Forms and their forecast
Thyroid tumors vary in origin and aggressiveness, and treatment and prognosis directly depend on the form. Papillary cancer is the most common, grows slowly, can metastasize to the cervical lymph nodes, but is well treated. Follicular cancer rarely affects the lymph nodes, but can spread through the blood. Medullary cancer develops from other calcitonin-producing cells and is hereditary in about a quarter of cases, requiring genetic testing of the family. Anaplastic cancer is a rare but very aggressive form.
- Papillary - the most common, the prognosis is favorable
- Follicular - less common, spread through the blood
- Medullary - from C-cells, can be hereditary
- Anaplastic - rare and aggressive
- Prognosis depends on shape, age and stage
Causes and risk factors
It is most often impossible to name the exact reason in a particular case. The most proven factor is the effect of ionizing radiation on the head and neck area, especially in childhood: the younger the person was at the time of exposure, the higher the risk. Heredity matters: thyroid cancer in close relatives and especially hereditary syndromes in the medullary form. The disease occurs more often in women than in men. The role of iodine deficiency, obesity and chronic autoimmune thyroiditis is discussed. Conventional ultrasound, dental photographs and fluorography do not carry any significant risk.
- Irradiation of the head and neck area in childhood
- Hereditary syndromes and familial cases
- Female gender
- Age
- Iodine deficiency
- Obesity
- Autoimmune thyroiditis
Symptoms
In the early stages there are no complaints, and that is why most tumors are detected by chance. A knot that can be felt on the neck should be alert, especially if it is dense, immovable and rapidly growing. Damage to the recurrent nerve causes persistent hoarseness not associated with a cold. A large tumor can press on the esophagus and trachea, making swallowing and breathing difficult. Enlarged, dense cervical lymph nodes are sometimes the first sign noticed. The function of the gland is usually not impaired in cancer, so a normal TSH does not exclude a tumor.
- Asymptomatic node in the early stages
- Dense, immobile formation on the neck
- Hoarseness of voice
- Difficulty swallowing and breathing
- Enlarged cervical lymph nodes
- Normal hormone levels do not rule out cancer
Diagnostics
The examination begins with an ultrasound of the thyroid gland, where each nodule is assigned a category according to the TI-RADS system, taking into account the structure, echogenicity, shape, contours and the presence of microcalcifications. It is the category, combined with the size, that determines the need for ultrasound-guided fine-needle aspiration biopsy, an outpatient procedure that is quick and relatively painless. The resulting material is assessed by a cytologist. Additionally, TSH is determined, and if the medullary form is suspected, calcitonin is determined. Be sure to examine the cervical lymph nodes, and in case of hoarseness, the vocal cords.
- Ultrasound of the thyroid gland with TI-RADS assessment
- Ultrasound-guided fine-needle aspiration biopsy
- TSH and in case of deviations free T4
- Calcitonin for suspected medullary cancer
- Ultrasound of neck lymph nodes
- Examination of the larynx for hoarseness
- CT or MRI for large tumors
Treatment and observation
The basis of treatment is surgical. For a small tumor limited to one lobe, removal of the lobe may be sufficient; in a more widespread process, the entire gland is removed, including, if necessary, the lymph nodes of the neck. After total removal, thyroid hormone replacement therapy is prescribed, which is taken for life, and this does not impair the quality of life. In some forms, radioactive iodine therapy is used to destroy the remaining cells. This is followed by regular monitoring with monitoring of ultrasound, TSH and thyroglobulin. For very small papillary tumors without signs of spread, active surveillance may be an option in some cases, as determined by your doctor.
- Removal of a lobe of the gland for a localized tumor
- Total thyroidectomy for advanced disease
- Removal of neck lymph nodes according to indications
- Radioactive iodine therapy
- Lifelong hormone replacement therapy
- Monitoring TSH, thyroglobulin and ultrasound
- Active surveillance for microcarcinoma at the discretion of the physician
