Thyroid Cancer

Widespread – 50% population have a thyroid nodule

The majority are benign –  90-95%

No correlation with thyroid hormone levels

Symptoms

• Swelling in front of the neck(most common)
• Swelling inside of the neck
• Change in voice
• Difficulty in breathing/eating

Tests To Do

• Ultrasound
• If suspicious – USG guided FNAC
• CT/MRI scan if necessary
• PETCT – not much role

FNAC - no cancer what to do

FNAC negative -> No other risk factors -> Regular Follow-ups

FNAC – Cancer, what to do?

• Cancer – Differentiated thyroid cancer – very good prognosis
• Rare types medullary ca thyroid and anaplastic ca – poor prognosis
• The younger age group has the best prognosis
• 10-year survival – 90- 95%

Treatment

• Surgery is the main treatment
• Radioiodine treatment in selected cases after surgery

Surgery For Thyroid Cancer

• Small Tumors – total removal of the thyroid
• Larger Tumors – total removal of thyroid with the removal of neck nodes

Thyroid Surgery and voice change

• Why the worry?
  • Recurrent Laryngeal nerve courses underneath the thyroid
  • Direct/Indirect injury can cause temporary/permanent damage.
• So should one avoid surgery?
  • Risk of permanent nerve injury in experienced hands < 3%.
  • No other alternatives to surgery.
• What other problems to expect?
  • Hypocalcemia – Low calcium levels
  • Bleeding, infection
  • Superior laryngeal nerve injury
• What happens after surgery
  • Based on the surgery report decision will be taken on the need for radioiodine therapy
  • They were usually given 4-6 weeks after surgery.
  • The patient is to be on an iodine-free diet and no thyroxine.

After Treatment

• Regular Follow-ups.
• Serum Thyroglobulin and scan
• Recurrences can be treated.