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What You
Need To
Know About
ThyroidCancer
NATIONAL INSTITUTES OF HEALTHNational Cancer Institute
™
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This booklet is about thyroid cancer.The Cancer Information Service canhelp you learn more about this disease.The staff can talk with you in English orSpanish.
The number is 1–800– 4 –CANCER(1– 800 – 422– 6237). The number fordeaf and hard of hearing callers withTTY equipment is 1– 800 –332–8615.The call is free.
Este folleto es acerca del cáncer detiroides. Llame al Servicio deInformación sobre el Cáncer para sabermás sobre esta enfermedad. Este serviciotiene personal que habla español.
El número a llamar es el1–800– 4 –CANCER(1– 800 – 422– 6237). Personas conproblemas de audición y que cuentancon equipo TTY pueden llamar al1– 800 –332–8615. La llamada es gratis.
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESPublic Health ServiceNational Institutes of Health
Contents
The Thyroid 2
Understanding Cancer 3
Thyroid Cancer: Who’s at Risk? 4
Symptoms 7
Diagnosis 8
Staging 10
Treatment 11
Side Effects of Cancer Treatment 19
Followup Care 22
Support for People with Thyroid Cancer 23
The Promise of Cancer Research 24
Dictionary 25
National Cancer Institute Information Resources 34
National Cancer Institute Booklets 35
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What You Need To Know About™ Thyroid Cancer
his National Cancer Institute (NCI) booklet hasimportant information about cancer* of the
thyroid. Each year in the United States, thyroid canceris diagnosed in 14,900 women and 4,600 men.
This booklet discusses possible causes, symptoms,diagnosis, treatment, and followup care. It also hasinformation to help patients cope with thyroid cancer.
Research is increasing what we know about thyroidcancer. Scientists are studying its causes. They are alsolooking for better ways to detect, diagnose, and treatthis disease. Because of research, people with thyroidcancer can look forward to a better quality of life andless chance of dying from the disease.
Information specialists at the NCI’s CancerInformation Service at 1–800–4–CANCER can helppeople with questions about cancer and can send NCIpublications. Also, many NCI publications are on theInternet at http://cancer.gov/publications. People inthe United States and its territories may use this Website to order publications. This Web site also explainshow people outside the United States can mail or faxtheir requests for NCI publications.
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*Words that may be new to readers appear in italics. The“Dictionary” section gives definitions of these terms. Some words inthe “Dictionary” have a “sounds-like” spelling to show how topronounce them.
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The Thyroid
he thyroid is a gland in the neck. It has two kindsof cells that make hormones. Follicular cells
make thyroid hormone, which affects heart rate, bodytemperature, and energy level. C cells make calcitonin,a hormone that helps control the level of calcium in theblood.
The thyroid is shaped like a butterfly and lies at thefront of the neck, beneath the voice box (larynx). It hastwo parts, or lobes. The two lobes are separated by athin section called the isthmus.
A healthy thyroid is a little larger than a quarter. Itusually cannot be felt through the skin. A swollen lobemight look or feel like a lump in the front of the neck.A swollen thyroid is called a goiter. Most goiters arecaused by not enough iodine in the diet. Iodine is asubstance found in shellfish and iodized salt.
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This picture shows the thyroid.
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Understanding Cancer
ancer is a group of many related diseases. Allcancers begin in cells, the body’s basic unit of
life. Cells make up tissues, and tissues make up theorgans of the body.
Normally, cells grow and divide to form new cells asthe body needs them. When cells grow old and die,new cells take their place.
Sometimes this orderly process goes wrong. Newcells form when the body does not need them, and oldcells do not die when they should. These extra cells canform a mass of tissue called a growth or tumor.Growths on the thyroid are usually called nodules.
Thyroid nodules can be benign or malignant:
• Benign nodules are not cancer. Cells from benignnodules do not spread to other parts of the body.They are usually not a threat to life. Most thyroidnodules (more than 90 percent) are benign.
• Malignant nodules are cancer. They are generallymore serious and may sometimes be life threatening.Cancer cells can invade and damage nearby tissuesand organs. Also, cancer cells can break away from amalignant nodule and enter the bloodstream or thelymphatic system. That is how cancer spreads fromthe original cancer (primary tumor) to form newtumors in other organs. The spread of cancer iscalled metastasis.
The following are the major types of thyroid cancer:
• Papillary and follicular thyroid cancers account for80 to 90 percent of all thyroid cancers. Both typesbegin in the follicular cells of the thyroid. Mostpapillary and follicular thyroid cancers tend to growslowly. If they are detected early, most can be treatedsuccessfully.
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• Medullary thyroid cancer accounts for 5 to 10percent of thyroid cancer cases. It arises in C cells,not follicular cells. Medullary thyroid cancer iseasier to control if it is found and treated before itspreads to other parts of the body.
• Anaplastic thyroid cancer is the least common typeof thyroid cancer (only 1 to 2 percent of cases). Itarises in the follicular cells. The cancer cells arehighly abnormal and difficult to recognize. This typeof cancer is usually very hard to control because thecancer cells tend to grow and spread very quickly.
If thyroid cancer spreads (metastasizes) outside thethyroid, cancer cells are often found in nearby lymphnodes, nerves, or blood vessels. If the cancer hasreached these lymph nodes, cancer cells may have alsospread to other lymph nodes or to other organs, such asthe lungs or bones.
When cancer spreads from its original place toanother part of the body, the new tumor has the samekind of abnormal cells and the same name as theprimary tumor. For example, if thyroid cancer spreadsto the lungs, the cancer cells in the lungs are thyroidcancer cells. The disease is metastatic thyroid cancer,not lung cancer. It is treated as thyroid cancer, not aslung cancer. Doctors sometimes call the new tumor“distant” or metastatic disease.
Thyroid Cancer: Who’s at Risk?
o one knows the exact causes of thyroid cancer.Doctors can seldom explain why one person gets
this disease and another does not. However, it is clearthat thyroid cancer is not contagious. No one can“catch” cancer from another person.
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Research has shown that people with certain riskfactors are more likely than others to develop thyroidcancer. A risk factor is anything that increases aperson’s chance of developing a disease.
The following risk factors are associated with anincreased chance of developing thyroid cancer:
• Radiation. People exposed to high levels of radiationare much more likely than others to developpapillary or follicular thyroid cancer.
One important source of radiation exposure istreatment with x-rays. Between the 1920s and the1950s, doctors used high-dose x-rays to treatchildren who had enlarged tonsils, acne, and otherproblems affecting the head and neck. Later,scientists found that some people who had receivedthis kind of treatment developed thyroid cancer.(Routine diagnostic x-rays—such as dental x-rays orchest x-rays—use very small doses of radiation.Their benefits nearly always outweigh their risks.However, repeated exposure could be harmful, so itis a good idea for people to talk with their dentistand doctor about the need for each x-ray and to askabout the use of shields to protect other parts of thebody.)
Another source of radiation is radioactive fallout.This includes fallout from atomic weapons testing(such as the testing in the United States andelsewhere in the world, mainly in the 1950s and1960s), nuclear power plant accidents (such as theChornobyl [also called Chernobyl] accident in 1986),and releases from atomic weapons production plants(such as the Hanford facility in Washington state inthe late 1940s). Such radioactive fallout containsradioactive iodine (I-131). People who were exposedto one or more sources of I-131, especially if theywere children at the time of their exposure, mayhave an increased risk for thyroid diseases.
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People who are concerned about their exposure toradiation from medical treatments or radioactivefallout may wish to ask the Cancer InformationService at 1–800–4–CANCER about additionalsources of information.
• Family history. Medullary thyroid cancer can becaused by a change, or alteration, in a gene calledRET. The altered RET gene can be passed fromparent to child. Nearly everyone with the alteredRET gene will develop medullary thyroid cancer. A blood test can detect an altered RET gene. If theabnormal gene is found in a person with medullarythyroid cancer, the doctor may suggest that familymembers be tested. For those found to carry thealtered RET gene, the doctor may recommendfrequent lab tests or surgery to remove the thyroidbefore cancer develops. When medullary thyroidcancer runs in a family, the doctor may call this“familial medullary thyroid cancer” or “multipleendocrine neoplasia (MEN) syndrome.” People withthe MEN syndrome tend to develop certain othertypes of cancer.
A small number of people with a family history ofgoiter or certain precancerous polyps in the colon areat risk for developing papillary thyroid cancer.
• Being female. In the United States, women are twoto three times more likely than men to developthyroid cancer.
• Age. Most patients with thyroid cancer are morethan 40 years old. People with anaplastic thyroidcancer are usually more than 65 years old.
• Race. In the United States, white people are morelikely than African Americans to be diagnosed withthyroid cancer.
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• Not enough iodine in the diet. The thyroid needsiodine to make thyroid hormone. In the UnitedStates, iodine is added to salt to protect people fromthyroid problems. Thyroid cancer seems to be lesscommon in the United States than in countries whereiodine is not part of the diet.
Most people who have known risk factors do not getthyroid cancer. On the other hand, many who do get thedisease have none of these risk factors. People whothink they may be at risk for thyroid cancer shoulddiscuss this concern with their doctor. The doctor maysuggest ways to reduce the risk and can plan anappropriate schedule for checkups.
Symptoms
arly thyroid cancer often does not causesymptoms. But as the cancer grows, symptoms
may include:
• A lump, or nodule, in the front of the neck near theAdam’s apple;
• Hoarseness or difficulty speaking in a normal voice;
• Swollen lymph nodes, especially in the neck;
• Difficulty swallowing or breathing; or
• Pain in the throat or neck.
These symptoms are not sure signs of thyroid cancer.An infection, a benign goiter, or another problem alsocould cause these symptoms. Anyone with thesesymptoms should see a doctor as soon as possible. Onlya doctor can diagnose and treat the problem.
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Diagnosis
f a person has symptoms that suggest thyroidcancer, the doctor may perform a physical exam
and ask about the patient’s personal and family medicalhistory. The doctor also may order laboratory tests andimaging tests to produce pictures of the thyroid andother areas.
The exams and tests may include the following:
• Physical exam—The doctor will feel the neck,thyroid, voice box, and lymph nodes in the neck forunusual growths (nodules) or swelling.
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• Blood tests—The doctor may test for abnormallevels (too low or too high) of thyroid-stimulatinghormone (TSH) in the blood. TSH is made by thepituitary gland in the brain. It stimulates the releaseof thyroid hormone. TSH also controls how fastthyroid follicular cells grow.
If medullary thyroid cancer is suspected, the doctormay check for abnormally high levels of calcium inthe blood. The doctor also may order blood tests todetect an altered RET gene or to look for a highlevel of calcitonin.
• Ultrasonography—The ultrasound device usessound waves that people cannot hear. The wavesbounce off the thyroid, and a computer uses theechoes to create a picture called a sonogram. Fromthe picture, the doctor can see how many nodules arepresent, how big they are, and whether they are solidor filled with fluid.
• Radionuclide scanning—The doctor may order anuclear medicine scan that uses a very small amountof radioactive material to make thyroid nodulesshow up on a picture. Nodules that absorb lessradioactive material than the surrounding thyroidtissue are called cold nodules. Cold nodules may bebenign or malignant. Hot nodules take up moreradioactive material than surrounding thyroid tissueand are usually benign.
• Biopsy—The removal of tissue to look for cancercells is called a biopsy. A biopsy can show cancer,tissue changes that may lead to cancer, and otherconditions. A biopsy is the only sure way to knowwhether a nodule is cancerous.
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The doctor may remove tissue through a needle orduring surgery:
—Fine-needle aspiration: For most patients, thedoctor removes a sample of tissue from a thyroidnodule with a thin needle. A pathologist looks atthe cells under a microscope to check for cancer.Sometimes, the doctor uses an ultrasound device toguide the needle through the nodule.
—Surgical biopsy: If a diagnosis cannot be madefrom the fine-needle aspiration, the doctor mayoperate to remove the nodule. A pathologist thenchecks the tissue for cancer cells.
Staging
f the diagnosis is thyroid cancer, the doctor needsto know the stage, or extent, of the disease to plan
the best treatment. Staging is a careful attempt to learnwhether the cancer has spread and, if so, to what partsof the body.
A person who needs a biopsy may want to askthe doctor the following questions:
• What kind of biopsy will I have?
• How long will the procedure take? Will I beawake? Will it hurt?
• Will I have a scar on my neck after the biopsy?
• How soon will you have the results? Who willexplain them to me?
• If I do have cancer, who will talk to me abouttreatment? When?
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The doctor may use ultrasonography, magneticresonance imaging (MRI), or computed tomography(CT) to find out whether the cancer has spread to thelymph nodes or other areas within the neck. The doctormay use a nuclear medicine scan of the entire body,such as a radionuclide scan known as the “diagnostic I-131 whole body scan,” or other imaging tests to learnwhether thyroid cancer has spread to distant sites.
Treatment
eople with thyroid cancer often want to take anactive part in making decisions about their
medical care. They want to learn all they can abouttheir disease and their treatment choices. However, theshock and stress that people may feel after a diagnosisof cancer can make it hard for them to think ofeverything they want to ask the doctor. It often helps tomake a list of questions before an appointment. To helpremember what the doctor says, patients may take notesor ask whether they may use a tape recorder. Some alsowant to have a family member or friend with themwhen they talk to the doctor—to take part in thediscussion, to take notes, or just to listen.
The doctor may refer patients to doctors(oncologists) who specialize in treating cancer, orpatients may ask for a referral. Specialists who treatthyroid cancer include surgeons, endocrinologists(some of whom are called thyroidologists because theyspecialize in thyroid diseases), medical oncologists, andradiation oncologists. Treatment generally beginswithin a few weeks after the diagnosis. There will betime for patients to talk with the doctor about treatmentchoices, get a second opinion, and learn more aboutthyroid cancer.
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Getting a Second OpinionBefore starting treatment, the patient might want a
second opinion about the diagnosis and the treatmentplan. Some insurance companies require a secondopinion; others may cover a second opinion if thepatient or doctor requests it. Gathering medical recordsand arranging to see another doctor may take a littletime. In most cases, a brief delay does not maketreatment less effective.
There are a number of ways to find a doctor for asecond opinion:
• The patient’s doctor may refer the patient to one ormore specialists. At cancer centers, severalspecialists often work together as a team.
• The Cancer Information Service, at1–800–4–CANCER, can tell callers about treatmentfacilities, including cancer centers and otherprograms supported by the National Cancer Institute.
• A local medical society, a nearby hospital, or amedical school can usually provide the name ofspecialists.
• The Official ABMS Directory of Board CertifiedMedical Specialists lists doctors’names along withtheir specialty and their educational background.This resource is available in most public libraries.The American Board of Medical Specialties(ABMS) also offers information by telephone and on the Internet. The public may use these services to check whether a doctor is board certified. Thetelephone number is 1–866–ASK–ABMS(1–866–275–2267). The Internet address ishttp://www.abms.org/newsearch.asp.
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People do not need to ask all of their questions orunderstand all of the answers at one time. They willhave other chances to ask the doctor to explain thingsthat are not clear and to ask for more information.
Preparing for TreatmentThe doctor can describe treatment choices and
discuss the results expected with each treatment option.The doctor and patient can work together to develop atreatment plan that fits the patient’s needs.
Treatment depends on a number of factors, includingthe type of thyroid cancer, the size of the nodule, thepatient’s age, and whether the cancer has spread.
These are some questions a person may wantto ask the doctor before treatment begins:
• What type of thyroid cancer do I have?
• Has the cancer spread? What is the stage of thedisease?
• Do I need any more tests to check for thespread of the disease?
• What are my treatment choices? Which do yourecommend for me? Why?
• What are the benefits of each type oftreatment?
• What are the risks and possible side effects ofeach treatment?
• What is the treatment likely to cost?
• How will the treatment affect my normalactivities?
• Would a clinical trial (research study) beappropriate for me? Can you help me find one?
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Methods of TreatmentPeople with thyroid cancer have many treatment
options. Depending on the type and stage, thyroidcancer may be treated with surgery, radioactiveiodine, hormone treatment, external radiation, orchemotherapy. Some patients receive a combination of treatments.
The doctor is the best person to describe thetreatment choices and discuss the expected results.
A patient may want to talk to the doctor about takingpart in a clinical trial, a research study of new treatmentmethods. The section on “The Promise of CancerResearch” has more information about clinical trials.
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Surgery is the most common treatment for thyroidcancer. The surgeon may remove all or part of thethyroid. The type of surgery depends on the type andstage of thyroid cancer, the size of the nodule, and thepatient’s age.
• Total thyroidectomy—Surgery to remove the entirethyroid is called a total thyroidectomy. The surgeonremoves the thyroid through an incision in the neck.Nearby lymph nodes are sometimes removed, too. Ifthe pathologist finds cancer cells in the lymph nodes,it means that the disease could spread to other partsof the body. In a small number of cases, the surgeonremoves other tissues in the neck that have beenaffected by the cancer. Some patients who have atotal thyroidectomy also receive radioactive iodine orexternal radiation therapy.
• Lobectomy—Some patients with papillary orfollicular thyroid cancer may be treated withlobectomy. The lobe with the cancerous nodule isremoved. The surgeon also may remove part of theremaining thyroid tissue or nearby lymph nodes.Some patients who have a lobectomy receiveradioactive iodine therapy or additional surgery toremove remaining thyroid tissue.
Nearly all patients who have part or all of the thyroidremoved will take thyroid hormone pills to replace thenatural hormone.
After the initial surgery, the doctor may need tooperate on the neck again for thyroid cancer that hasspread. Patients who have this surgery also may receiveI-131 therapy or external radiation therapy to treatthyroid cancer that has spread.
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Radioactive iodine therapy (also called radioiodinetherapy) uses radioactive iodine (I-131) to destroythyroid cancer cells anywhere in the body. The therapyusually is given by mouth (liquid or capsules) in asmall dose that causes no problems for people who areallergic to iodine. The intestine absorbs the I-131,which flows through the bloodstream and collects inthyroid cells. Thyroid cancer cells remaining in theneck and those that have spread to other parts of thebody are killed when they absorb I-131.
If the dose of I-131 is low enough, the patientusually receives I-131 as an outpatient. If the dose ishigh, the doctor may protect others from radiationexposure by isolating the patient in the hospital duringthe treatment. Most radiation is gone in a few days.Within 3 weeks, only traces of radioactive iodineremain in the body.
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These are some questions a person may wantto ask the doctor before having surgery:
• What kind of operation will I have?
• How will I feel after the operation?
• What will you do for me if I have pain?
• How long will I be in the hospital?
• Will I have any long-term effects?
• When can I get back to my normal activities?
• What will my scar look like?
• What is my chance of a full recovery?
• Will I need to take thyroid hormone pills?
• How often will I need checkups?
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Patients with medullary thyroid cancer or anaplasticthyroid cancer generally do not receive I-131 treatment.These types of thyroid cancer rarely respond to I-131therapy.
Hormone treatment after surgery is usually part ofthe treatment plan for papillary and follicular cancer.When a patient takes thyroid hormone pills, the growthof any remaining thyroid cancer cells slows down,which lowers the chance that the disease will return.
After surgery or I-131 therapy (which removes ordestroys thyroid tissue), people with thyroid cancermay need to take thyroid hormone pills to replace thenatural thyroid hormone.
External radiation therapy (also calledradiotherapy) uses high-energy rays to kill cancer cells.A large machine directs radiation at the neck or at partsof the body where the cancer has spread.
People may want to ask these questions aboutradioactive iodine (I-131) therapy or hormonetherapy:
• Why do I need this treatment?
• What will it do?
• Will I need to stay in the hospital for thistreatment?
• Will it cause side effects? What can I do aboutthem?
• How long will I be on this treatment?
• How often will I need checkups?
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External radiation therapy is local therapy. It affectscancer cells only in the treated area. External radiationtherapy is used mainly to treat people with advancedthyroid cancer that does not respond to radioactiveiodine therapy. For external radiation therapy, patientsgo to the hospital or clinic, usually 5 days a week forseveral weeks. External radiation may also be used torelieve pain or other problems.
Chemotherapy, the use of drugs to kill cancer cells, is sometimes used to treat thyroid cancer.Chemotherapy is known as systemic therapy becausethe drugs enter the bloodstream and travel throughoutthe body. For some patients, chemotherapy may becombined with external radiation therapy.
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These are some questions a person may wantto ask the doctor before having external radiationtherapy:
• Why do I need this treatment?
• When will the treatments begin? When willthey end?
• How will I feel during therapy? Are there sideeffects?
• What can I do to take care of myself duringtherapy?
• How will we know if the radiation is working?
• Will I be able to continue my normal activitiesduring treatment?
• How often will I need checkups?
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Side Effects of Cancer Treatment
ecause cancer treatment may damage healthycells and tissues, unwanted side effects sometimes
occur. These side effects depend on many factors,including the type and extent of the treatment. Sideeffects may not be the same for each person, and theymay even change from one treatment session to thenext. Before treatment starts, the health care team willexplain possible side effects and suggest ways to helpthe patient manage them.
The NCI provides helpful booklets about cancertreatments and coping with side effects, such asRadiation Therapy and You, Chemotherapy and You,and Eating Hints for Cancer Patients. See the sections“National Cancer Institute Information Resources” and“National Cancer Institute Booklets” for other sourcesof information about side effects.
Patients may want to ask these questions aboutchemotherapy:
• Why do I need this treatment?
• What will it do?
• Will I have side effects? What can I do aboutthem?
• How long will I be on this treatment?
• How often will I need checkups?
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SurgeryPatients are often uncomfortable for the first few
days after surgery. However, medicine can usuallycontrol their pain. Patients should feel free to discusspain relief with the doctor or nurse. It is also commonfor patients to feel tired or weak. The length of time ittakes to recover from an operation varies for eachpatient.
After surgery to remove the thyroid and nearbytissues or organs, such as the parathyroid glands,patients may need to take medicine (thyroid hormone)or vitamin and mineral supplements (vitamin D andcalcium) to replace the lost functions of these organs. Ina few cases, certain nerves or muscles may be damagedor removed during surgery. If this happens, the patientmay have voice problems or one shoulder may belower than the other.
Radioactive Iodine (I-131) TherapySome patients have nausea and vomiting on the first
day of I-131 therapy. Thyroid tissue remaining in theneck after surgery may become swollen and painful. Ifthe thyroid cancer has spread to other parts of the body,the I-131 that collects there may cause pain andswelling.
Patients also may have a dry mouth or lose theirsense of taste or smell for a short time after I-131therapy. Chewing sugar-free gum or sucking on sugar-free hard candy may help.
During treatment, patients are encouraged to drinklots of water and other fluids. Because fluids help I-131pass out of the body more quickly, the bladder’sexposure to I-131 is reduced.
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Because radioactive iodine therapy destroys the cellsthat make thyroid hormone, patients may need to takethyroid hormone pills to replace the natural hormone.
A rare side effect in men who received large doses ofI-131 is loss of fertility. In women, I-131 may not causeloss of fertility, but some doctors suggest that womenavoid pregnancy for one year after I-131 therapy.
Researchers have reported that a very small numberof patients may develop leukemia years after treatmentwith high doses of I-131.
Hormone TreatmentThyroid hormone pills seldom cause side effects.
However, a few patients may get a rash or lose some oftheir hair during the first months of treatment.
The doctor will closely monitor the level of thyroidhormone in the blood during followup visits. Too muchthyroid hormone may cause patients to lose weight andto feel hot and sweaty. It also may cause chest pain,cramps, and diarrhea. (The doctor may call thiscondition “hyperthyroidism.”) If the thyroid hormonelevel is too low, the patient may gain weight, feel cold,and have dry skin and hair. (The doctor may call thiscondition “hypothyroidism.”) If necessary, the doctorwill adjust the dose so that the patient takes the rightamount.
External Radiation TherapyExternal radiation therapy may cause patients to
become very tired as treatment continues. Resting isimportant, but doctors usually advise patients to try tostay as active as they can. In addition, when patientsreceive external radiation therapy, it is common fortheir skin to become red, dry, and tender in the treatedarea. When the neck is treated with external radiation
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therapy, patients may feel hoarse or have troubleswallowing. Other side effects depend on the area ofthe body that is treated. If chemotherapy is given at thesame time, the side effects may worsen. The doctor cansuggest ways to ease these problems.
ChemotherapyThe side effects of chemotherapy depend mainly on
the specific drugs that are used. The most common sideeffects include nausea and vomiting, mouth sores, lossof appetite, and hair loss. Some side effects may berelieved with medicine.
Followup Care
ollowup care after treatment for thyroid cancer isan important part of the overall treatment plan.
Regular checkups ensure that any changes in health arenoted. Problems can be found and treated as soon aspossible. Checkups may include a careful physicalexam, x-rays and other imaging tests (such as a nuclearmedicine scan), and laboratory tests (such as a bloodtest for calcitonin). The doctor can explain thefollowup plan—how often the patient must visit thedoctor and which types of tests are needed.
An important test after thyroid cancer treatmentmeasures the level of thyroglobulin in the blood.Thyroid hormone is stored in the thyroid asthyroglobulin. If the thyroid has been removed, thereshould be very little or no thyroglobulin in the blood. A high level of thyroglobulin may mean that thyroidcancer cells have returned.
For six weeks before the thyroglobulin test, patientsmust stop taking their usual thyroid hormone pill. Forpart of this time, some patients may take a different,
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shorter-lasting thyroid hormone pill. But all patientsmust stop taking any type of thyroid hormone pill forthe last two weeks right before the test. Withoutadequate levels of thyroid hormone, patients are likelyto feel uncomfortable. They may gain weight and feelvery tired. It may be helpful to talk with the doctor ornurse about ways to cope with such problems. After thetest, patients go back to their usual treatment withthyroid hormone pills.
The doctor may request an I-131 scan of the entirebody. This may be called a “diagnostic I-131 wholebody scan.” For a short time (usually six weeks) beforethis scan, the patient stops taking thyroid hormone pills.Thyroid cancer cells anywhere in the body will showup on the scan. After the test, the doctor will tell thepatient when to start taking thyroid hormone pillsagain.
Support for People with Thyroid Cancer
iving with a serious disease such as cancer is noteasy. Some people find they need help coping
with the emotional and practical aspects of theirdisease. Support groups can help. In these groups,patients or their family members get together to sharewhat they have learned about coping with the diseaseand the effects of treatment. Patients may want to talkwith a member of their health care team about finding asupport group. Groups may offer support in person,over the telephone, or on the Internet.
People living with cancer may worry about caringfor their families, keeping their jobs, or continuingdaily activities. Concerns about treatments andmanaging side effects, hospital stays, and medical billsare also common. Doctors, nurses, and other membersof the health care team can answer questions about
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treatment, working, or other activities. Meeting with asocial worker, counselor, or member of the clergy canbe helpful to those who want to talk about theirfeelings or discuss their concerns. Often, a socialworker can suggest resources for financial aid,transportation, home care, or emotional support.
The Cancer Information Service can provideinformation to help patients and their families locateprograms, services, and publications.
The Promise of Cancer Research
octors all over the country are conducting manytypes of clinical trials. These are research studies
in which people take part voluntarily. Studies includenew ways to treat thyroid cancer. Research already hasled to advances, and researchers continue to search formore effective approaches.
Patients who join these studies have the first chanceto benefit from treatments that have shown promise inearlier research. They also make an importantcontribution to medical science by helping doctorslearn more about the disease. Although clinical trialsmay pose some risks, researchers take very carefulsteps to protect their patients.
Patients who are interested in being part of a clinicaltrial should talk with their doctor. They may want toread Taking Part in Clinical Trials: What CancerPatients Need To Know. This NCI booklet describeshow research studies are carried out and explains theirpossible benefits and risks. NCI’s cancerTrials™ Website at http://cancertrials.nci.nih.gov provides generalinformation about clinical trials. It also offers detailedinformation about specific ongoing studies of thyroidcancer by linking to PDQ®, NCI’s cancer informationdatabase. The Cancer Information Service at
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1–800–4–CANCER can answer questions and provideinformation from the PDQ database.
Another agency of the Federal Government, the National Institute of Diabetes and Digestive andKidney Diseases (NIDDK), conducts a ThyroidResearch Program. NIDDK performs laboratory studies and conducts clinical trials on thyroid cancer.NIDDK clinical trials are listed in the PDQ database.The Web site address of the NIDDK ishttp://www.niddk.nih.gov.
Dictionary
Anaplastic thyroid cancer (an-a-PLAS-tik): The leastcommon but most aggressive type of thyroid cancer.Anaplastic is another word for undifferentiated; that is,the highly malignant cells do not look like normalthyroid cells.
Benign (beh-NINE): Not cancerous; does not invadenearby tissue or spread to other parts of the body.
Biopsy (BY-ahp-see): The removal of cells or tissuesfor examination under a microscope. When only asample of tissue is removed, the procedure is called anincisional biopsy or core biopsy. When an entire tumoror lesion is removed, the procedure is called anexcisional biopsy. When a sample of tissue or fluid isremoved with a needle, the procedure is called a needlebiopsy or fine-needle aspiration.
C cell: A type of cell in the thyroid. C cells makecalcitonin, a hormone that helps control the calciumlevel in the blood.
Calcitonin (cal-si-TOE-nin): A hormone formed by theC cells of the thyroid gland. It helps maintain a healthylevel of calcium in the blood. When the calcium level istoo high, calcitonin lowers it.
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Cancer: A term for diseases in which abnormal cellsdivide without control. Cancer cells can invade nearbytissues and can spread through the bloodstream andlymphatic system to other parts of the body.
Cell: The individual unit that makes up all of thetissues of the body. All living things are made up ofone or more cells.
Chemotherapy (kee-mo-THER-a-pee): Treatment withanticancer drugs.
Clinical trial: A research study that tests how well newmedical treatments or other interventions work inpeople. Each study is designed to test new methods ofscreening, prevention, diagnosis, or treatment of adisease.
Cold nodule: When radioactive material is used toexamine the thyroid with a scanner, nodules that collectless radioactive material than the surrounding thyroidtissue are considered “cold.” A nodule that is cold doesnot make thyroid hormone. Cold nodules may bebenign or cancerous. Cold nodules are sometimescalled hypofunctioning nodules.
Colon (KO-lun): The long, coiled, tubelike organ thatremoves water from digested food. The remainingmaterial, solid waste called stool, moves through thecolon to the rectum and leaves the body through theanus.
Computed tomography (tuh-MAH-gra-fee): CT scan.A series of detailed pictures of areas inside the body,taken from different angles; the pictures are created bya computer linked to an x-ray machine. Also calledcomputerized tomography and computerized axialtomography (CAT) scan.
Endocrinologist (en-do-krih-NAH-lo-jist): A doctorwho specializes in diagnosing and treating hormonedisorders.
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External radiation (ray-dee-AY-shun): Radiationtherapy that uses a machine to aim high-energy rays atthe cancer. Also called external-beam radiation.
Fertility (fer-TIL-i-tee): The ability to produce children.
Fine-needle aspiration: The removal of tissue or fluidwith a needle for examination under a microscope. Alsocalled needle biopsy.
Follicular cell: A type of cell in the thyroid. Follicularcells make thyroid hormone.
Follicular thyroid cancer (fo-LIK-yu-ler): Developsfrom thyroid follicular cells. One of the slow-growing,highly treatable types of thyroid cancer.
Gene: The functional and physical unit of hereditypassed from parent to offspring. Genes are pieces ofDNA, and most genes contain the information formaking a specific protein.
Gland: An organ that produces and releases one ormore substances for use in the body. Some glandsproduce fluids that affect tissues or organs. Othersproduce hormones.
Goiter: An enlarged thyroid. It may be caused by toolittle iodine in the diet or by other conditions. Mostgoiters are not cancer.
Hormone treatment: Treatment that removes, blocks,or adds hormones. Also called endocrine therapy.
Hormones: Chemicals produced by glands in the bodyand circulated in the bloodstream. Hormones controlthe actions of certain cells or organs.
Hot nodule: When radioactive material is used toexamine the thyroid with a scanner, nodules that collectmore radioactive material than the surrounding thyroidtissue are considered “hot.” Hot nodules are rarelymalignant. Hot nodules are sometimes calledhyperfunctioning nodules.
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Hyperthyroidism: Too much thyroid hormone. Alsocalled overactive thyroid. Symptoms include weightloss, chest pain, cramps, diarrhea, and nervousness.
Hypothyroidism: Too little thyroid hormone. Alsocalled underactive thyroid. Symptoms include weightgain, constipation, dry skin, and sensitivity to the cold.
Imaging: Tests that produce pictures of areas inside thebody.
Incision (in-SIH-zhun): A cut made in the body duringsurgery.
Iodine: Substance found in shellfish and iodized salt.
Isthmus (iz-muhs): A narrow part inside the body thatconnects two larger structures.
Larynx (LAIR-inks): The area of the throat containingthe vocal cords and used for breathing, swallowing, andtalking. Also called the voice box.
Leukemia (loo-KEE-mee-a): Cancer of blood-formingtissue.
Lobe: A portion of an organ, such as the liver, lung,breast, thyroid, or brain.
Lobectomy (lo-BEK-toe-mee): The removal of a lobe.
Local therapy: Treatment that affects cells only in thetumor and the area close to it.
Lymph node: A rounded mass of lymphatic tissue thatis surrounded by a capsule of connective tissue. Alsoknown as a lymph gland. Lymph nodes are spread outalong lymphatic vessels and contain manylymphocytes, which filter the lymphatic fluid (lymph).
Lymphatic system (lim-FAT-ik): The tissues and organsthat produce, store, and carry white blood cells thatfight infection and other diseases. This system involvesthe bone marrow, the spleen, the thymus, lymph nodes,and a network of thin tubes that carry lymph and whiteblood cells. These tubes branch, like blood vessels, intoall tissues of the body.
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Magnetic resonance imaging (mag-NET-ik REZ-o-nans IM-a-jing): MRI. A procedure in which a magnetlinked to a computer is used to create detailed picturesof areas inside the body.
Malignant (ma-LIG-nant): Cancerous; a growth with atendency to invade and destroy nearby tissue andspread to other parts of the body.
Medical oncologist (on-KOL-o-jist): A doctor whospecializes in diagnosing and treating cancer usingchemotherapy, hormonal therapy, and biologicaltherapy. A medical oncologist often serves as the maincaretaker of someone who has cancer and coordinatestreatment provided by other specialists.
Medullary thyroid cancer (MED-yoo-LAIR-ee): Arisesin C cells of the thyroid. The C cells make a hormone(calcitonin) that lowers the calcium level in blood.
Metastasis (meh-TAS-ta-sis): The spread of cancerfrom one part of the body to another. Tumors formedfrom cells that have spread are called “secondarytumors” and contain cells that are like those in theoriginal (primary) tumor. The plural is metastases.
Metastasize (meh-TAS-ta-size): To spread from onepart of the body to another. When cancer cellsmetastasize and form secondary tumors, the cells in themetastatic tumor are like those in the original (primary)tumor.
Multiple endocrine neoplasia syndrome: MEN. Aninherited tendency to develop thyroid cancer and othercancers of the endocrine system. The altered gene canbe detected with a blood test.
Nodule (NOD-yool): A growth or lump that may becancerous or noncancerous.
Nuclear medicine scan: A method of diagnosticimaging that uses very small amounts of radioactivematerial. The patient is injected with a liquid thatcontains the radioactive substance. The substance
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collects in the part of the body to be imaged.Sophisticated instruments detect the radioactivesubstance in the body and process that information intoan image.
Oncologist (on-KOL-o-jist): A doctor who specializesin treating cancer. Some oncologists specialize in aparticular type of cancer treatment. For example, aradiation oncologist specializes in treating cancer withradiation.
Papillary thyroid cancer (PAP-i-lair-ee): Developsfrom thyroid follicular cells. The most common type ofthyroid cancer.
Parathyroid glands (pair-a-THIGH-roid): Four pea-sized glands found on the thyroid. The parathyroidhormone produced by these glands increases thecalcium level in the blood.
Pathologist (pa-THOL-o-jist): A doctor who identifiesdiseases by studying cells and tissues under amicroscope.
Pituitary gland (pih-TOO-ih-tair-ee): The mainendocrine gland; it produces hormones that controlother glands and many body functions, especiallygrowth.
Precancerous polyps: Growths that protrude from amucous membrane. Precancerous polyps may (or arelikely to) become cancer.
Primary tumor: The original tumor.
Quality of life: The overall enjoyment of life. Manyclinical trials measure aspects of an individual’s senseof well-being and ability to perform various tasks toassess the effects of cancer and its treatment on thequality of life.
Radiation: Radiant energy given off by x-ray machines,radioactive substances, rays that enter the Earth’satmosphere, and other sources.
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Radiation oncologist (ray-dee-AY-shun on-KOL-o-jist): A doctor who specializes in using radiation to treatcancer.
Radiation therapy (ray-dee-AY-shun): The use of high-energy radiation from x-rays, gamma rays, neutrons,and other sources to kill cancer cells and shrink tumors.Radiation may come from a machine outside the body(external-beam radiation therapy), or it may come fromradioactive material placed in the body in the area nearcancer cells (internal radiation therapy, implantradiation, or brachytherapy). Systemic radiation therapyuses a radioactive substance, such as a radiolabeledmonoclonal antibody, that circulates throughout thebody. Also called radiotherapy.
Radioactive (RAY-dee-o-AK-tiv) fallout: Airborneradioactive particles that fall to the ground during andafter an atomic bombing, nuclear weapons test, ornuclear plant accident.
Radioactive (RAY-dee-o-AK-tiv) iodine: A radioactiveform of iodine, often used for imaging tests or as atreatment for cancer. For imaging tests, the patient takesa small amount of radioactive iodine by mouth, and itcollects in the thyroid. A probe is used to scan thethyroid. For treatment, the patient takes a large dose ofradioactive iodine, which kills thyroid cells.
Radionuclide scanning: A test that produces pictures(scans) of internal parts of the body. The person isgiven an injection or swallows a small amount ofradioactive material; a machine called a scanner thenmeasures the radioactivity in certain organs.
Risk factor: A substance, agent, genetic alteration, trait,habit, or condition that increases a person’s chance ofdeveloping a disease.
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Side effects: Problems that occur when treatmentaffects healthy cells. Common side effects of cancertreatment are fatigue, nausea, vomiting, decreasedblood cell counts, hair loss, and mouth sores.
Sonogram (SON-o-gram): A computer picture of areasinside the body created by bouncing sound waves offorgans and other tissues. Also called ultrasonogram orultrasound.
Stage: The extent of a cancer, especially whether thedisease has spread from the original site to other partsof the body.
Staging: Performing exams and tests to learn the extentof the cancer within the body, especially whether thedisease has spread from the original site to other partsof the body.
Surgeon: A doctor who removes or repairs a part of thebody by operating on the patient.
Surgery: A procedure to remove or repair a part of thebody or to find out whether disease is present.
Symptom: An indication that a person has a conditionor disease. Some examples of symptoms are headache,fever, fatigue, nausea, vomiting, and pain.
Systemic therapy (sis-TEM-ik): Treatment that usessubstances that travel through the bloodstream,reaching and affecting cells all over the body.
Thyroglobulin (THIGH-roe-GLOB-yu-lin): The formthat thyroid hormone takes when stored in the cells ofthe thyroid. If the thyroid has been removed,thyroglobulin should not show up on a blood test.Doctors measure thyroglobulin level in blood to detectthyroid cancer cells that remain in the body aftertreatment.
Thyroid (THIGH-roid): A gland located beneath thevoice box (larynx) that produces thyroid hormone. Thethyroid helps regulate growth and metabolism.
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Thyroidectomy (thigh-roid-EK-toe-mee): Surgery toremove part or all of the thyroid.
Thyroid hormone: The thyroid gland makes T3(triiodothyronine) and T4 (thyroxine), which togetherare considered thyroid hormone. T3 and T4 haveidentical effects on cells. Thyroid hormone affects heartrate, blood pressure, body temperature, and weight. T3and T4 are stored as thyroglobulin, which can beconverted back into T3 and T4.
Thyroid-stimulating hormone: TSH. A hormoneproduced by the pituitary gland. TSH stimulates therelease of thyroid hormone from thyroglobulin. It alsostimulates the growth of thyroid follicular cells. Anabnormal TSH level may mean that the thyroidhormonal regulation system is out of control, usually asa result of a benign condition (hyperthyroidism orhypothyroidism).
Tissue (TISH-oo): A group or layer of cells that arealike in type and work together to perform a specificfunction.
Tumor (TOO-mer): An abnormal mass of tissue thatresults from excessive cell division. Tumors perform nouseful body function. They may be benign (notcancerous) or malignant (cancerous).
Ultrasonography (UL-tra-son-OG-ra-fee): A procedurein which sound waves (called ultrasound) are bouncedoff tissues and the echoes produce a picture(sonogram).
X-ray: High-energy radiation used in low doses todiagnose diseases and in high doses to treat cancer.
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National Cancer Institute InformationResources
ou may want more information for yourself, your family, and your doctor. The following
National Cancer Institute (NCI) services are available to help you.
TelephoneCancer Information Service (CIS)
Provides accurate, up-to-date information on cancerto patients and their families, health professionals, andthe general public. Information specialists translate the latest scientific information into understandablelanguage and respond in English, Spanish, or on TTYequipment.
Toll-free: 1–800–4–CANCER (1–800–422–6237)
TTY: 1–800–332–8615
Internethttp://cancer.gov
NCI’s Web site contains comprehensive informationabout cancer causes and prevention, screening anddiagnosis, treatment and survivorship; clinical trials;statistics; funding, training, and employmentopportunities; and the Institute and its programs.
FaxCancerFax®
Includes NCI information about cancer treatment,screening, prevention, and supportive care. To obtain acontents list, dial 1–800–624–2511 or 301–402–5874from your touch-tone phone or fax machine hand setand follow the recorded instructions.
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National Cancer Institute Booklets
ational Cancer Institute (NCI) publications can beordered by writing to the address below, and some
can be viewed and downloaded fromhttp://cancer.gov/publications on the Internet.
Publications Ordering ServiceNational Cancer InstituteBuilding 31, Room 10A3131 Center Drive, MSC 2580Bethesda, MD 20892–2580
In addition, people in the United States and itsterritories may order these and other NCI booklets bycalling the Cancer Information Service at1–800–4–CANCER. They may also order many NCIpublications on-line at http://cancer.gov/publications.
Booklets About Cancer Treatment• Radiation Therapy and You: A Guide to Self-Help
During Treatment
• Chemotherapy and You: A Guide to Self-HelpDuring Treatment
• Help Yourself During Chemotherapy: 4 Steps forPatients
• Eating Hints for Cancer Patients
• Understanding Cancer Pain
• Pain Control: A Guide for People with Cancer andTheir Families
• Get Relief From Cancer Pain
• Taking Part in Clinical Trials: What Cancer PatientsNeed To Know
• La quimioterapia y usted: Una guía de autoayudadurante el tratamiento del cáncer (Chemotherapy
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and You: A Guide to Self-Help During Treatment forCancer)
• El dolor relacionado con el cáncer (UnderstandingCancer Pain)
• El tratamiento de radioterapia: Guía para elpaciente durante el tratamiento (Radiation Therapy and You: A Guide to Self-Help DuringTreatment)
• ¿En qué consisten los estudios clínicos? Un folletopara los pacientes de cáncer (What Are Clinical Trials All About? A Guide for CancerPatients)
Booklets About Living With Cancer• Advanced Cancer: Living Each Day
• Taking Time: Support for People With Cancer andthe People Who Care About Them
• When Cancer Recurs: Meeting the Challenge
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This booklet was written and published by theNational Cancer Institute (NCI), 31 Center Drive,MSC 2580, Bethesda, MD 20892–2580. The NCI, thelargest component of the National Institutes of Health,coordinates a national research program on cancercauses and prevention, detection and diagnosis, andtreatment. In addition, NCI’s mission includesdissemination of information about cancer to patients,the public, and health professionals.
The National Cancer Act, passed by Congress in 1971,made cancer research a National priority. Since thattime, the NCI, the lead Federal agency for cancerresearch, has collaborated with top researchers andfacilities across the country to conduct innovativeresearch leading to progress in cancer prevention,detection, diagnosis, and treatment. These efforts haveresulted in a decrease in the overall cancer death rate,and have helped improve and extend the lives ofmillions of Americans.
The written text of NCI material is in the publicdomain and is not subject to copyright restrictions.One does not need special permission to reproduce ortranslate NCI written text. However, we wouldappreciate a credit line and a copy of any translatedmaterial.
The copyright for artwork developed for NCI byprivate sector designers, photographers, and illustratorsunder contract to the Government remains in the handsof the originators. One must have permission to use orreproduce these materials. In many cases, permissionwill be granted, but a credit line and/or fees for usagemay be required. To learn if permission is required, orto obtain permission to reproduce NCI artwork, writeto: Communication Services Branch, Office ofCommunications, National Cancer Institute, Room10A28, 31 Center Drive, MSC 2580, Bethesda, MD20892–2580.
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NIH Publication No. 01–4994September 2001
P620
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
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