Thyroid and Parathyroid Cancer
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.
Nodules of the thyroid gland are extremely common. 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.
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.
Types of Thyroid Cancer
There 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.
Thyroid Cancer Treatment Options
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.
Surgical Removal of they Thyroid Gland
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.
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.
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.
Parathyroid Cancer Treatment
The 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.
Follow-Up Care for Thyroid Cancer
Even 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.