Well Differentiated Thyroid Cancer Follow Up

Papillary and/or Follicular thyroid cancer will recur or persist in about 25% of patients, and 80% of these recurrences will be in the neck. Recurrence occurs most commonly in the first 2 years after thyroidectomy. In papillary thyroid cancer, however, recurrence can occur up to 45 years after surgery, whereas virtually all patients with follicular and Hürthle cell cancer recur before 12 years after surgery.

• The current recommendations for postoperative follow-up of well-differentiated thyroid cancer, except for very low-risk patients, are thyroid remnant ablation and thyroid stimulating hormone (TSH) suppression. 

• Radioiodine ablation is recommended for patients with papillary thyroid cancers larger than 1.5cm, multifocal tumors, and for those with lymph node metastases. 

• Invasive follicular and Hürthle cell cancer also warrant radioiodine therapy.  

• Doctors routinely recommend the  use 30 to 50 mCi of radioiodine in low risk and 100 to 200 mCi of radioiodine in high-risk patients. 

• The initial radioiodine treatment should be performed under hormone withdrawal, or with recombinant TSH stimulation 6-8 weeks post operatively in an iodine deficient patient. 

• Patients should have a thyroid hormone levels (TSH, T3, T4, Thyroglobulin) measured as well  pregnancy test prior to 131-Iodine scanning and ablation therapy, and post-treatment imaging. 

TSH  is known to stimulate tumor growth, invasion, angiogenesis, and thyroglobulin secretion. Therefore post operatively patients are placed on thyroid hormone replacement therapy. 

• In  low-risk patients doctors maintain the serum TSH level just below the lower limit of the normal range between 0.1 and 0.4 mU/ mL. 

• In high-risk patients the dosage is adjusted to maintain a serum TSH level less than 0.1 mU/ mL, as this has been reported to improve tumor free survival. 

Adverse effects of TSH suppression may include:  

• subclinical thyrotoxicosis 
• exacerbation of angina 
• atrial fibrillation
• osteoporosis in postmenopausal women

External beam radiation and chemotherapy have a limited role in the postoperative management of well differentiated thyroid carcinoma patients. 

• External beam radiation is used infrequently in the management of thyroid cancer except as a palliative treatment for locally advanced unresectable disease, positive tumor margins, or recurrent disease after re-resection. 

• Chemotherapy has shown only minimal benefit in the treatment of well-differentiated thyroid cancer. New clinical trials have recently become available.

Follow-up is different for patients at low, intermediate, and high risk of having persistent or recurrent disease. 

• Low risk patients are defined as patients with no local or distant metastases, complete resection of tumor contained within the thyroid with no locoregional invasion, tumor without aggressive histology, and if radioiodine was given there was no uptake outside of the thyroid bed. 

• Intermediate risk patients have microscopic invasion of tumor into the peri-thyroidal soft tissue at initial surgery or tumor with aggressive histology or vascular invasion. 

• High-risk patients have macroscopic tumor invasion, incomplete tumor resection, distant metastases, or radioiodine uptake outside the thyroid bed on the post-treatment scan after thyroid remnant ablation.

The absence of persistent disease in patients that have undergone at least a total thyroidectomy and thyroid remnant ablation comprises of no clinical evidence of tumor, no imaging evidence of tumor, and undetectable serum thyroglobulin levels during TSH suppression and stimulation in the absence of interfering antibodies.

All patients with a history of well-differentiated thyroid cancer should have yearly cervical ultrasound scanning, thyroglobulin and thyroglobulin antibodies. 

• Approximately 20% of patients who are clinically disease free with serum thyroglobulin levels less than 2 ng/mL during thyroid hormone suppression will have a thyroglobulin level greater than 5 ng/mL after rhTSH or thyroid hormone withdrawal. One third of this group will have persistent disease identified on imaging studies. Therefore, a serum thyroglobulin level above 5 ng/mL after rhTSH stimulation is highly sensitive in identifying patients with persistent disease. Furthermore, the clinical significance of minimally detectable thyroglobulin levels is unclear, especially if only detected after TSH stimulation. 

• Approximately 25% of patients with thyroid cancer have antithyroglobulin antibodies making follow-up with thyroglobulin insensitive. In this group serial serum antithyroglobulin antibody measurements may serve as an imprecise surrogate marker to detect recurrence among these patients. Accurate surveillance for possible recurrence and treatment in patients thought to be free of disease is a major goal of long-term follow-up.

SOURCE: Weill Cornell Medical College

Radioactive Iodine Treatment Basics

Radioactive iodine, given in a liquid form or pill, is absorbed and concentrated by the thyroid gland which is the only organ in your body with cells that actually absorbs iodine. The treatment destroys thyroid tissue but does not harm other tissue in the body.

*While radiation exposure can cause thyroid cancer, treatment of hyperthyroidism with radioactive iodine does not increase your chances of getting thyroid cancer.

Why Radioactive Iodine

Radioactive iodine is used after surgical removal of the thyroid gland (thyroidectomy) because of thyroid cancer. Radioactive iodine therapy destroys any remaining thyroid tissue or cancer cells that were not removed during surgery. Radioactive iodine may also be used to treat hyperthyroidism in people who have noncancerous (benign) thyroid nodules that make too much thyroid hormone.

What to Expect After Treatment

• Within days, the radioactive iodine passes out of your body in your urine.

• To avoid exposing other people to radioactivity, it is important to do the following for the first one week after your radioactive iodine treatment:

• Drink plenty of fluids –an eight ounce glass of water every couple of hours is ideal  to help flush the radiation out of your body.

• Avoid children, pregnant women and pets for a minimum of one week.

• Remain a minimum of 3 feet away from people at all times for at least one week.

• Do not sit next to someone in a motor vehicle for more than 1 hour for one week.

• Avoid kissing or sexual intercourse for a minimum of one week.

• Do not sleep with your spouse or anyone else in your own room for one week (if you have small children it is best to stay in a hotel the first few days).

• Use separate (or disposable) eating utensils for the first one week after treatment, wash them or dispose of them separately.

• Use separate towels, washcloths, and sheets. Wash these items and all your personal clothing separately for one week. (Ideally keep get rid of them).

• Wash your hands with soap and lots of water frequently, specially each time you use the toilet and before touching any cooking utensils.

• Keep the toilet very clean: flush the toilet 2 or 3 times after each use. Men should urinate sitting down to avoid splashing for one week.

• Rinse the bathroom sink and tub thoroughly 2 or 3 times after using them for one week.

How Well It Works

In almost all cases, your thyroid hormone levels will return to normal or below normal after radioactive iodine treatment. This may take 8 to 12 weeks or longer. If your thyroid hormone level does not go down after 6 months, you may need another dose of radioactive iodine.

If you have thyroid cancer and you are treated with radioactive iodine, it may take from several weeks to many months for your body to get rid of any remaining cancer cells.

Your thyroid nodule is unlikely to grow after being treated with radioactive iodine.

Common Side Effects

• The risks from radioactive iodine treatment include:
• Metallic taste in your mouth.
• Dry mouth.
• Sore throat.
• Neck pain. Radioactive iodine treatment can make your neck swell up or hurt.
• Nausea or vomiting, which is usually mild.
• Constipation or diarrhea.
• Extreme fatigue.
• Unusually low (hypothyroidism) or unusually high (hyperthyroidism) thyroid levels.

Important Risk Factors To Think About

If you are pregnant, you should not receive radioactive iodine treatment. This kind of treatment can damage your fetus's thyroid gland or expose your fetus to radioactivity. For this reason it is very important to stay away from pregnant women after radioactive iodine treatment.

You should NOT breast-feed your baby after you have been treated with radioactive iodine. Ask your doctor when it will be safe to breast-feed.

Different people with thyroid cancer will receive different doses of radioactive iodine. If you are young and you do not have a great risk of your cancer coming back, you will probably need less radioactive iodine than an older person. Sometimes this means that a younger person who receives radioactive iodine treatment will not have to stay overnight in a hospital.

If you have had radioactive iodine treatment and you want to travel 3 to 4 days after treatment, it is important to prepare for any problems you may have at airport security. People who have had radioactive iodine treatment can set off the radiation detection machines in airports and other public/government buildings. If you plan to travel by airplane within 3 or 4 days after your treatment, check with local authorities about any steps or permission you may need to travel.

A special low iodine diet  must be followed prior to radioactive iodine treatment so that it can be effective. Sometimes antithyroid medication such as Thyrogen are used before radioactive iodine to treat a noncancerous nodule that is making too much thyroid hormone and causing hyperthyroidism.

MEDICAL REVIEW 02/28/2012

Thyroid Cancer Surgery Complications: Vocal Cord Paralysis and Paresis

The recurrent laryngeal nerve also runs in close proximity to the thyroid gland making hoarseness of voice due to partial paralysis an important side effect of thyroid surgery -Wikipedia.


A common and rarely discussed complication of thyroidectomy or thyroid cancer surgery is vocal cord paralysis which can resolve with therapy or may be permanent depending on the extent of nerve damage associated with the cancer itself or the extent of surgery necessary to remove the cancer.

Vocal cord paralysis occurs when the nerve impulses to your voice box (larynx) are interrupted. This results in paralysis of the muscle of the vocal cords. Vocal cord paralysis can affect your ability to speak and even breathe. That's because your vocal cords, sometimes called vocal folds, do more than just produce sound. They also protect your airway by preventing food, drink and even your saliva from entering your windpipe (trachea) and causing you to choke.

• There are a number of causes of vocal cord paralysis including damage to nerves during surgery and certain cancers. Vocal cord paralysis can also be caused by a viral infection or a neurological disorder.

• Treatment for vocal cord paralysis usually includes voice therapy; however, surgery is also sometimes necessary.

Your vocal cords are two flexible bands of muscle tissue that sit at the entrance to the windpipe (trachea). When you speak, the bands come together and vibrate to make sound. The rest of the time, the vocal cords are relaxed in an open position, so you can breathe. In most cases of vocal cord paralysis, only one vocal cord is paralyzed. If both of your vocal cords are affected, you may have vocal difficulties, as well as significant problems with breathing and swallowing.

Signs and symptoms of vocal cord paralysis may include:

• A breathy quality to the voice
• Hoarseness
• Noisy breathing
• Loss of vocal pitch
• Choking or coughing while swallowing food, drink or saliva
• The need to take frequent breaths while speaking
• Inability to speak loudly
• Loss of your gag reflex
• Ineffective coughing

Vocal Cord Paralysis Basics:

In vocal cord paralysis, the nerve impulses to your voice box (larynx) are interrupted, resulting in paralysis of the muscle. Doctors often don't know the cause of vocal cord paralysis. Known causes may include:

• Injury to the vocal cord during surgery. Surgery on or near your neck or upper chest can result in damage to the nerves that serve your voice box. Surgeries that carry a risk of damage include surgeries to the thyroid or parathyroid glands, esophagus, neck and chest.
• Neck or chest injury. Trauma to your neck or chest may injure the nerves that serve your vocal cords or the voice box itself.
• Stroke. A stroke interrupts blood flow in your brain and may damage the part of your brain that sends messages to the voice box.
• Tumors. Tumors, both cancerous and noncancerous, can grow in or around the muscles, cartilages or nerves of your voice box and can cause vocal cord paralysis.
• Inflammation. Arthritis or surgery can cause inflammation and scarring of the vocal cord joints or the space between the two vocal cord cartilages, and this inflammation may prevent your vocal cords from opening and closing. The symptoms and signs of this disorder mimic vocal cord paralysis, even though the vocal cord nerves remain normal. In addition, some viral infections can cause inflammation and damage directly to the nerves in the larynx.
• Neurological conditions. If you have certain neurological conditions, such as multiple sclerosis or Parkinson's disease, you may experience vocal cord paralysis; however, these conditions are more likely to cause vocal cord weakness than complete paralysis.

Factors that increase your risk of vocal cord paralysis include:

• Being female. Women are slightly more likely to develop vocal cord paralysis.
• Undergoing throat or chest surgery. People who need surgery on their thyroid, throat or upper chest have an increased risk of vocal cord nerve damage. Sometimes breathing tubes used in surgery or to help you breathe if you're having serious respiratory trouble can damage the vocal cord nerves.
• Having a neurological condition. People with certain neurological conditions, such as Parkinson's disease, multiple sclerosis or myasthenia gravis, are more likely to develop vocal cord weakness or paralysis.

Vocal Cord Paralysis Complications:

Breathing problems associated with vocal cord paralysis may be so mild that you just have a hoarse-sounding voice, or they can be so serious that they're life-threatening. Because vocal cord paralysis keeps the opening to the airway from completely opening or closing, other complications may include choking on or actually inhaling (aspirating) food or liquid. Aspiration that leads to severe pneumonia is very serious and requires immediate medical care.

When to see a doctor?  If you have unexplained, persistent hoarseness for more than three or four weeks, or if you notice any unexplained voice changes or discomfort, contact your doctor.


Medical Review: 02/18/2012

Understanding Thyroid Gland Surgery Options

There are several surgical pptions for the thyroid gland nodules, tumors and diseases. Which operation is performed on a thyroid gland depends upon two major factors:

1.    Thyroid disease present requiring surgery.

2.    Anatomy of the thyroid gland itself, tumor or nodule involved.

If a dominant solitary nodule is present in a single lobe, then removal of that lobe is the preferred operation (if an operation warranted).  

If a massive goiter is compressing the trachea and esophagus, the goal of surgery will be to remove the mass, and usually this means a sub-total or  total thyroidectomy (occasionally a lobectomy will suffice).

If a hot nodule is producing too much hormone resulting in hyperthyroidism, then removal of the lobe that harbors the hot nodule is all that is needed.

Most surgeons and endocrinologists recommend total or near total thyroidectomy in virtually all cases of thyroid carcinoma. In some patients with small papillary carcinomas, a less aggressive approach may be taken (lobectomy with removal of the isthmus).

A lymph node dissection within the anterior and lateral neck is indicated in patients with well differentiated (papillary or follicular) thyroid cancer if the lymph nodes can be palpated. This is a more extensive operation than is needed in the majority of thyroid cancer patients.

All patients with medullary carcinoma of the thyroid require total thyroidectomy and aggressive lymph node dissection.

Partial Thyroid Lobectomy: This operation is not performed very often because there are not many conditions which will allow this limited approach. Additionally, a benign lesion must be ideally located in the upper or lower portion of one lobe for this operation to be possible.

Thyroid Lobectomy: This is typically the "smallest" operation performed on the thyroid gland. It is performed for solitary dominant nodules, which may be thyroid cancer or those which are indeterminate following fine needle biopsy. This surgery may also be appropriate for follicular adenomas, solitary hot or cold nodules, or goiters which are isolated to one lobe (not common).

Thyroid Lobectomy with Isthmusectomy: This simply means removal of a thyroid lobe and the isthmus (the part that connects the 2 lobes). This removes more thyroid tissue than a simple lobectomy, and is used when a larger margin of tissue is needed to assure that the "problem" has been removed. Appropriate for those indications listed under thyroid lobectomy as well as for Hurthle cell tumors, and some very small and non-aggressive thyroid cancers.

Subtotal Thyroidectomy: Just as the name implies, this operation removes all the "problem" side of the gland as well as the isthmus and the majority of the opposite lobe. This operation is typical for small, non-aggressive thyroid cancers. Also a common operation for goiters that are causing problems in the neck or even those which extend into the chest (substernal goiters).

Total Thyroidectomy: This operation is designed to remove all of the thyroid gland. It is the operation of choice for all thyroid cancers which are not small and non-aggressive in young patients. Many surgeons prefer complete removal of thyroid tissue for all types of thyroid cancer.

Surgical Technique: The standard neck incision is made typically measuring about 4 to 5 inches in length, although many endocrine surgeons are now performing this operation through an incision as small as 3 inches in thin patients. This incision is made in the lower part of the central neck and usually heals very well. It is almost unheard of to have an infection or other problem with this wound. The surgeon will then typically remove part or all of the thyroid.

As mentioned above, for thyroid cancer, this will usually entail all of the thyroid lobe that harbors the malignancy, the isthmus, and a variable amount of the opposite lobe (ranging from 0% to 100%, depending on the size and aggressive nature of the cancer, the cancer type, and the experience of the surgeon).

The surgeon must be careful of the recurrent laryngeal nerves, which are very close to the back side of the thyroid and are responsible for movement of the vocal cords. Damage to this nerve will cause hoarseness of the voice, which is usually temporary but can be permanent. This is an uncommon complication (about 1% to 2% of patients experience this), but it is serious.

Your surgeon must also be careful to identify the parathyroid glands so their blood supply can be maintained. Another potential complication of thyroid surgery—although  rare—is hypoparathyroidism which is due to damage to all 4 parathyroid glands.  Usually the only thyroid operations that have even a slight chance of this complication is the total or subtotal thyroidectomy. 

Although the complications mentioned can be serious, their risk should not be the sole determinant of whether or not to undergo surgery. Often, formal thyroid surgery is not needed to determine if a thyroid mass is cancerous. Because these masses are often palpable, a pathologist  can usually stick a small needle into it to sample cells for malignancy. This is called fine needle aspiration (FNA) biopsy.

The relationship of the thyroid gland to the voice box and parathyroid glands in the image above can be seen quite clearly.  Remember that they share the same blood supply, so the surgeon must take care to preserve the parathyroid artery and vein while ligating the vessels to the thyroid gland itself. This is usually not a problem, but sometimes it is not possible to save them all. In this case, the surgeon will usually implant the parathyroid gland into a muscle in the neck. The parathyroid will re-grow and attach itself there and function normally.

Don't be afraid to ask questions if you don't understand something about your thyroid surgery and what your doctors expectations are for your case. Your surgeon should be able to talk you clearly about all your thyroid surgery options, including total thyroidectomy.

Diagnostic Testing for Thyroid Cancer Basics

The Following Diagnostic Tests and Procedures  that examine the thyroid, neck, and blood are used to detect (find) and diagnose thyroid cancer.

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or swelling in the neck, voice box, and lymph nodes, and anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

• Laryngoscopy: A procedure in which the doctor checks the larynx (voice box) with a mirror or with a laryngoscope. A laryngoscope is a thin, tube-like instrument with a light and a lens for viewing. A thyroid tumor may press on vocal cords. The laryngoscopy is done to see if the vocal cords are moving normally.

• Blood hormone studies: A procedure in which a blood sample is checked to measure the amounts of certain hormones released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. The blood may be checked for abnormal levels of thyroid-stimulating hormone (TSH). TSH is made by the pituitary gland in the brain. It stimulates the release of thyroid hormone and controls how fast follicular thyroid cells grow. The blood may also be checked for high levels of the hormone calcitonin.

• Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as calcium, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.

• Radioactive iodine scan (RAI scan): A procedure to find areas in the body where thyroid cancer cells may be dividing quickly. Radioactive iodine (RAI) is used because only thyroid cells take up iodine. A very small amount of RAI is swallowed, travels through the blood, and collects in thyroid tissue and thyroid cancer cells anywhere in the body. Abnormal thyroid cells take up less iodine than normal thyroid tissue. Areas that do not absorb the iodine normally (cold spots) show up lighter in the picture made by the scan. Cold spots can be either benign (not cancer) or malignant, so a biopsy is done to find out if they are cancer.

• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. This procedure can show the size of a thyroid tumor and whether it is solid or a fluid-filled cyst. Ultrasound may be used to guide a fine-needle aspiration biopsy.

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

• Fine-needle aspiration biopsy of the thyroid: The removal of thyroid tissue using a thin needle. The needle is inserted through the skin into the thyroid. Several tissue samples are removed from different parts of the thyroid. A pathologist views the tissue samples under a microscope to look for cancer cells. Because the type of thyroid cancer can be hard to diagnose, patients should ask to have biopsy samples checked by a pathologist who has experience diagnosing thyroid cancer.

• Surgical biopsy: The removal of the thyroid nodule or one lobe of the thyroid during surgery so the cells and tissues can be viewed under a microscope by a pathologist to check for signs of cancer. Because the type of thyroid cancer can be hard to diagnose, patients should ask to have biopsy samples checked by a pathologist who has experience diagnosing thyroid cancer.

MEDICAL REVIEW: 02/12/2012

Thyroid Cancer Facts and Stats 2012

As you know January is Thyroid Health Awareness Month and Stevie JoEllie's Cancer Care Fund is officially launching the 10,000 Strong Against Thyroid Cancer Campaign. Here is a list of the most common unknown facts about thyroid cancer you should learn  and talk to your family doctor about during your next visit.

Did you know? Thyroid cancer is the most common endocrine cancer. Thyroid cancer is a cancerous tumor or growth located within the thyroid gland.


Did you know? Thyroid cancer is one of the few cancers that has increased in incidence rates over recent years. It occurs in all age groups from children through seniors.

Did you know? The American Cancer Society estimates that there where about 48,020 new cases of thyroid cancer in the U.S. in 2011. Of these new cases, about 36,550 will occur in women and about 11,470 will occur in men. About 1,740 people (980 women and 760 men) will die of thyroid cancer in 2011.

Did you know? Many patients, especially in the early stages of thyroid cancer, do not experience symptoms. However, as the cancer develops, symptoms can include a lump or nodule in the front of the neck, hoarseness or difficulty speaking, swollen lymph nodes, difficulty swallowing or breathing, and pain in the throat or neck.

Did you know? There are several types of thyroid cancer: papillary, follicular, medullary, anaplastic, and variants.

• Papillary and follicular thyroid carcinomas are referred to as well-differentiated thyroid cancer and account for 80–90% of all thyroid cancers. Variants include tall cell, insular, columnar, and Hurthle cell. Their treatment and management are similar. If detected early, most papillary and follicular thyroid cancer can be treated successfully.

• Medullary thyroid carcinoma (MTC) accounts for 5-10% of all thyroid cancers. Medullary cancer is easier to treat and control if found before it spreads to other parts of the body. There are two types of medullary thyroid cancer: sporadic and familial. Genetic testing (of the RET proto-oncogene should be performed in all patients with MTC to determine whether there are genetic changes that predict the development of MTC. In individuals with these genetic changes, removal of the thyroid during childhood has a high probability of being curative.

• Anaplastic thyroid carcinoma is the least common and accounts for only 1–2% of all thyroid cancer. This type is difficult to control and treat because it is a very aggressive type of thyroid cancer.

Treatments for thyroid cancer include surgery, radioactive iodine treatment, external beam radiation therapy, and chemotherapy.  In most cases, patients undergo surgery to remove most of the thyroid gland, and are treated with thyroid hormone replacement therapy. For those with papillary and follicular thyroid cancer, the dose of thyroid hormone replacement is usually high enough to suppress thyroid stimulating hormone (TSH) well below the range that is normal for someone not diagnosed with thyroid cancer, to help prevent the growth of cancer cells while providing essential thyroid hormone to the body.


Factors associated with thyroid cancer include a family history of thyroid cancer, gender (women have a higher incidence of thyroid cancer), age (the majority of cases occur in people over 40, although thyroid cancer affects all age groups from children through seniors), and prior exposure of the thyroid gland to radiation. Like women childhood cancer survivors have an increased risk of developing the condition.


While the prognosis for most thyroid cancer patients is very good, the rate of recurrence can be up to 30%, and recurrences can occur even decades after the initial diagnosis. Therefore, it is important that patients get regular follow-up examinations to detect whether the cancer has re-emerged. Monitoring should continue throughout the patient’s lifetime.


Periodic follow-up examinations can include a review of the medical history together with selected blood tests appropriate for the type of cancer and stage of treatment (TSH, thyroglobulin, CEA, and calcitonin levels), physical examination, and imaging techniques (ultrasound, radioiodine whole body scan, chest X-ray, CT, MRI, PET, and other tests).

Stevie JoEllie's Cancer Care Fund  is a thyroid cancer awareness, access to care and free supportive services  project of United Charitable Programs Inc., a registered 501(c) 3 public charity. All donations are tax deductible as allowed by state and federal law. SJCCF  differs greatly from other thyroid cancer organizations  and awareness groups in that it's mission and objective is to alleviate the financial burden placed on patients and survivors of thyroid cancer, not research funding. To learn more about our volunteer opportunities please email info@sjccfthynet.org  subject line: volunteer opportunities

LAST UPDATED: January 2012

Body Temperature and Thyroid Problems

When your thyroid hormone is working properly inside cells you will make 65% energy and 35% heat as you burn calories for fuel. Thyroid hormone is governing your basal metabolic rate, orchestrating the idling speed at which all cells make energy and thus heat. A classic symptom of poor thyroid function is being too cold. And conversely, a classic symptom of hyperthyroidism is being too hot (making too much heat). However, many people with slow thyroid are too hot, a seeming paradox that I will explain shortly.

Generally, you know all too well if you fit into the too cold category. You always want the thermostat set higher than everyone else or you have on an extra layer of clothes. You go to bed with socks on your feet or you want extra layers of blankets. When this type of coldness matches up with the symptoms of thyroid-related fatigue, you fall into the classic pattern of sluggish or hypothyroid.

In many cases of poor thyroid function a cold feeling is not quite so obvious. Dr. Broda Barnes pioneered the use of the basal temperature test to help identify sluggish thyroid function. This is done by placing a thermometer (not digital) under your arm for ten minutes before getting out of bed. This should be done ten days in a row, averaging the daily reading. Menstruating women should start their ten day test when their menstrual cycle begins, as basal temperature naturally rises 2 degrees at ovulation. If your waking temperature averages from 97.8 to 98.2 degrees it is normal. Less than 97.8 reflects sluggish thyroid function.

It should be noted that there are other factors besides thyroid that can make a person run too cold. Common ones include:

A) Protein malnutrition that is resulting in a loss of muscle. Individuals with borderline thyroid should eat at least ½ their ideal weight in grams of protein per day (avoiding excessive intake of soy protein).

B) Nutrients lacking for cellular energy production (co-enzyme B vitamins, Q10, magnesium).

C) Nutrients lacking to implement cellular DNA thyroid instructions (iron or zinc).

D) Excessive stress, which pools blood around central organs and makes hands and feet cold. Anti-inflammatory nutrients are required to fix this, along with stress management. Fish oil and squalene are very helpful.

E) A viral infection, even a subclinical viral infection. Viruses hijack cellular energy production, shutting down energy and heat production, and making excess lactic acid. This leaves one feeling cold and achy from the lactic acid. This is why you get the chills from the flu. Many viruses, like Epstein-Barr or cytomegalovirus, can operate on a low grade basis – enough to make a person cold, tired, and achy. Such individuals often wake up with a sore throat in the morning. Monolaurin is a top choice for nutrient support.

These coldness issues can masquerade as thyroid problems, and in some cases may in fact be the primary cause of the hypothyroid symptoms. The proof of the source of the problem is in the solution. Whatever helps get energy on and temperature up is what is needed. Sometimes this means thyroid support nutrition. Sometimes it is addressing any issue in A-E above. And many times it is some combination of approaches, including thyroid support.

Many individuals with hypothyroid symptoms are not cold and may even be hot. Remember, normal cell energy production is 65% energy and 35% heat. In classic low thyroid both numbers drop. However, if thyroid hormone is still signaling cells to go, but cells lack nutrients to properly make energy, then a person may make 50% energy and 50% heat. If the problem worsens a person could make 35% energy and 65% heat (and lots of anxiety). Such a problem will present itself as low thyroid, but it is really a deficiency in energy-producing nutrients like co-enzyme B vitamins, Q10, magnesium, and antioxidants.

The most common reason for true low thyroid with excess heat occurs in the overweight individual. In this case the body is trying to dispose of surplus fat calories by converting them to 100% heat. Even though cells are not making adequate energy or heat, the heat is coming from the desperate attempt of the body to get rid of fat so it doesn’t clog organs, cells, and arteries. Eating according to the Leptin Diet solves this problem. Since excess heat produces too many free radicals, extra antioxidants are a good idea.

As thyroid problems deteriorate a person becomes both heat and cold intolerant. Hot humid days are stressful; frigid winter days are stressful. The body’s heat regulating system simply struggles to keep up with environmental demands, especially when they are more extreme. Aging is generally associated with deteriorating thyroid function and troubles regulating body temperature.

Understanding your body’s heating and cooling system is central to effectively managing thyroid health.

Faces of Thyroid Cancer: Patricia Stephens Due

Civil rights legend Patricia Stephens Due

Civil rights legend Patricia Stephens Due has died, according to the Tallahassee Democrat.

The 72-year-old, whom they called the Joan of Arc of the civil rights movement in Tallahassee, Fla., succumbed on Tuesday after a long fight with thyroid cancer. She died in Atlanta, where she had moved to to be closer to her three daughters.

During the civil rights era's peak in the 1960s, Due led demonstrations at segregated theaters and pools and conducted voter-registration drives. Her landmark moment was a "jail-in" at Florida A&M when she and eight other black students tried to integrate a Tallahassee lunch counter. When faced with paying a fine or going to jail, she chose the latter. Her courage attracted the attention of Martin Luther King Jr., who sent her a letter in jail. Her activism garnered her an FBI file that ran more than 400 pages.

A member of several civil rights organizations, Due went on to become the local field secretary for the Congress of Racial Equality.

"Patricia Stephens Due was the heart of the civil rights movement in Tallahassee,'” said author Glenda Rabby, whose book, The Pain and the Promise, details the Tallahassee civil rights movement. "Her bravery and lifetime commitment to the advancement of racial justice and equality is legendary in this community and in the annals of civil rights history."

Florida officials honored her contributions last year by naming May 11 Patricia Stephens Due Day in the state.

Throughout her life, Due wore dark glasses because her eyes became sensitive to light after a policeman threw a teargas bomb at her face in 1960. But despite her hampered vision, she kept fighting and saw the light at the end of the tunnel clearly. 

The same fight she gave cancer in her final two years is the same energy and strength she gave to the civil rights movement. She may never have received the media attention of Malcolm X, Rosa Parks or King, but one thing we can be assured of is that her legacy and her spirit will endure. May she rest in peace.

Read more at CNN.com.

Hyperthyroidism and Your Heart Health: What you should Know

In hyperthyroidism, caused by the overproduction of thyroid hormone, the heart muscle is "whipped" like a horse, and for a person with heart disease it's like whipping a tired horse. Thyroid hormone increases the force of contraction of, and the amount of oxygen demanded by, the heart muscle. It also increases the heart rate. For these reasons the work of the heart is greatly increased in hyperthyroidism. Hyperthyroidism increases the amount of nitric oxide in the lining of the blood vessels, causing them to dilate and become less stiff.

Cardiac symptoms of hyperthyroidism

Cardiac symptoms can be seen in anybody with hyperthyroidism, but can be particularly dangerous in people with underlying heart disease. Common symptoms include:

·         Fast heart rate (tachycardia) and palpitations. Occult hyperthyroidism is a common cause of an increased heart rate at rest and with mild exertion. Hyperthyroidism should always be ruled out with blood tests before making the diagnosis of Inappropriate Sinus Tachycardia. Especially in patients with underlying heart disease, hyperthyroidism can also produce a host of other arrhythmias such as Premature Ventricular Complex (PVC’s) ,  ventricular tachycardia and especially atrial fibrillation. Indeed, it is important to rule out hyperthyroidism in a patient with atrial fibrillation and no clear underlying cause.

·         Systolic hypertension. The forceful cardiac contraction increases the systolic blood pressure, though the increased relaxation in the blood vessels reduces the diastolic blood pressure.

·         Shortness of breath on exertion. This can be due to the skeletal muscle weakness cause by hyperthyroidism, or to a worsening in heart failure.

·         Heart failure. Hyperthyroidism itself can produce heart failure, but this condition is relatively rare. On the other hand, if pre-existing heart disease is present, worsening of heart failure with hyperthyroidism is common, and can be extremely difficult to treat.

·    Worsening angina. Patients with coronary artery disease often experience a marked worsening in symptoms with hyperthyroidism. These can include an increase in chest pain (angina) or even a heart attack.

As with hypothyroidism, hyperthyroidism can be present - and often is - without the classic, textbook symptoms. So patients with any of these cardiac symptoms that cannot otherwise be readily explained should have thyroid function measured. Furthermore, sometimes a "mild" hyperthyroidism can exist in which thyroid blood tests can be misinterpreted. In these cases thyroid hormone levels themselves are normal, but the level of thyroid stimulating hormone (TSH - a hormone excreted by the pituitary gland that regulates the thyroid gland) is low. 


A low TSH indicates hyperthyroidism, despite "normal" thyroid hormone levels. This pattern of thyroid blood tests especially ought to be sought in all patients displaying any of the above symptoms with no clear reason for them.

Treating hyperthyroidism

The "best" way of treating hyperthyroidism is controversial. In the U.S., most doctors immediately opt for ablating the overactive thyroid gland with radioactive iodine, then giving the patient thyroid hormone pills since the thyroid gland is no longer functional. This method is certainly "easiest" for the doctors, but often patients are left feeling chronically abnormal. Using drugs to partially suppress the thyroid gland - in the U. S., Tapazole or PTU - creates somewhat more of a long-term management issue for doctors, but may lead to ultimately happier patients.