Programs and Services
Thyroid and Parathyroid Cancer and Tumors
The thyroid gland regulates the body’s metabolism and can affect heart rate, breathing, body temperature, growth, digestion and more. While many thyroid tumors are not cancerous, it’s important to accurately diagnose and treat any thyroid tumor to catch any cancer at its earliest stage. The American Cancer Society estimates that 33,550 new cases of thyroid cancer will be diagnosed in 2007 in the United States, and women are three times more likely than men to develop it. Still, many kinds of thyroid cancer, with the appropriate treatment, can be cured.
While medical oncologists typically treat most kinds of cancer, endocrinologists are more likely to assist in treating thyroid cancer in conjunction with thyroid surgeons because of the unique nature of the thyroid gland. Diagnostic tests including blood tests, ultrasound and needle biopsies may all play a part in diagnosing thyroid cancer and determining the best course of treatment.
Froedtert & The Medical College of Wisconsin offers a multidisciplinary approach to diagnosing and treating thyroid cancer that draws on experts in endocrinology, otolaryngology, nuclear medicine, surgery and other specialties. In regular Endocrine Surgical Case Conference, endocrinologists, thyroid/parathyroid surgeons, radiologists, pathologists, nuclear medicine physicians and other experts discuss more difficult cases, including thyroid cancer cases.
Our collaborative approach means patients get the best possible care from highly skilled experts using advanced treatments and techniques. And, because we’re an academic medical center, we see more cases and more different kinds of thyroid cancer. That means patients benefit every day from our extensive experience treating all forms of thyroid cancer.
Treatment ApproachesThere are four major types of thyroid cancer:
- Papillary carcinoma (also called papillary cancer or papillary adenocarcinoma) is the most common type and accounts for about 80 percent of all thyroid cancers.
- Follicular carcinoma (also called follicular cancer or follicular adenocarcinoma) is the next most common type.
- Medullary thyroid carcinoma accounts for about 3 percent to 5 percent of thyroid cancers.
- Anaplastic carcinoma is a rare, aggressive form and accounts for 1 percent to 2 percent of all thyroid cancers.
For the most common types of thyroid cancer, the prognosis can be very good. Even if the cancer has spread to the lymph nodes in the neck, it can be highly curable. One common treatment approach involves surgical removal of the thyroid gland (thyroidectomy), followed by treatment with radioactive iodine, which is trapped by and destroys any remaining thyroid cells. Together, those treatments are often enough to cure the cancer.
At Froedtert & The Medical College of Wisconsin, Medical College of Wisconsin physicians are specially trained in thyroid surgery. Thyroid surgeons conduct thyroid surgeries and often collaborate with other clinicians on cases for the best possible patient outcomes. Our surgeons use their skills, knowledge and experience to perform multiple thyroid surgeries each week.
Minimally Invasive Surgery While a traditional thyroidectomy is one effective treatment option, minimally invasive approaches can be as effective in treating thyroid cancer.
One advancement involves intraoperative nerve integrity monitoring (NIM) of the recurrent laryngeal nerve to help prevent injury to the nerves of the vocal cords during thyroid surgery. NIM uses a special tube placed in the trachea to continuously monitor the nerves to the vocal cords during surgery to help avoid injury to the laryngeal nerve.
Parathyroid SurgeryThe parathyroid glands, which are separate from but very near the thyroid gland, regulate the body’s balance of calcium and phosphorous. With parathyroid cancer, the challenge is determining which of the four tiny parathyroid glands is causing the problem. At Froedtert & The Medical College of Wisconsin, we perform a procedure called minimally invasive parathyroidectomy with rapid parathyroid hormone testing. A Sestamibi scan (a type of nuclear medicine test) can identify which of the four parathyroid glands is enlarged and needs to be surgically removed. Once the gland has been identified, it can be removed in a minimally invasive procedure using a small incision. By adding rapid parathyroid hormone testing, surgeons can conduct a blood test in the operating room to confirm that the correct gland has been removed. In rare cases where two of the glands are abnormal, the blood test will show this and surgeons can search for the second gland while the patient is still under anesthesia.
Advancements in Follow-Up CareEven after thyroid cancer has been successfully treated, we recommend our patients get tested on a regular basis for the rest of their lives to ensure the cancer hasn’t recurred.
As part of our follow-up care, Froedtert & The Medical College of Wisconsin use different tests to help determine sooner if thyroid cancer has recurred. One blood test looks for thyroglobulin, a protein made by the thyroid cells, whether normal or cancerous. Thyroglobulin is a tumor marker, and the test can show much earlier if the thyroid cancer has recurred, giving physicians more treatment options.
Even after the thyroid gland has been removed, thyroid cancer can still recur in other parts of the body, most commonly in the lymph nodes in the neck or, less often, the in lungs, liver or bone. That’s why thyroid cancer patients are generally tested regularly for this marker.
Another follow-up test is appropriate for some thyroid cancer patients. Called an Iodine-131 whole body scan, it can detect recurrence of thyroid cancer anywhere in the body. Froedtert & The Medical College use an approach that allows patients to remain on thyroid hormones longer when preparing for the Iodine-131 scan.
After having the thyroid removed, patients must take thyroid hormone for the rest of their lives to do the work of the missing thyroid. Previously, patients would have to stop taking the hormone for several weeks to elevate their thyroid-stimulating hormone (TSH) levels enough to perform the scan. However, elevated TSH levels could stimulate the growth of cancer cells. The longer patients are off the thyroid hormone, the longer their TSH is elevated, and any existing cancer cells are exposed to this stimulator.
Today, Froedtert & The Medical College use Thyrogen, a synthetic, injectable form of TSH, to raise the TSH levels for a shorter time, enabling physicians to do the scan without taking patients off the thyroid hormone. The benefit is that TSH levels are only elevated for a few days, because the synthetic Thyrogen wears off quickly. These kinds of advancements benefit our patients and lead to better outcomes.
ResearchResearch is a strong focus at Froedtert & The Medical College. Every day, we see how research leads to new and better medicines, more effective treatment approaches, new options where none existed before, better patients outcomes and renewed hope. For example, Stuart J. Wong, MD, a Medical College of Wisconsin medical oncologist, is actively researching new drugs to treat thyroid cancer. In some thyroid cancer patients, radioactive iodine can become less effective in treating thyroid cancer that has recurred. Dr. Wong is part of team researching a drug that decreases blood flow to the cancer in cases where the radioactive iodine will no longer trap the thyroid cancer. Research studies and clinical trials are always evolving and leading to new discoveries. — one reason even patients with the most complex cases find outstanding care here.
Author: Joan Cotter Pike
Date: Nov. 15, 2007
|Medical Reviewer: ||Diana Maas, MD|
Last Review Date: Oct. 15, 2008
Online Editor(s): Christopher Sadler