January is Thyroid Awareness Month, so it’s an apt time to discuss the thyroid, thyroid cancer and other thyroid conditions. The terrible earthquake in Japan last year, and the resulting nuclear meltdowns, again have placed thyroid cancer in the news. There is a very close link between radiation exposure and thyroid cancer, and it is likely that Japan will see a sharp increase in aggressive thyroid cancers in the coming years, as was the case in Russia after the Chernobyl disaster in 1986.
Here in the United States, there was an increase in thyroid cancer following the nuclear testing in the 1950s in the Southwest. Though we have ceased such open-air testing, there are still numerous ways to be exposed to radiation, such as by receiving radiation therapy for cancer. And there is also a natural incidence of thyroid cancer unrelated to radiation exposure.
What is the thyroid?
The thyroid is a gland in the neck that regulates metabolism. Around New Year’s, it is common to hear talk of underactive thyroid and how it can cause weight gain and sluggishness. Underactive thyroids can be treated very successfully with medication. Hormone replacement therapy is typically associated with few complications.
While thyroids can be underactive, they also can be overactive, causing jitteriness, weight loss, bulging eyes and sweating, among other symptoms. Overactive thyroids can be treated with medication, doses of radioactive iodine or surgery.
While all surgeries carry risks, surgical removal of a portion of the thyroid is a very effective way of treating overactive thyroid. Some surgeons will choose to remove only enough of the thyroid to reduce the glandular activity to a normal level. However, this carries the risk that the thyroid will again become overactive. As such, I, and other surgeons in my field, prefer to remove all of the thyroid — total thyroidectomy — and then place the patient on hormone replacement therapy. This helps to ensure additional surgery is not necessary.
What About Thyroid Cancer?
Thyroid cancer is much more common in women than in men. Often it is discovered when the patient feels a lump in the neck that is subsequently diagnosed as cancer.
If there is a question about whether a lump is benign, patients with a history of radiation exposure typically will be advised to have it removed. In patients without a history of radiation exposure, a course of action can include fine-needle aspiration, or needle biopsy, of the lump in order to guide decision-making. Thyroid cancer typically is very slow growing, and that allows a latitude in treatment that is unavailable when dealing with fast-growing cancers.
There are aggressive forms of thyroid cancer unrelated to radiation exposure, but they are very rare and typically occur in older males. You may recall that former U.S. Supreme Court Chief Justice William Rehnquist was diagnosed with an aggressive form of thyroid cancer.
More common forms of thyroid cancer often can be treated very effectively with thyroid surgery and medication.
Women should have their thyroids checked as part of their annual physical. Thyroid cancer can strike women of any age, from the teenage years through the golden years.
People with a history of radiation exposure also should be careful in monitoring their thyroids. And anyone who develops a lump in the neck that remains for more than a couple of weeks should visit a doctor.
At the University of Virginia Health System, they take a multidisciplinary approach to treating thyroid cancer and other thyroid issues. Their physicians have significant experience and expertise in thyroid cases, and they work collaboratively to determine the best course of treatment for each patient. Dr. John B. Hanks is a surgeon who treats thyroid and adrenal issues at the University of Virginia Health System.
Visit uvahealth.com for more information about thyroid health issues and treatment.