Thyroid Cancer

Malcolm Steiner, MD, Endocrinologist, Discusses Thyroid Cancer Video Transcript

My name is Malcolm Steiner. I’m an endocrinologist which is the study of glandular disorders. I work out of Atrium Medical Center in Middletown, Ohio.

The Evaluation

The goal of the thyroid cancer evaluation is to separate those folks who have a serious problem that need aggressive lifelong treatment from the vast majority who have a problem that is going to be easily cured and really has no long term consequences after good surgical treatment up front.

The Diagnosis

Patients come to me with a diagnosis of a possible thyroid problem. They are concerned about a lump usually. Discomfort may be a reason they see it. A woman may see this asymmetry as she’s looking in a mirror. There might be some pressure discomfort or difficulty when swallowing. Hoarseness is a sign of a much more advanced problem because the thyroid is right on top of the nerve that controls the vocal chord.

Symptoms of Thyroid Cancer

The symptoms of thyroid illness are very non-specific. They are shared by a host of medical problems. Fatigue and hoarseness can be caused by lots of metabolic disorders including thyroid disease but also chronic anemia, so far as fatigue is concerned, problems with anemia, chronic liver disease, chronic kidney disease, calcium metabolism problems, chronic illness from muscle disorders, fibromyalgia.

Are There Specific Symptoms?

Are there specific symptoms for a diagnosis of thyroid cancer? Other than a mass developing on physical examination or self exam, the woman who feels her neck when she’s putting on make up or looking in a mirror and sees an asymmetry or the guy who while shaving notices a lump that didn’t used to be there. There really isn’t a specific thyroid cancer symptom or sign.

What is thyroid cancer?

What is thyroid cancer? Like any type of cancer, it’s a disorder of uncontrolled growth . . in this case it’s the thyroid gland, the gland that lives right over the breast bone at the base of the neck. It looks like a U-shaped gland. It’s about two inches tall and about half an inch wide and deep on the right lobe and the left lobe.

Needle Aspiration

The needle aspiration test is a procedure that most endocrinologists in the last decade have been trained on in the United States. It’s done by identifying on ultrasound which of the thyroid lobes has an area which is irregular, usually a lump that is pretty well defined on ultrasound.  The lump itself is usually pretty small . . . about an inch or less. It is usually half an inch to an inch below the skin. Then I infiltrate the tissue with some lidocaine and that just numbs it up. Lidocaine is what we use in dentists’ offices. It’s pretty rare that people have a problem with lidocaine. That makes the tissue around the area that I’m going to be biopsying numb.

Thyroid Cancer Treatment

I now tell patients ‘yes you have a thyroid cancer and the likelihood is it’s going to be very similar to a skin cancer, you treat it simply, surgically once and you’re done with no long-term impact on your life’. We’ve got aggressive options available but the fact is because most thyroid cancers we pick up are at very early stage, a relatively simple surgical procedure is sufficient.

Thyroid Surgery

The surgery should be done by someone who is comfortable discussing the risks with the patient. Now everyone who goes thru this type of surgery, because you have to have a plastic tube in your airway during the surgery will have some hoarseness and that should be gone within weeks to months.

Post-Operative Care

The smaller the incision the less tissue is removed the lower the trauma and the shorter the recovery period. If the thyroid surgery is more aggressive you will expect a more prolonged recovery. The recovery period could be anywhere from two weeks to two months.

What is the thyroid?

The thyroid is a gland at the base of the neck right above the breast bone which produces thyroid hormone. Thyroid hormone goes to cells all over the body through the blood stream and gets into the nucleus where all the genetics that run the cells reside and controls the rate of metabolism of that cell by adjusting nuclear signals.

Hormone Replacement After Surgery

All these patients who have their thyroid gland removed will need thyroid hormone replacement for the rest of their lives If a patient only has one lobe of their thyroid removed . . . basically half of their thyroid. . . . because it’s such an early stage of the cancer, they may not need any hormone because the remaining thyroid tissue is perfectly satisfactory to meet their body’s needs.

Recurrence and Prognosis

A lot of patients have microscopic involvement of lymph nodes in the neck and it may have a very low likelihood of affecting their life expectancy. Most patients are going to have a low stage thyroid cancer and very little impact on their life expectancy.