Resected thyroid cancer has a good prognosis
Thyroid nodules are common and often found incidentally on imaging of the neck. While most are benign, appropriate work up is required to identify the roughly five per cent that are cancers and need referral to a thyroid surgeon.
Symptoms
Most thyroid nodules do not cause any symptoms. Some thyroid nodules may produce excessive amounts of thyroid hormones leading to an overactive thyroid gland and symptoms similar to those in Grave’s Disease. Occasionally, large nodules will cause compression of the trachea or oesophagus.
Symptoms that may be related to thyroid nodules include:
- difficulty breathing
- trouble swallowing
- lump in the neck
- voice change - hoarseness.
When to see a doctor
Seek medical advice if you have known thyroid nodules and are experience any of the above symptoms.
Certain risk factors for thyroid cancer include:
- history of prior head and neck radiation
- family history of thyroid cancer
- thyroid cancer syndromes (multiple endocrine neoplasia, familial adenomatosis polyposis, or Cowden syndrome).
Testing for thyroid nodules may include:
- thyroid and neck ultrasound (TiRADS system for scoring ultrasound appearance and risk assessment of thyroid nodules)
- thyroid function tests
- thyroid antibodies
- fine needle biopsy of suspicious nodules (Classified according to the Bethesda system for risk assessment)
- nuclear thyroid uptake scans
- molecular typing of indeterminate nodules on biopsy.
Indications for surgery for thyroid nodules include:
- nodules that are increasing significantly in size
- large nodules causing compressive symptoms
- nodules with fine needle aspirate biopsies suspicious of malignancy (Bethesda 4 and 5 nodules).
Some of the paradigms for treatment of nodules is changing, and advice about surgery and the type of surgery is based on current guidelines and patient preference. Your surgeon may recommend a diagnostic hemithyroidectomy (removal of half the gland), or a total thyroidectomy, and sometimes excision of lymph nodes in the neck.
If a cancer is confirmed, your case will be discussed at the endocrine multidisciplinary meeting to work out if additional treatments such as radioactive iodine ablation is required, and plan a surveillance regime depending on multiple pathological features of the cancer.