The thyroid gland is a butterfly-shaped gland nestling at the base of the neck. It plays a pivotal role in the regulation of metabolism, heart rate, and other crucial body functions through hormone production.
Thyroid cancer originates in the thyroid gland and is a silent but increasing global health concern with a significant increase in global incidence noted from 1990 to 2017.
Today, thyroid cancer is ranked ninth among all cancers. However, unlike other cancers, the majority of the thyroid cancers have good prognosis with more than 90 percent of patients surviving diagnosis of thyroid cancer.
Thyroid Nodules - Not All Swellings Are Cancer!
Thyroid nodules and swellings are common with an incidence of 8-10% among the masses in India. The incidence is on the rise globally as well. Nodules are 5-10 times more common in females as compared to males.
It is important to distinguish nodules that are malignant from those which are not and can be put under observation.
This will help to avoid unnecessary surgeries on the thyroid gland. Thyroid surgeries cause metabolic changes in a young female’s body.
Moreover, this gland is intimately related to important structures including nerves that supply the voice box and parathyroid glands that look after the calcium of the body. Thyroid surgery must be done only after properly triaging which nodules are bad, i.e., distinguishing good from the bad.
Various studies in medical literature show that thyroid surgeries conducted at high-volume centres, or medical institutions that frequently perform these surgeries, yield the most favourable outcomes.
This is due to high-volume centres having surgeons with extensive experience and specialized training in thyroid surgeries who are familiar with the intricacies of the procedure, leading to more precise surgery and less risk of complications.
These centres have access to the latest technology with a multi-disciplinary team comprising endocrinologists, radiologists, pathologists, anaesthesiologists, and nursing staff that specialize in thyroid conditions.
This improves pre-operative evaluation, surgical planning, and post-operative care for better outcomes. There is also a lower rate of complications with improved long-term outcomes.
Understanding Thyroid Cancer
The four main types of thyroid cancer are:
Papillary thyroid cancer
Follicular thyroid cancer
Medullary thyroid cancer
Anaplastic thyroid cancer
Papillary and Follicular thyroid cancers, also termed differentiated thyroid cancers, together constitute approximately 95% of all cases. These are often detected early due to their slow-growing nature, resulting in high survival rates. Medullary thyroid cancer is rarer but has a unique trait; it starts in thyroid cells that do not make thyroid hormones.
Anaplastic thyroid cancer, though extremely rare, is aggressive and difficult to treat, making early detection critical. The underlying causes of thyroid cancer remain somewhat enigmatic.
Nevertheless, several factors have been identified that increase the risk of developing this disease.
Exposure to high levels of radiation, particularly during childhood, a family history of thyroid disease or cancer, chronic inflammation of the thyroid, and certain inherited genetic syndromes such as familial medullary thyroid cancer or multiple endocrine neoplasia, are known contributors.
Recognising The Symptoms
Incidentaloma
Incidentalomas are lesions or tumors found unexpectedly during imaging tests conducted for unrelated reasons, such as an MRI scan of the spine or a CT scan of the chest. When these incidental findings involve thyroid nodules, they are referred to as thyroid incidentalomas. With the growing use of advanced imaging techniques, the incidental detection of these nodules has significantly increased.
While the concern is often that these nodules may be cancerous, leading some physicians to suggest precautionary thyroid surgery, it is crucial to understand that the majority of thyroid nodules are benign. In fact, studies indicate that only around 5-15% of thyroid nodules turn out to be malignant.
Rather than immediately resorting to surgical intervention, many of these incidentalomas can be managed through a process known as "active surveillance."
This involves closely monitoring the patient for any changes or progression of the condition with regular imaging tests to track the nodule's size and appearance, and potentially fine-needle aspiration biopsies to study its cellular characteristics.
If any evidence of growth is detected, more aggressive treatments like surgery can be considered. This approach helps prevent unnecessary surgeries and their associated risks, especially for patients with small, asymptomatic, and non-growing nodules.
Diagnosis And Traditional Treatment Options
Diagnosis of thyroid cancer typically begins with a physical exam where doctors check for lumps in the thyroid. Blood tests to measure thyroid function, imaging tests like ultrasound, and a biopsy for a microscopic examination of thyroid tissue are other diagnostic methods.
The saying "less is more" means that it is very important to tell the difference between slow-growing (indolent) and fast-growing (aggressive) thyroid cancers. Doing so helps avoid unnecessary thyroid surgeries and the problems they can cause.
Upon confirmation of thyroid cancer, several treatment options are considered, depending on the type and stage of the disease, and the patient's overall health.
Surgical removal of all or part of the thyroid –thyroidectomy, is often the first-line treatment.
Intraoperative Nerve Monitoring
Intraoperative nerve monitoring is a technique used during surgery to help protect delicate nerves from accidental damage.
damage. In the case of thyroid surgery, it is especially used to protect the recurrent laryngeal nerves, which control voice box functions and are closely located to the thyroid gland. During the surgery, small electrodes are attached to the patient's vocal cords.
These electrodes can pick up signals from the nerves, providing real-time feedback to the surgeon about nerve function. This feedback helps the surgeon avoid harming these nerves while they are removing the thyroid.
By doing so, intraoperative nerve monitoring can help prevent complications like voice changes or difficulties with breathing after surgery, making the procedure safer for the patient.
The Advent of Radionuclide Therapy
Radionuclide therapy, an innovative systemic treatment, is revolutionizing the oncology landscape. This therapy uses a molecule labelled with a radioactive isotope to deliver high levels of radiation to treat specific cancers. It offers a more targeted approach than traditional chemotherapy as the radioactive substances home in on the diseased cells, thus minimizing potential side effects to normal tissue.
While thyroid cancer remains a significant health challenge, therapies like radionuclide therapy that target cancer cells more accurately offer improved patient outcomes and quality of life.
These advancements, combined with early detection and increased public awareness, can help turn the tide in the battle against thyroid cancer!
(Dr. Anil D’Cruz has over 30 years’ experience in the field of Surgical Oncology focusing primarily on head and neck cancers. He is the Director – Oncology at Apollo Hospitals in Mumbai, Delhi, Chennai and he is based in Mumbai.)
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