Health Chats
Thyroid Cancer: Causes, Symptoms, Treatments and Outcomes
Tuesday Sep 27, 2011, 07:00PM - 08:00PM (EST)
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.
Hello everyone and welcome to today's Thyroid Cancer Health Chat with Dr. Mark Lupo. We'll be starting at 7:00PM (EDT) but please feel free to submit your questions now.
Welcome back Dr. Lupo!  We are all so happy to have you here today.
It's nice to be back for a health chat.  As many of you may know, it's thyroid cancer awareness month and I am happy we are able to have a thyroid cancer focused chat!
What are the types of thyroid cancer. I've heard about papillary, hurthle cell and follicular.
Papillary is most common type, then Follicular, Hurthle, Medullary followed by Anaplastic and lymphoma.  We also see metastasis from other cancers (breast, lung, kidney, etc) to the thyroid from time to time.
I have been told that I have a nodule on my thyroid and that the thyroid has an irregular texture. I began taking synthroid about 2 months ago and my levels returned to normal. My appointment with an endocrinologist is not til the end of October. What are my risks of thyroid cancer? What are my treatment options at this point?
The labs do not predict cancer.  If there is an irregular nodule >1cm on ultrasound, FNA biopsy should be done.  2 recent studies suggested that patients with nodules who have a high TSH may have an increased risk for cancer - overall the risk for cancer for a nodule is about 5-10%. Next step is FNA biopsy if the nodule is confirmed on ultrasound.
I have a medium-sized thyroid nodule that I have checked by ultrasound every year or so.  The biopsy was "inconclusive."  The only thing the Dr did was change my dosage of synthroid from .025 to .050  daily in hopes of shrinking it.  Does something like this eventually "turn" cancerous?  And why would it present as "inconclusive?" Thanks for any explanation you can give me.
We don't suppress nodules anymore in most cases - unless it's a younger patient w/ history of radiation exposure or the TSH is high -- only in these cases typically do we treat nodules with thyroid hormone.  
An "inconclusive" FNA ---- I would need more info, most likely it means not enough cells.  OR it could mean "indeterminate" (a better word) which requires another FNA or surgery to help make the diagnosis.  In either case it may be worthwhile to repeat the FNA (unless the nodule is clearly shrinking) or get a second opin.
What is the chance my nodule is cancer?
On average - 5-10% of nodules are cancer.
My maid has been detected of Papillary thyroid cancer.She is 35 yrs old. We are just confused about what to do next. Is surgery the only option?
Surgery is the most important part of treatment for PTC.  It is important to have a good pre-operative ultrasound of the entire neck to see if there are any suspicious lymph nodes --- this would change the extent of surgery in 1 of 7 patients.  She should find a good surgeon who does at least 30 thyroidectomies per year and is experienced with thyroid cancer.
My doctor recently told me that I might need an FNA (Fine Needle Aspiration) Biopsy.  I did not ask many questions when I was in her office, can you please describe the above procedure?
This uses a small needle - smaller than a blood draw needle - to obtain cells from the thyroid nodule.  Anesthesia is seldom required and this can be done in endocrinologists or surgeon's office, preferably with ultrasound guidance.  Larger or core needle biopsies are not needed for thyroid nodules and carry a much higher risk of bleeding complications.
are there any known long term side effects from oral RAI therapy for papillary thyroid cancer?
RAI does carry some long-term risks.  The most frequent involve salivary gland damage (dry mouth and taste sensation change and less commonly tear duct damage (dry eyes). There have been recent reports of "secondary cancers" arising many years after radioactive iodine treatment -- this risk is very small...cont'd
but has made us re-think RAI risk/benefit ratios and in general we are using less RAI for thyroid cancer than we used to.  The risk of other cancers increases with increasing RAI dosing but in most cases the benefit of RAI for the thyroid cancer outweights this risk....cont
There is also a slight increase risk of hyperparathyroidism several decades after the RAI -- this is true for RAI treatment for any thyroid condition....cont'
The other risk is contaminating family members, etc with RAI, so radiation safety precautions must be followed.
Can the thyroid correct itself without any medication?  What causes the thyroid to not function properly, is it age related?  
It depends (docs love to give that response!)......If the thyroid is damaged by radiation or a chronic inflammatory attack from the immune system (like Hashimoto's) then recovery is not likely.  There are temporary insults to the thyroid that cause dysfunction from which one can recover.  We see thyroid dysfunction across the age spectrum, but it appears to increase with age.
Will the nodules in subacute granulomatous thyroiditis go away completely? If not, would any of these nodules turn malignant in the future?
I like this question on subacute thyroiditis(SAT) -- this can cause focal infiltration of inflammatory cells that look like a nodule on US that then resolve completely in 3-6 months.  Sometimes it will start on one side then go to the other.  If the clinical diagnosis is SAT then I monitor initially without FNA (unless the nodule is clearly suspicious) and follow closely.  There may be a chance that the inflammation would increase risk of future nodules or cancer (like we see in Hashimoto's) but this has not been proven.
I had a FN Biopsy and the results came back negative however my doctor is telling me that I will need to repeat the FN Biopsy in 6-12 month why do I need to have another FN Biopsy? Also I have symptoms of throat and ear pain could this be related to the thyroid? Is there any medication that will shrink the nodule?  
We do not (yet) routinely repeat FNA, however larger nodules and nodules that have suspicious US features should be considered for repeat FNA if the initial biopsy is read as benign.
Throat and ear pain may be "referred" from the thyroid, but other things may cause such pain as well -- if this persists, an ENT evaluation may be helpful.  Medications are only needed if the TSH is abnormal
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.
If this was your first RAI treatment, then this may well have been the remnant thyroid tissue left behind after the surgery 39 years ago....cont'd
However the high Tg-Ab test is concerning as it clouds the ability to interpret a tumor marker.  If the Tg-Ab is trending upwards then that is a concern for thyroid/tumor growth....cont'd
A good neck ultrasound should have already been done -- this would have helped to evaluate the thyroid remnant tissue and see if there are any conspicuous lymph nodes, etc.