Endocrine Cancer Program

Thyroid Cancer Information

The following is a brief contribution from Tracy Wang, MD, MPH, Medical College of Wisconsin Surgeon. Dr. Wang joined the Medical College in 2007 and believes care of each patient should be individualized, while emphasizing a multidisciplinary approach and use of the most recent advances in surgical technique. To make an appointment with Dr. Wang or her colleagues in the Clinical Cancer Center, please call 414-805-0505 or 866-680-0505 .

The Thyroid Gland

The thyroid gland is located in the lower front of the neck, below the voice box (larynx) located in the upper part of the neck, and above the collarbones. The thyroid gland regulates the body’s metabolism and can affect the heart, body temperature, digestion, and growth.

What are thyroid nodules?

Nodules of the thyroid gland are extremely common. Many patients with thyroid nodules have no symptoms, and nodules are discovered by their physician during a routine office visit or by imaging studies (ultrasound, CT scan, MRI) performed for other health reasons. The majority of thyroid nodules are benign; this can sometimes be determined by performing a biopsy, called a fine needle aspiration, of the tissue within the nodule. This test is not always able to determine if the nodule is benign; in these cases, surgery may be recommended for a definitive diagnosis.

An enlarged thyroid gland is called a goiter. Thyroid nodules are often present in enlarged thyroid glands, a condition referred to as a multinodular goiter. Goiters can sometimes cause pressure on other structures within the neck, including the esophagus and trachea. When severe, this can cause difficulty with swallowing and breathing. For some patients, the presence of a goiter can also be less desirable for cosmetic reasons. For all of the above reasons, surgery can be recommended.

What is thyroid cancer?

While the majority of thyroid nodules are benign, more than 38,000 cases of thyroid cancer will be diagnosed in the United States this year. There are four main types of thyroid cancer: papillary, follicular, medullary and anaplastic. The most common type is papillary cancer; it accounts for about 80 percent of all thyroid cancers. The overall prognosis is excellent, especially when diagnosed early and treated by a physician who is familiar with its management. Froedtert & The Medical College of Wisconsin has a dedicated team of healthcare professionals with special training and expertise in endocrine surgery.

What is the treatment for thyroid cancer?

Surgery: The primary therapy for all forms of thyroid cancer is surgery. The generally accepted approach is to remove the entire thyroid gland (total thyroidectomy).
Radioactive iodine therapy: A major reason for the usually excellent prognosis for patients with papillary and follicular thyroid cancer is that radioactive iodine (RAI) is used to seek out and destroy thyroid cancer cells with little or no damage to other tissues in the body.

Radioactive iodine is a radioactive isotope that gives off radiation. There are two radioactive isotopes that can be used — I-123 and I-131. These isotopes can be given by mouth to patients with suspected thyroid conditions. RAI is then concentrated inside thyroid cells exactly like iodine and can be used to diagnose or treat thyroid problems. The radiation that RAI gives off can be harmless to the thyroid cells (I-123) or the radiation may destroy the thyroid cells (I-131). RAI that is not concentrated in the thyroid gland is eliminated from the body through sweat and urine.

Having high levels of thyroid stimulating hormone (TSH) causes thyroid cancer cells left after surgery to take up significant amounts of iodine. This will occur by making your body hypothyroid by either stopping thyroid hormone pills or not starting hormone pills after surgery. Once TSH levels are high enough, a whole body iodine scan is done by administering a small dose of radioactive iodine by mouth to determine if there are remaining thyroid cells that need to be destroyed. If enough cells show up on the scan, a large dose of radioactive iodine is given and then the thyroid pills are re-started.
Follow-up: A periodic physical exam will usually be performed by an endocrinologist. Follow-up may also include ultrasound examinations and radioactive body scans. Follow-up will also include thyroid hormone replacement (levothyroxine) to replace the function of the thyroid and to decrease the likelihood of cancer recurrence. Routine blood tests will also be performed. Thyroid function tests are usually performed four to six weeks after medication is started to determine if the correct dose of thyroid hormone medication is being taken. In addition, a thyroglobulin level will be measured at follow-up appointments. Thyroglobulin is a thyroid cell protein that serves as a thyroid cancer marker.

Overnight Pathology for Thyroid Patients

While a pathologist routinely performs an initial thyroid tissue evaluation during surgery for all nodules that are not known to be cancerous, a more comprehensive analysis is still necessary to produce a final pathology report. In rare cases, if the final report shows cancer in tissue that was initially thought to be cancer-free, the patient may need another operation to remove the entire thyroid gland.

In most hospitals, the final pathology report is produced several days after the initial thyroid surgery. Therefore, if a patient needs a second operation to remove the remaining thyroid gland, he or she must be readmitted to the hospital. The pathologists in the Endocrine Cancer Program at Froedtert & The Medical College of Wisconsin have committed to providing the final pathology for thyroid patients in less than 24 hours. That way, if a patient needs an additional surgery, it may be done during the same hospital stay — typically the day after the initial surgery.

Dr. Tracy Wang is part of the exceptional staff of physicians in the Endocrine Cancer Program.

Author: Tracy Wang, MD, MPH

Medical Reviewer:

Tracy Wang, MD, MPH

Last Review Date: Jan. 23, 2009