Thyroid Cancer: An Overview of Diagnosis and Treatment
Thyroid Cancer on the Parathyroid Website?Parathyroid.com is the world's leading source for information about parathyroid glands and hyperparathyroidism. Thyroid cancer is discussed on this page because most of our parathyroid patients have thyroid nodules and they are often worried about these nodules being thyroid cancer and whether or not they should have them removed during their parathyroid surgery. We perform about 65 parathyroid operations per week, and we remove part of the thyroid gland (to remove thyroid nodules, for example) in about 28% of our patients (27.6% of our last 25,000 patients). We do this so the patients don't have to worry about their thyroid and if they have thyroid cancer in their nodules. We are right there, so examining the thyroid is part of EVERY operation we do. This is an important point about our operations and something you should consider if your surgeon is only going to look at the one parathyroid gland that shows on the scan. We check all four parathyroid glands, and we check both sides of the thyroid in nearly every patient. We discover thyroid cancer about once or twice per week, and we deal with it right then and there almost every time. HOWEVER, our patients are VERY fortunate in that Dr Gary Clayman, the world's most respected thyroid cancer surgeon joined our staff in September, 2016. He opened the Clayman Thyroid Cancer Center within the same Institute with the Norman Parathyroid Center. Thus our parathyroid patients are afforded access to the best thyroid cancer specialists should they need it. They have a very comprehensive thyroid cancer website, but let's keep going.
Symptoms of Thyroid Cancer and Thyroid NodulesThyroid cancer usually doesn't have any symptoms. Occasionally a person can feel a lump under their skin, and rarely symptoms such as hoarseness, neck pain, and enlarged lymph nodes do occur in people with thyroid cancer. Although as much as 75 % of the population will have thyroid nodules, the vast majority of thyroid nodules are benign. That's right, most of us have nodule in our thyroid glands! Young people usually don't have thyroid nodules, but as we get older, more and more of us will develop a nodule. By the time we are 80, 90% of us will have at least one nodule. Less than 1% of all thyroid nodules are malignant. A nodule which is "cold" on scan (doesn't take up the radioactive dye) is more likely to be malignant, nevertheless, the majority of these are benign as well.
Thyroid Nodules in Patients with Primary HyperparathyroidismThyroid Cancer almost always occurs within a thyroid nodule. Since the majority of adults will have thyroid nodules, and since the incidence of thyroid nodules increases with age, and since the incidence of parathyroid tumors increases with age, it follows that most of our parathyroid patients have thyroid nodules. Interestingly, since endocrinologists will often perform a thyroid ultrasound on patients with hyperparathyroidism to try to find their parathyroid tumor, they will find thyroid nodules. In fact, the vast majority of our patients who had an ultrasound to look for the parathyroid tumor, the scan didn't find the parathyroid tumor, but did find a thyroid nodule! How crazy is that? What is occasionally frustrating for us is that many doctors will get sidetracked at this step. They forget that the patient feels bad and has a serious parathyroid problem that needs fixed, and they obsess with the thyroid nodules which are overwhelmingly benign. They often want to stick needles into the thyroid nodule and the entire parathyroid issue just drags on. Listen folks and remember this: primary hyperparathyroidism is a more serious problem and more deadly in the long run than the vast majority of thyroid cancers! Stop worrying about the thyroid nodules and get the parathyroid tumor out that is making you miserable while it slowly causes many other health issues.
Thyroid Cancer in Parathyroid Patients
What we do with the thyroid during your parathyroid operation to look for thyroid cancer
- We perform thyroid ultrasound on our patathyroid patients inside the operating room as soon as they are asleep so we can check the thyroid gland for nodules we don't like. This is very important to you and something that very few surgeons do.
- We will remove any thyroid nodule (or multiple nodules) that we think is suspicious for cancer by it's appearance on ultrasound or how it looks/feels during the operation. The vast majority of thyroid cancers we find during parathyroid surgery are found this way. The very good news is that we remove the entire nodule and if there is thyroid cancer in it, it us usually very small cancer that is typically considered cured just by removing the complete nodule. The overwhelming majority of patients that we diagnosis thyroid cancer in during their parathyroid operation do not need another operation.
- If a thyroid cancer is very highly suspicious, and bigger than a simply small nodule, we will get the pathologists to look at it under the microscope right away.
- If thyroid cancer is found that is larger than 1.5 cm or so, and diagnosed by the pathologist (very rare for this to happen, about one in 500 cases) then we will leave the operating room and discuss this with your family and then finish the operation to include an appropriate thyroid cancer operation. The goal is to do everything at one operation, and avoid a second operation. Occasionally we don't know this information for several days, and under these conditions, a second operation would be necessary. We do everything we can to avoid a second operation for thyroid cancer, trying our best to take care of everything the first time.
Types of Thyroid Cancer that we may see During Your Parathyroid OperationThere are four major types of thyroid cancer some of which are much more common than others. Since about 85% are papillary thyroid cancer (see below) this is what we see most often. About once a week we find a papillary thyroid cancer in one of our parathyroid patients. But as noted above, we understand it and we deal with it accordingly. Often, the entire cancer is limited (confined) to one nodule in the thyroid and when we take this nodule out, and if the thyroid cancer inside of it is small (typically less than 1 cm), then we don't need to do any further surgery. IMPORTANTLY, we are closely affiliated with Dr Gary Clayman and the Clayman Thyroid Cancer Center which is housed within our new Institute. We have the best thyorid cancer surgeon in the world at our disposal! Below are links to specific pages of ThyroidCancer.com that discuss the various different thyroid cancers.
Thyroid Cancer Types and IncidenceRead the rest of this page to understand the concept of finding thyroid cancer during your parathyroid operation, and then if you want more specific information, click on these links to go to a different website for the best information about these specific cancers. But please folks, do not get too worked up about thyroid cancer during your parathyroid operation. Pick the best and most experienced surgeons and stop worrying about it!
- Papillary and/or mixed papillary/follicular ~ 85%. We see this about once a week during a parathyroid surgery, but usually very small and easy to cure.
- Follicular thyroid cancer ~ 10%. We see this every few months during parathyroid surgery.
- Hurthle Cell thyroid cancer ~ 2%. We see this very rarely during our parathyroid operations.
- Medullary Thyroid Cancer ~ 2%. We have never seen this during more than 25,000 parathyroid operations.
- Anaplastic < 1%. We have never seen this during more than 25,000 parathyroid operations.
What's the Prognosis of Thyroid Cancer Found During Your Parathyroid Operation?Most thyroid cancers are very curable. In fact, the most common types of thyroid cancer (papillary and follicular) are the most curable. In younger patients, both papillary and follicular cancers can be expected to have better than 97% cure rate if treated appropriately. As stated above, the vast majority of thyroid cancer that we find while operating to remove a parathyroid tumor are papillary-types of thyroid cancer. And, the ones we find are usually small! More than 90% of the thyroid cancers we find are less than 1.5 cm (1/2 inch) and are completely confined to the thyroid (not spread to lymph nodes, etc). Since we typically remove the entire thyroid nodule that we don't like (is suspicious on ultrasound or don't like the way it feels when we touch it), and since the vast majority of thyroid cancers are confined to this nodule, and since most are 1 cm or less, then there is often nothing else do do. These small thyroid cancers are called "minimal thyroid cancers" and they really don't have much danger to them. More aggressive surgery is usually not needed and the patient can be considered cured. It is best if the endocrinologist follows this for some time and checks an ultrasound every year or so, but many endocrinologists consider the patient cured and nothing else should be done. Check with your own doctors on this.
What to read next
- The best page of this website is the video of our doctors performing a complete parathyroid operation, removing two parathyroid tumors--all in less than 13 minutes. You can see that the thyroid is examined on both sides for worrisome nodules.
- For more information on thyroid cancer we refer you to the very comprehensive ThyroidCancer.com website. This is written by Dr Gary Clayman at the Clayman Thyroid Cancer Center.
- More information on Thyroid Nodules and when to have a FNA needle biopsy. Very good information!
- More information on Thyroid Cancer Surgery and when a larger, more extensive thyroid cancer operation is necessary.
- How to become our patient