THYROID NODULES AND CANCER

Nearly half of all Americans are likely to have a thyroid nodule — solid or fluid-filled lump — sometime in their lives. One or more of these nodules may develop in the thyroid gland. Most of them are non-cancerous (benign). However, about 5% to 10% of thyroid nodules are cancerous (malignant), and require prompt and appropriate treatment.

The thyroid is a gland located at the base of the neck, just below the Adam's apple. Although very small, it makes a big difference in our health. An endocrine gland, it is a part of the human body that secretes hormones. The thyroid produces hormones that regulate many of the body's basic functions, such as how fast the heart beats and how quickly calories are burned.

Thyroid nodules, whether benign or malignant, rarely cause any symptoms. Most of the time, they are discovered by self-examination, by a physician or incidentally during some x-ray test of the neck being performed for unrelated reasons. A very large nodule can sometimes cause some difficulty swallowing and occasionally shortness of breath.

If a patient with a thyroid nodule develops a hoarse, weak voice, then thyroid cancer is a concern. Other risk factors for malignancy in a thyroid nodule are prior history of radiation exposure and family history of thyroid cancer.

Thyroid cancer is the most common endocrine cancer. It occurs in all age groups, mainly adults, affecting about three times as many women as men. Its incidence has increased in recent years — by about 3% per 100,000 people per year. It is, in fact, now ranked first among all cancers in terms of its "incidence growth" in women and ranked third in men.

An estimated 23,600 people will be diagnosed with thyroid cancer in 2004 in the United States, according to the American Cancer Society. And about 1,460 people will die of this cancer this year.

For most individuals with thyroid cancer, the prognosis is excellent. The most common types of it can often be completely removed with surgery. What's more, five-year survival rates are among the highest of any kind of cancer-more than 80%.

Time to See Your Doctor

If you feel a lump in your neck, see your primary care doctor to find out what the problem is. Some people first notice lymph node swellings, fullness in the neck, voice changes, or difficulty breathing or swallowing. These are signs of a possible thyroid nodule.

A family physician or an internist can usually do the initial evaluation of thyroid nodules. The thyroid functions test (a blood test that determines the level of thyroid hormones) and thyroid ultrasound (sometimes called sonogram) are usually the initial tests that are performed. Sometimes a nuclear scan is ordered to determine if the nodule is cold, meaning that it is not functioning, or hot, meaning that it is overactive. After some initial basic tests, the patient is usually referred to a specialist called an endocrinologist who specializes in diseases of the endocrine glands. Thyroid nodules that are smaller than 3/8 inch — about the size of a pea — can usually be watched. Large nodules, especially if they are cold on a nuclear scan, or nodules associated with the risk factors previously mentioned, should be biopsied, which is done with a fine, thin needle.

Following a thorough work-up, the patient may need to have an operation called thyroidectomy (removal of the thyroid gland) for several reasons including removal of thyroid cancer, removal of part of the thyroid gland for definitive diagnosis, or treatment of a overactive thyroid gland (hyperthyroidism), or an enlarged thyroid gland that is causing breathing or swallowing difficulties.

Time to See Our Specialist

Patients who need surgery are usually referred to a surgical specialist like Dr. Maisie L. Shindo, associate professor of surgery and director of head and neck oncology at Stony Brook University Hospital. Dr. Shindo has extensive experience in thyroid surgery.

Since thyroid cancers are highly curable, it is extremely important for the patient to undergo proper treatment and close follow-up. The initial treatment for most thyroid cancers is removal of the thyroid gland, and sometimes removal of lymph nodes that may contain metastatic cancer (cancer cells that have escaped from where they first arose and spread to other areas, such as lymph nodes).

In the hands of an experienced surgeon, this procedure can be accomplished with a low risk of complications and a short, overnight hospital stay. Depending on the type and extent of the cancer, some patients may require treatment with radioactive iodine after surgery. Also essential is close follow-up by the patient's endocrinologist for tumor surveillance and regulation of the thyroid hormone.

Dr. Shindo takes a multidisciplinary approach to providing care for patients with thyroid cancer. The team of physicians consists of the surgeon, endocrinologists, and radiation oncologists who administer radioactive iodine therapy. Management decisions are often made jointly among the team members.

At Stony Brook University Hospital, such a team approach has ensured long-term successful outcomes for our patients with thyroid cancer.