Thyroid cancer

Thyroid cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Thyroid cancer Thyroid cancer About thyroid cancer Symptoms of thyroid cancer Causes of thyroid cancer Diagnosing thyroid cancer Treating thyroid cancer Complications of thyroid cancer About thyroid cancer Thyroid cancer is a rare type of cancer that affects the thyroid gland, a small gland at the base of the neck. The most common symptom ofcancer of the thyroid is a painless lump or swelling that develops in the neck. Other symptoms only tend to occur afterthe condition has reached an advanced stage, and may include: unexplained hoarseness that lasts for more than a few weeks a sore throat or difficulty swallowing that doesnt get better a lump elsewherein yourneck If you have a lump in your thyroid gland, it doesnt necessarily mean you have thyroid cancer.About 1 in 20 thyroid lumps are cancerous. Read more about the symptoms of thyroid cancer The thyroid gland The thyroid gland consists of 2lobes located oneither side of the windpipe. Its main purpose is to release hormones (chemicals that have powerful effects on many different functions of the body). The thyroid gland releases 3separate hormones: triiodothyronine known as T3 thyroxine known as T4 calcitonin The T3 and T4 hormones help regulate the bodys metabolic rate (the rate at which the various processes in the body work, such as how quickly calories are burnt). An excess ofT3 and T4 will make you feel overactive and youmay lose weight. If you dont have enough of these hormones, youll feel sluggish and youmay gain weight. Calcitonin helps control blood calcium levels. Calcium is a mineral that performs a number of important functions, such as building strong bones. Calcitonin isnt essential for maintaining good health because your body also has other ways of controlling calcium. Types of thyroid cancer There are 4main types of thyroid cancer. They are: papillary carcinoma  this is the most common type, accounting for about 6 out of 10(60%) cases; it usually affects people under the age of 40, particularly women follicular carcinoma  accounts for around3 out of 20 (15%) cases of thyroid cancer and tends to affect older adults medullary thyroid carcinoma  accounts for between 5 and 8 out of every 100 diagnosed cases (5% to 8%); unlike the other types of thyroid cancer, medullary thyroid carcinomacan run in families anaplastic thyroid carcinoma  this is the rarest and most aggressive type of thyroid cancer, accounting for less than 1in 20 thyroid cancers; it usually affects older people over the age of 60 Papillary and follicular carcinomas are sometimes known as differentiated thyroid cancers, and theyre often treated in the same way. How common is thyroid cancer? Thyroid cancer is a rare form of cancer, accounting for less than 1% of all cancer cases in the UK. Its most common in people aged 35 to 39 years and in those aged 70 years or over. Women are 2to 3times more likely to develop thyroid cancer than men. Its unclear why this is, but it may bea result ofthe hormonal changes associated with the female reproductive system. What causes thyroid cancer? In most cases, the cause of thyroid cancer is unknown. However, certain things can increase your chances of developing the condition. Risk factors for thyroid cancer include: having a benign (non-cancerous) thyroid condition having a family history of thyroid cancer (in the case of medullary thyroid cancer) having a bowel condition known as familial adenomatous polyposis acromegaly a rare condition where the body produces too much growth hormone having a previous benign (non-cancerous) breast condition weight and height radiation exposure Read more about the causes of thyroid cancer Diagnosing thyroid cancer Atype of blood test known as a thyroid function testwill measure the hormone levels in your blood and rule out or confirm other thyroid problems. If nothing else seems to be causing the lump in your thyroid, fine-needle aspiration cytology (FNAC) is used. Further testing may be required if the FNAC results are inconclusive, or if more information is needed to make your treatment more effective. Read more about how thyroid cancer is diagnosed . Treating thyroid cancer Yourrecommended treatment plan will depend on the type and grade of your cancer, and whether a complete cure is realistically achievable. Differentiated thyroid cancers (DTCs)are treated using a combination of surgery to remove the thyroid gland (thyroidectomy) and a type of radiotherapy that destroys any remaining cancer cells and prevents the thyroid cancer returning. Medullary thyroid carcinomas tend to spread faster than DTCs, so it may be necessary to remove any nearby lymph nodes, as well as your thyroid gland. Read more about treating thyroid cancer Recurrence Cancerous cells will returnin an estimated 5% to 20% of people with a history of thyroid cancer. In approximately 10% to 15% of people, the cancerous cells will come back in other parts of their body, such as their bones. Cancerous cells can sometimesreturn many years after surgery and radioactive iodine treatment has been completed. Youll be asked to attend regular check-ups so any cancerous cells that return can be treated quickly. Read more about the complications of thyroid cancer Preventing thyroid cancer From the available evidence, eating a healthy, balanced diet is the best way to avoid getting thyroid cancer and all other types of cancer. A low-fat, high-fibre diet is recommended that includes plenty of fresh fruit and vegetables (at least 5 portions a day) and whole grains. Symptoms of thyroid cancer In its early stages, thyroid cancer tends to cause no or very few symptoms. The main symptom of thyroid cancer is a lump or swelling at the front of the neckjust below your Adams apple, which is usually painless. Women also have Adams apples, but theyremuch smaller and less prominentthan a mans. The lymph nodes in your neck can also be affected and become swollen. Lymph nodes are small glands that are part of the lymphatic system, which helps fight infection. Other symptoms of thyroid cancer only tend to occur after the condition has reached an advanced stage, and may include: unexplained hoarseness that doesnt get better after a few weeks a sore throat or difficulty swallowing that doesnt get better pain in your neck When to seek medical advice You should always speak to your GP if you develop a swelling or lumpat the front of your neck. Although its unlikely to be thyroid cancer, its important thatit isinvestigated. About 1 in 20 swellings or lumps in the neck are caused by thyroid cancer. Most cases are caused by non-cancerous swellings calledgoitres. Goitres Agoitre is an enlarged thyroid gland. Non-cancerous goitresare usually caused by other less serious problems with your thyroid gland, such as: too much triiodothyronine (T3) and thyroxine (T4) hormones this is known as having an overactive thyroid gland , or hyperthyroidism not enough T3 and T4 hormones this is known as having an underactive thyroid gland , or hypothyroidism Thyroid cancer support The Butterfly Thyroid Cancer Trust provides information, advice and support for people with thyroid cancer. As well as the website, they also have a helpline number that can be contacted on01207 545469, Monday to Friday, 10am to 4pm. Causes of thyroid cancer In most cases, the exact cause of thyroid cancer is unknown. However, there are certain things that can increase your chances of developing the condition, including having another thyroid condition and being exposed toradiation. What is cancer? Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means cells grow andreproduce uncontrollably, producing a lump of tissue called a tumour. Left untreated, cancer can spread to other parts of the body, usually through the lymphatic system. The lymphatic system is made up of a network of vessels and glands (lymph nodes) located throughout the body. Lymph nodesproduce many of the cells needed by your immune system (the bodys natural defence system against infection and illness). Once the cancer reaches your lymphatic system, its capable of spreading to other parts of your body, including your blood, bones and organs. The most common types of thyroid cancer are papillary carcinomas and follicular carcinomas, which are known as differentiated thyroid cancers (DTCs). They spread much more slowly than other types of cancer. When DTCs are diagnosed, theyre usually limited to the thyroid gland itself or nearby lymph nodes. The rarer types of thyroid cancer are more aggressive and spread faster. By the time medullary thyroid carcinoma is diagnosed, it may have spread to the lymph nodes. In advanced cases, it may have also spread to the bones and lungs. Anaplastic thyroid cancer often spreads to the windpipe and, in some cases, the lungs. Risk factors for thyroid cancer The main risk factors for developing thyroid cancer are: having a thyroid condition having a family history of thyroid cancer (in the case of medullary thyroid cancer) having a bowel condition known as familial adenomatous polyposis (FAP) acromegaly (a rare condition where the body produces too much growth hormone) having previous benign (non-cancerous) breast conditions weight and height radiation exposure Thyroid conditions Your risk of developingthyroid cancer isslightly increased if you have certain non-cancerous (benign) thyroid conditions, such as an inflamed thyroid gland(thyroiditis) or anenlarged thyroid gland (goitre). Having an overactive thyroid gland (hyperthyroidism) or an underactive thyroid gland (hypothyroidism) doesnt increase your chances of developing thyroid cancer. Around 1in 5cases ofthyroid cancer occur in people whove had a previous benign thyroid condition. Family history Inherited genetic mutations are responsible for a small number of medullary thyroid carcinomas. If the instructions carried in genes are altered, some of the bodys processes wont work normally. This inherited mutation occurs in: familial medullary thyroid cancer multiple endocrine neoplasia (MEN) syndrome, types 2A and 2B In cases of MEN2A or MEN2B thyroid cancer, the mutations usually develop during childhood or the teenage years. In familial medullary thyroid cancer, the mutations usually develop in adulthood. If one of your parents has a history of medullary thyroid carcinoma or MEN syndrome, you should consider having a blood test to find out whether you have the mutated genes. If your test results are positive, its recommended you have surgery to remove your thyroid gland as a precaution. Familial adenomatous polyposis If you have a bowel condition calledfamilial adenomatous polyposis (FAP), your risk of developing thyroid cancer is increased. FAP runs in families and is caused by inheriting a faulty gene. Macmillan Cancer Support have more information about familial adenomatous polyposis . Acromegaly Thyroid cancer risk is increased in people who have acromegaly.Thisis a rare condition where the body produces too much growth hormone. Previous breast conditions If youve hada benign (non-cancerous) breast condition in the past, such as abreast cyst or fibroadenoma (non-cancerous tumour), yourrisk of developing thyroid cancerincreases by around half (50%) comparedwith women who havent had this type of condition. Weight and height If youre overweight, youre more at risk of developing thyroid cancer than someone who isnt overweight. Research hasalso shown thattaller adultshavean increased risk. However, the reasons for this are unclear. Radiation exposure Exposure to radiation during childhood is another risk factor for thyroid cancer. Radiation from nuclear fallout and radiation used for medical treatments have bothbeen associated with thyroid cancer. Many recently reported cases of thyroid cancer are thought to have been caused by radiation exposure during medical procedures carried out between 1910 and 1960. During this time, not much was known about the risks of radiation treatment. Today there are much stricter regulations regarding the use of radiation for medical procedures. Other risk factors Diet If your diet contains low levels of the trace element iodine, youre at anincreased risk of developing thyroid cancer. Peopleexposed to radiation, or those witha history of benign thyroid conditions,are more likely to have low levels of iodine. Eating a lot of butter, cheese and meat may also increase your risk of developing thyroid cancer. To help reduce your risk, you should include plenty of fresh fruit and vegetables in your diet. People with a high body mass index (BMI) also have an increased risk of developing thyroid cancer. Gender Women are about 2to 3times more likely to develop thyroid cancer than men. Its thought this may bebecause of thehormones released during a womans monthly period or during pregnancy. However, theres little scientific evidence to support this theory. Diagnosing thyroid cancer For many people, the first stage of diagnosing thyroid cancer is a consultation with a GP. Your GP will examine your neck and ask about any associated symptoms you may be experiencing, such as unexplained hoarseness. Thyroid function test A blood test known as a thyroid function test is used to check whether the swelling in your neck is caused by other problems with your thyroid gland. It will rule out conditions such as an overactive thyroid gland (hyperthyroidism) or an underactive thyroid gland (hypothyroidism), which are the most common thyroid problems. A thyroid function test measures the amount of certain types of hormones in your blood. Further tests will be needed if the thyroid function test reveals your thyroid gland is working normally. Fine-needle aspiration cytology Fine-needle aspiration cytology (FNAC)is the next stage in diagnosing thyroid cancer. Its an outpatient procedure, which means you wont have to spend the night in hospital. Asmall needleis inserted into the lump in your neck to allow a tiny sample of cells to be removed. The sampleis thenstudied under a microscope. This testcan usually reveal whether cancerous cells are present in your thyroid gland and, if they are, what type of thyroid cancer you have. Further testing Further testing may be recommended if the FNAC results are inconclusive or if further information is needed to make your treatment more effective. These tests may include: repeat FNAC combined with an ultrasound scan other types of scan, such as a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan In most cases, surgery will be recommended to remove the part of the thyroid gland that contains the lump or swellingwhen it hasnt been possible to rule out thyroid cancer. Treating thyroid cancer If youre diagnosed with thyroid cancer, youll be assigned a care team, who will devise a treatment plan for you. Your recommendedtreatment plan will depend on the type and grade of your cancer, and whether your care team thinks that a complete cure is realistically achievable. Cancer treatment team All NHS hospitals have multidisciplinary teams (MDTs)that treat thyroid cancer. An MDT is made up of a number of different specialists, and may include: a surgeon an endocrinologist (a specialist in treating hormonal conditions) an oncologist (a cancer treatment specialist) a pathologist (a specialist in diseased tissue) a radiotherapist or clinical oncologist (a specialist in non-surgical methods of treating cancer, such aschemotherapy and radiotherapy) a specialist cancer nurse, who will usually be yourfirst point of contact with the rest of the team Deciding on the best course of treatment can be difficult. Your cancer team will make recommendations after reviewing your case, but the final decision will be yours. Before you go to hospital to discuss your treatment options, you may want to write a list ofquestions to askthe specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are. Your treatment plan Your recommended treatment will depend on a number of things, including: the type of thyroid cancer you have the grade of your cancer whether your care team thinksa complete cure is realistically achievable Most differentiated thyroid cancers papillary carcinomas and follicular carcinomas and some medullary thyroid carcinomas have a good prospect of achieving a cure. Differentiated thyroid cancersare treated using a combination of: surgery to remove your thyroid gland (thyroidectomy) a type of radiotherapy calledradioactive iodine treatment, which isdesigned to destroy any remaining cancer cells and prevent the thyroid cancer returning Medullary thyroid carcinomas tend to spread faster than differentiated thyroid cancers, so it may be necessary to removeyour thyroid gland and any nearby lymph nodes. Radiotherapy iodine treatment is not effectiveat treating this type of thyroid cancer. Stage 4 medullary thyroid carcinomas arent usually curable, but it should be possible to slow their progression and control any associated symptoms. In most cases of anaplastic thyroid carcinoma, a cure isnt usually achievable. This is because its usually spread to other parts of thebody by the time its been diagnosed. Radiotherapyandchemotherapy can be used to slow the progression of anaplastic thyroid carcinoma and help control any symptoms. Some cases of differentiated thyroid cancer, medullary thyroid carcinoma and anaplastic thyroid carcinoma may benefit from a new type of treatment known as targeted therapies. This is where medication is used to directly target the cancerous cells. However, thesetypes of treatments are currently undergoingclinical trials and arent offered routinely on the NHS. Thyroidectomy In almost all cases of thyroid cancer its necessary to either remove some of your thyroid gland in a procedure called a hemithyroidectomy, or all of your thyroid gland(total thyroidectomy). This decisionwill be influenced by: the type of thyroid cancer you have the size of the tumour whether or not the cancer has spread beyond your thyroid gland Your surgeon should discuss with you the type of surgery required and why soyou can make an informed decision. A thyroidectomyis carried out under a general anaesthetic and usually takes around 2hours. The operation will leave a small scar on your neck, whichshouldnt be very noticeable. In a small number of cases, it may cause permanent hoarseness. Most people are well enough to leave hospital 3to 5days after having thyroid surgery. However, youll need to rest at home for 2to 3weeks and avoid any activities that could put a strain on your neck, such as heavy lifting. A member of your care team will be able to advise you about when youll be fit enough to resume normal activities and return to work. Replacement hormone therapy If some or all of your thyroid gland is removed, it will no longer be able to produce the hormones that regulate your metabolic system. This means youll experience symptoms of an underactive thyroid (hypothyroidism), such as fatigue (extreme tiredness), weight gain and dry skin. To compensate, youll need to take replacement hormone tablets for the rest of your life. If your surgery is to be followed by radioactive iodine treatment, its likely youll be given a hormone tablet called triiodothyronine. After radioactive iodine treatment is completed, youll be prescribed an alternative hormone tablet called thyroxine, which most people only need to take once a day. Youll need to have regular blood tests to check youre receiving the right amount of hormones and to determine whether your dose needs to be adjusted. It may take some time to achieve the optimum dose. Until this time, you may experience symptoms of tiredness or weight gain if your hormone levels are too low. Alternatively, if your hormone levels are too high, you may experience symptoms such as weight loss, hyperactivity or diarrhoea. You shouldnt experience any more side effects once theright dose has been achieved. Calcium levels Occasionally, the parathyroid glands can be affected during surgery. The parathyroid glands are located close to the thyroid gland and help regulate the levels of calcium in your blood. If your parathyroid glands are affected, your calcium levels may decrease, which can cause a tingling sensation in your hands, fingers, lips and around your nose. These symptoms should be reported to your MDT or GP as you may need to take calcium supplements. Most people only need to take a short course of calcium tabletsas the parathyroid glands will soon start to function normally again. Radioactive iodine treatment After having thyroid surgery, a course of radioactive iodine treatment may be recommended. This willhelp destroy any remaining cancer cells in your body and prevent the cancer returning. If youre taking thyroid hormone replacement tablets, youll need to stop taking them for 2 to 4 weeks before having radioactive iodine treatment. This is because they can interfere with the effectiveness of the iodine treatment. If withdrawing your hormone replacement treatment is problematic, you may be given a medicine called recombinant human thyroid stimulating hormone (rhTSH). This is given as an injection on 2 consecutive days. Your MDT will be able to advise you about whether or not rhTSH is suitable for you. The procedure Radioactive iodine treatment involves swallowing radioactive iodine in either liquid or capsule form. Theradiation in the iodine travels up into your neck through your blood supply and destroys any cancerous cells. Side effects of radioactive iodine treatment are uncommon, but a small number of people may experience tightness, pain or swelling in their neck and may feel flushed (warm). These side effects usually pass within 24 hours. After treatment, you may have a dry mouth and notice a change in your taste. These symptoms usually disappear after a few weeks or months, although they can be permanent in some people. Youll need to stay in hospital for3 to 5 days after the procedure because the iodine will make your body slightly radioactive. As a precaution, youll need to stay in a single room protected by lead sheets so that hospital staff arent exposed to radiation. You wont be able to have visitors during this time and hospital staff will keep their contact with you to a minimum. Your bodily fluids, such as urine, will alsobe slightly radioactive for3 to 5 days after your treatment, so its important that you flush the toilet every time you use it. Your sweat willbe radioactive, too, so you shouldbathe or shower every day. Youll be allowed home after the radioactive levels in your body have subsided. Dietary recommendations While having radioactive iodine treatment, youll need to eat a dietlow in iodine. An iodine-richdiet may reduce the effectiveness of your treatment. Its recommended that you: avoid all seafood limit the amount of dairy products you eat dont take cough medicines or use sea saltas they both contain iodine You should eat plenty of fresh meat, fresh fruit and vegetables ,and pasta and rice. These areall low in iodine. Pregnancy and breastfeeding You shouldnt have radioactive iodine treatment if youre pregnant or if theres a good chance that you may be. The treatment could damage your baby. Tell a member of your care team if youre unsure whether youre pregnant. Any treatment will need to be delayed until after your pregnancy. You must stop breastfeeding before you can be treated with radioactive iodine. If possible, you should stop breastfeeding6 weeks prior to treatment. You should not resume breastfeeding after treatment for your current child, but you may safely breastfeed any babies you may have in the future. Breastfeeding also isnt recommended while receiving iodine treatment. If youre breastfeeding, you should stop at least 4 weeks (but preferably 8) before starting iodine treatment. You should also notresume breastfeeding your baby. However, its safe for you to breastfeed if you have another child in the future. You shoulduse a reliable method of contraception for at least 6 months after having iodine treatment. This is because theres a small risk that any child conceived during this time could develop birth defects. This applies to both men and women. Fertility Radioactive iodine treatment doesnt affect fertility in women. However,theres a small risk that it could affect fertility in men who need to have multiple treatment sessions. Yourcare team will be able to advise you about the level of risk in your individual circumstances. If theres asignificant risk youll become infertile after having radioactive iodine treatment, you may wish to consider having your sperm or eggs harvested and frozen so they can be used for fertility treatment at a later date. External radiotherapy External radiotherapy , where radioactive waves are targeted at affected parts of the body, is usually only used to treat advanced or anaplastic thyroid carcinomas. The length of time youll need to have radiotherapy for will depend on the particular type of thyroid cancer you have and its progression. Side effects of radiotherapy include: nausea vomiting tiredness pain when swallowing dry mouth These side effects should pass 2 to 3 weeks after your course of radiotherapy has finished. Chemotherapy Chemotherapy is usually only used to treat anaplastic thyroid carcinomas that have spread to other parts of your body. Itinvolves taking powerful medicines that kill cancerous cells. Its rarely successfulin curing anaplastic cancer, but can slow its progression and help relieve symptoms. Possible side effects of chemotherapy include: nausea vomiting tiredness loss of appetite hair loss mouth ulcers If youre receiving chemotherapy, youll also be more vulnerable to infection. See your GP if you suddenly feel ill or your temperature rises above 38C (100.4F). Targeted therapies A number of targeted therapies are being tested inclinical trials to treat advanced cases of: medullary thyroid cancers differentiated thyroid cancers that dont respond to radioactive iodine anaplastic thyroid carcinomas In targeted therapies, medication specifically targets the biological functions that cancers need to grow and spread. As research is ongoing, some medications used in this type of treatment are unlicensed. In exceptional circumstances, your specialist may suggest using an unlicensed medication. Theyll do this if: they think its likely to be effective there are no better alternatives the benefits of treatment outweigh any associated risks If your specialist is considering prescribing an unlicensed medication, theyll tell you that its unlicensed and will discuss the possible risks and benefits with you. The decision about whether to fund treatment with medications used in targeted therapies is often made by individualclinical commissioning groups (CCGs). Complications of thyroid cancer Cancerous cells can return many years after surgery and radioactive iodine treatment has been completed. Itsestimated that 5% to 20% of people with a history of thyroid cancer will experience a return of cancerous cells in their neck. An estimated 10% to 15% of people willsee a return of cancerous cells in other parts of their body, such as their bones. Because ofthe risk of cancer cells returning, youll be asked to attend regular check-ups so any cancerous cells that do return can be treated quickly. Thyroglobulin testing Thyroglobulin testing is a special type of blood test thats used to monitor some types of thyroid cancer and to check for the return of cancerous cells. Thyroglobulin is a protein released by a healthy thyroid gland, but it can also be released by cancerous cells. If youve had your thyroid gland removed, there should be no thyroglobulin present in your blood, unless cancerous cells have returned. Regularly testing your blood for thyroglobulin can be an effective way of checking whether or not any cancerous cells have returned. For the first few years after having surgery youll probably need to have thyroglobulin testing every 6 months. After this period, youll need to be tested once a year. Ultrasound scan An ultrasound scanner uses high-frequency sound waves to create an image of part of the inside of the body. An ultrasound scan can detect changes inside your neck that could indicate the recurrence of cancer. Radioactive iodine scan Aftersurgery to remove part or all of your thyroid gland, you may be asked to attend a radioactive iodine scanning test. You swallow a small amount of radioactive iodine before undergoing a scan. The radioactive iodine will highlight any cancerous thyroid cells in the body. Before the scan, youll need to go on a low-iodine diet and stop taking your thyroid hormone medication. Asonly a smalldose of radioactive iodineis used, its not necessary tokeep your distance from others. However, if you think you may be pregnant or youre breastfeeding, let the doctors know before your test. A radioactive iodine scan willusually be carried out6 to 8 months after surgery. Source: NHS 24 - Opens in new browser window Last updated: 14 November 2023 How can we improve this page? 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