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.
ChitChatNine:
Have there been advances in thyroidectomy surgical techniques over the past few years, or do you foresee any in the near future?
MLupoMD:
Thyroid surgery is becoming more minimally invasive. Robotic surgery is around the corner as the next major advance, but not yet ready from prime time in most centers.  the higher volume thyroid surgeons can do incredible things through very small incisions.  With robotics, in the future we may see thryoid surgery performed through the axilla (underarm) rather than the neck.
ART_MHAdmin:
How large does my nodule have to be to have a biopsy?
MLupoMD:
Depends on risk factors (family history and radiation exposure) as well as ultrasound characteristics -- the more suspicious, the lower the threshold.  We used to FNA all nodules >1cm but now it's more complicated and actually we are doing less FNA (if the guidelines are followed).
suse522:
I was diagnosed and treated for follicular thyroid cancer in 1995. I have annual blood tests for thyroglobulin levels which have been clear although I do suffer with exhaustion on occasions. What is the likelihood of my cancer returning and is an annual blood test all the after care I need? I am a 57 yr old woman living in the North west of England. Also do you think my thyroid cancer may have been caused by the 1986 nuclear fallout from Chernobyl when a cloud of nuclear material was found over Northern England? I was pregnant with my twins at the time and have always wondered if this may have been a factor in my developing the cancer
MLupoMD:
You were 32 during Chernobyl and not too very close - so not likely connected....cont'd
MLupoMD:
However the twins would potentially be at higher risk - so should undergo ultrasound evaluation of the thyroid if not already done....cont;d
MLupoMD:
At this point if the Tg levels are negative and the neck ultrasound is negative, then the risk is low.  One might do a "stimulated" Tg (with thryogen or after stopping thyroid hormone) but this decision would be based on more details of your history (such as pathology staging and if you received RAI).
celou:
I was diagnosed with pap. thyroid cancer 39 years ago had TT and parathyroids removed andRAI.  A few years ago I had a thyroglobulin antibodies test results 3000 another at 1000 and another at 900  After 3 ultra sounds which showed no nodes and a bone scan (negative)  I had 100 mill of RAI and a WBS which showed uptake at the base of my throat  Now they want to do a CT scan with contrast  Do you think this is the right course of action?  Are they looking for spread in the chest?  Should I just be going to Mayo or MD Anderson at this point?
MLupoMD:
Thanks for the additioanl info.  The CT of the chest is reasonable.  The TG-Ab trend (that you listed) appears to be decreasing (if chronologic and performed at the same lab).  If this is not the case or it trends upwards, then second opinion at one of those centers would be reasonable in addition to whole-body PET/CT scan.
AKJK406:
My dad was treated with radioactive iodine many years ago and now they say he may have parathyroid cancer.  Is this caused by the iodine treatments?  What treatments will he need for this cancer?
MLupoMD:
The association with RAI and parathyroids is for benign adenomas, I have not seen a clear association with parathyroid cancer which is quite rare.  This is sometimes related to jaw-tumor syndromes that run in families, so genetic testing may be appropriate.  He will need surgery and sometimes radiation.
katscan:
Do thyroid problems run in one's family? I believe my grandpa had thyroid cancer. I'm just wondering if I should be screened for it? Thanks so much for answering my question, doctor!
MedHelp:
Unfortunately, we only have time for one more question.
MLupoMD:
Most thyroid cancer is sporadic, not genetic.  So we don't routinely screen family members of patients with papillary thyroid cancer. This is different for medullay cancer.
ChitChatNine:
What % of atypical nodules turn out to be thyroid cancer when removed during surgery?
MedHelp:
Unfortunately, that's all the time we have today. Thank you everyone for participating in today's chat and a big thank you to Dr. Lupo for taking the time to answer everyone's questions.
MLupoMD:
It should be 5-10% -- which was the pre-FNA odds of cancer -- which is why we repeat the FNA in these cases to try to better categorize it.  Repeatedly "atypical" FNAs may need surgery or molecular profiling for better clarification
MedHelp:
Please join us for our next health chat "Prostate Cancer: Early Detection and Proper Treatments" this Friday, September 30th at 12pm EST
MLupoMD:
You are welcome!  Thanks for inviting me back to chat!