is this normal?
MLupoMD:
Yes - sometimes the thyroid will self correct -- which is why we don't treat an isolated abnormal value.  If the thyroid is normal now and cholesterol is still high, the cholesterol issue is independent from the thyroid and needs separate evaluation and treatment.
kittykat929:
Hi Dr. Lupo. My aunt had surgery to remove a nodule and now she gets a soar throat often and has trouble talking at times. Is there anything you recommend, esp non-prescription remedies like tea?
MLupoMD:
This may or may not be related to the surgery.  A common cause of this would be acid reflux -- a trial of over-the-counter antacids (such as prilosec OTC for 3-4 weeks) may help sort this out.  Otherwise she should talk to her surgeon about her symptoms.  
celou:
I had papillary thyroid cancer surgery 39 years ago, total TT with para thyroids removed along with lymph nodes in neck region. Several years ago I had a thyrogloblin antibody test that was 3000, I have recently had 100mc of RAI with WBS scan that showed uptake in lower neck/upper chest region. Would my next test be a CAT scan or PET scan now or shall I wait 2 months to check thyroglobilin, then get CAT/PET.
MLupoMD:
I think we already answered this question.....
AEGGOF:
My grandmother was told that she has parathyroid adenoma.  Is this curable?  What kind of treatment will she need?  How long will it take her to recover...or will she never recover?  We are all so worried about her!
MLupoMD:
Yes - very curable.  A parathyroid adenoma is usually discovered in the context of hyperparathyroidism...cont'd
MLupoMD:
The parathyroid glands (we have 4 of them) control calcium balance.  Excess parathyroid hormone from an adenoma increases blood calcium and may cause bone loss and kidney stones...cont
MLupoMD:
the treatment is surgery to remove the culprit gland -- the key is to find a high-volume parathyroid surgey to make this a minimally invasive and curative surgery the first time around!  Recovery (in most cases) is very quick and she may not need any medications long term in most cases.  
sassyc65:
I had thyroid surgrey in 1962 and i was never put on synthroid, how could that be.
MLupoMD:
This must have not been a total thyroidectomy -- in other words, you have some normal, functioning thyroid tissue still present.
Pam:
Thank you so much for your answer and suggestions for my cousin.  We are in North Dakota, so I guess the Mayo Clinic in Minnesota would be the closest place for us.  Now we just need to find out if they will accept her insurance.
MLupoMD:
Pam - Mayo would be closest - they take most insurance -- good luck; don't delay.
Brightlight06:
Thank you a hundred times - at least you are willing to give me a quantitative way to choose a doctor.  You cannot imagine how helpful you have been...a doctor who performs 30 thyroidectomies a year.   Thank you so much Dr.Lupo
MLupoMD:
You are welcome -- now the trick is finding that data.  consider talking with the hospital's operating room supervisor....
Mmarcelle:
What does a change in appearance of the solid portion of a complex nodule on a comparative US exam incidacte?
MLupoMD:
It really depends -- most complex (cystic and solid) nodules are benign, but if the solid component has calcification or increased blood flow, then this may be suspicious and reason for targeted FNA w/ US guidance into that area.  Sometimes these "changes" are just different ways the techs take the images....
ChitChatNine:
Is a high TSH hyper or hypothyroid results .. It's so confusing
MLupoMD:
High TSH means the pituitary (near the brain) is requesting more thyroid hormone from the thyroid -- so it usually indicated HYPOthyroidism.