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Endocrine Surgery

Thyroid Surgery

Thyroid Cancer

  • How do I know if I have thyroid cancer?
    • Thyroid cancer can sometimes be diagnosed by a fine needle biopsy.
    • Many times, thyroid cancer can only be diagnosed after the thyroid is removed when the pathologist examines the thyroid under the microscope.

  • What are risk factors for thyroid cancer?
    The only risk factors for thyroid cancer are a history of radiation to the head and neck and a personal or family history of an endocrine tumor syndrome, specifically Multiple Endocrine Neoplasia types 2A and 2B.

  • What are the different types of thyroid cancer
    • Papillary: this is the most common type of thyroid cancer (80-90%). Garden variety papillary cancer is usually very slow growing and can be removed surgically. Though the cancer often metastasizes to the surrounding lymph nodes, this does not affect prognosis and the majority of patients go on to live long, healthy, normal lives.
    • Follicular and Hurthle cell: two different types of cancer but discussed together that make up 5-10% of all cancers. The only way to tell for sure that a nodule is cancerous is to remove the nodule and examine the capsule under the microscope for invasion. Follicular cancer tends to spread through the blood stream to the lungs and bone and not to the lymph nodes. Hurtle Cell cancer can spread to either the lymph nodes or organs.
    • Medullary: rare (3-10%) type of thyroid cancer.  This is the type of thyroid cancer in patients with hereditary endocrine tumor syndromes. 
    • Anaplastic: this is a rare, aggressive type of thyroid cancer that usually occurs in older patients that present with a very rapidly growing hard neck mass.

  • Is thyroid cancer serious?
    Most types of thyroid cancer are very treatable and patients go on to live long, healthy, normal lives.

  • Are any lymph nodes removed during surgery?
    • The lymph nodes on the sides of your neck will be evaluated with an ultrasound and possibly and needle biopsy prior to your surgery. This will determine whether a neck dissection or “lateral lymphadenectomy” (taking out all the lymph nodes in the lateral neck compartments) will be performed.
    • The lymph nodes closest to your thyroid are the central compartment, or level VI lymph nodes. For patients with a known cancer, determined either before or during surgery, these lymph nodes will be examined by your surgeon during the procedure and likely removed.

  • Do I need any additional treatment?
    • All thyroid cancer patients will be put on suppressive doses of thyroid hormone replacement. This will help prevent any remaining thyroid tissue or cells from growing back at all or in the form of cancer. Your TSH levels will be monitored by your endocrinologists to obtain your optimum dose.
    • In some patients radioactive iodine (RAI) will be recommended as additional treatment. There is controversy over which patients actually need RAI.
      • Definite indications for RAI: tumors that have spread to the surrounding tissues, distant metastases, and when gross tumor remains at the end of surgery.
      • Strong indications: large tumor size > 4cm, lateral lymph node involvement, aggressive histologic subtypes.
      • Definite indications to NOT give RAI: small tumors < 1-2 cm confined to the thyroid gland with no evidence of spread to the lymph nodes or surrounding tissues.
      • Unknown: all other tumors. Your treating endocrinologist will discuss with you the risks and benefits of RAI treatment specific to your situation with you.

  • Can my cancer come back?
    • Thyroid cancer can come back many years after your initial treatment, which is why it is very important to follow-up with your endocrinologist or surgeon on a regular basis.
    • If cancer comes back it is usually locally in the thyroid bed (where your thyroid was previously removed) or in the neighboring lymph nodes.

  • Are there risk factors for recurrence?
    • There are multiple staging systems for predicting recurrence in thyroid cancer that are each inclusive/exclusive of different prognostic factors.
    • Factors include: Age, tumor size, lymph node involvement, distant metastases, histological subtype, histological features (invasion of the capsule, spread to the surrounding tissues, invasion of the lymphatics and blood vessels), molecular tumor markers.

  • How is my cancer monitored after surgery?
    • You will have lifelong follow-up with your endocrinologist and sometimes your surgeon.
    • At a minimum, yearly blood tests to measure the level of thyroglobulin (thyroid tumor marker), thyroglobulin antibodies, and TSH (level of thyroid hormone suppression will be checked. Depending on your specific type of cancer, these blood tests may be more frequent.
    • A neck ultrasound is another common diagnostic test that you will likely have during your cancer follow-up. The frequency of ultrasounds will depend on your specific cancer and your treating physician.
    • Other tests may be ordered at the discretion of your physician. 

  • Are there support groups for thyroid cancer survivors?
    • ThyCa is a national thyroid cancer survivor support group. They put on a large, yearly national meeting that is well attended by survivors, endocrinologists, surgeons, oncologists, and other involved professionals. Additionally, many regions have local support groups that have monthly meetings (Southern California has a few). Their website is also has a lot of useful patient information. http://www.thyca.org

 

Please refer to the American Association of Endocrine Surgeons patient education website for more detailed information: http://endocrinediseases.org/thyroid/index.shtml

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