Your Thyroid Gland: The Basics Review

The thyroid is an organ that is considered part of the endocrine, or hormone, system. It is located in the neck below the Adam's apple. The thyroid's main purpose is to produce thyroid hormones. These hormones then travel through the bloodstream to all the other tissues and organs to help control metabolism in adults and growth, development, and metabolism in children.

• The thyroid is shaped like a butterfly. The two "wings" of the butterfly are the right and left lobes of the thyroid, with lie on both sides of the trachea or main breathing tube. The connection between the wings is called the isthmus.
  
  
• The two hormones that the thyroid produces are L-thyroxine(T4) and tri-iodothyronine (T3).

• The thyroxine (T4) and tri-iodothyronine (T3) hormones regulate your body's metabolic functions such as heat generation, and the utilization of carbohydrates, proteins, and fats. In children, thyroid hormones are responsible for growth and development.
  
  
• Regulatory hormones from different parts of the brain control the thyroid's production of T4 and T3. In the pituitary gland, thyrotropin-stimulating hormone (TSH) is released when more thyroid hormone is needed and travels via the bloodstream to the thyroid gland. TSH then stimulates the thyroid to produce T4 and T3.
  
  
• The pituitary gland acts like a thermostat. When there is too much thyroid hormone in the bloodstream, the pituitary releases less TSH to signal the thyroid to produce less thyroid hormone. When there is too little thyroid hormone in the bloodstream, the pituitary releases more TSH to signal the thyroid to increase thyroid hormone production. Through this "feedback" system, the production of thyroid hormone is tightly controlled.

Thyroid Cancer Screening and Prevention

Thyroid cancer can often be found early. Most early thyroid cancers are found when patients ask their doctors about lumps or nodules they have noticed or when doctors find a lump during a routine checkup.

No blood tests are regularly recommended for early detection of sporadic (not familial or inherited) thyroid cancers. However, some doctors recommend that people examine their own neck twice a year to look for growths or lumps.

If you have a family history of medullary thyroid carcinoma (MTC) with or without type 2 multiple endocrine neoplasia (MEN 2), you could be at very high risk of thyroid cancer. If so, most doctors would recommend that you have genetic testing to find out if you carry the gene for MTC. This can be done by a simple blood test. 

Prevention

Most people with thyroid cancer have no known risk factors, so it is not possible to prevent most cases of this disease. Some doctors believe that the increase in thyroid cancers in recent years is due to x-ray testing of young children. This has not been proven, but it is a good idea for children to avoid x-rays that are not necessary.

Because of the genetic blood tests now available, most familial cases of medullary thyroid carcinoma (MTC) can be treated early or prevented. If you have a family history of MTC, you should see a doctor who is familiar with the latest advances in genetic counseling and genetic testing for this disease. The rest of your family (your brothers, sisters, and children) should also be tested to see if they also have mutation in the RET gene that causes MTC.

Almost all children and adults who have positive genetic tests results for the RET gene mutation will develop MTC at some time. To prevent MTC, most doctors recommend surgery as soon as possible, even in children. Removing the thyroid gland in people who carry the abnormal gene will prevent a cancer that might otherwise be fatal.

• Preventive (prophylactic) surgery - If you have inherited a defective RET gene, which can cause MTC in you and other family members, your doctor may recommend that your thyroid gland be removed by surgery (total thyroidectomy) even if it seems to be healthy. This eliminates the risk of MTC. However, it does not reduce the likelihood of adrenal or parathyroid tumors if you have multiple endocrine neoplasia, type II (MEN 2).

According to the Mayo Clinic, a healthy diet might be able to reduce your risk of thyroid cancer:

• A healthy diet - A diet high in fruits and vegetables and low in animal fat can reduce your risk of many types of cancer. The American Cancer Society recommends eating at least five servings of fruits and vegetables every day. They contain antioxidants, which protect your cells from damage. In addition, you should eat plenty of unsaturated fats (omega-3 fatty acids), especially those in salmon and other fish, because they may help protect against cancer. Keeping a healthy weight can also help protect against many diseases, including thyroid cancer.

If a nuclear power plant has an accident or is attacked, the resulting nuclear fallout could increase the risk of thyroid cancer in people living in the area. The U.S. government recommends that people who live within 10 miles of these plants store potassium iodide tablets just in case they need to protect themselves from the effects of nuclear fallout.

• Potassium iodide tablets - Potassium iodide protects your thyroid gland from iodine 131 (a component of nuclear fallout that can cause thyroid cancer) if you take it just before or right after you are exposed to nuclear fallout. However, potassium iodide does not protect you from other radioactive material. Children are most at risk from exposure to radioactive iodine, and potassium iodide is safe and effective for even very young children when they take the proper dosage.

This content has been reviewed and approved by Myo Thant, MD. 

Cancer Research Video: Using Mice Models to Fight Thyroid Cancer

Dr. Sheue-yann Cheng, Head of the Gene Regulation Section in the Laboratory of Molecular Biology, takes you into her lab where she researches the biology and molecular actions of thyroid hormone receptors in health and disease. Dr. Cheng uses mouse models to study resistance to thyroid hormone (RTH), a key step in cancer development. Watch and listen to Dr. Cheng's passion for uncovering possible molecular targets for the treatment of thyroid cancer. Learn more about Dr. Cheng's research at    http://ccr.cancer.gov/staff/staff.asp?profileid=5784

Recurrent Thyroid Cancer Treatment

If your thyroid cancer comes back (recurs) after you finish your original treatment, the treatment for the recurrence will depend on where the cancer comes back, the type of cancer you have, the treatment you had before, and your overall health.

If you did not have your thyroid removed when you received your treatment for cancer the first time, you might be treated with a total thyroidectomy.

• Total thyroidectomy - The surgeon removes the entire thyroid, and sometimes nearby lymph nodes, through an incision in the neck. In some rare cases, the surgeon also takes out other tissues in the neck that have been affected by the cancer.

If you already had a thyroidectomy, the doctor might do surgery to remove any cancer that you have still have.

Other treatment options are radioactive iodine and external beam radiation therapy.Radioactive iodine treatment can destroy cancer cells not removed by surgery and those that have spread beyond the thyroid.

• Radioactive iodine (radioiodine) - Radioiodine can destroy the rest of the thyroid gland and thyroid cancer (if the cancer takes up iodine) without affecting the rest of your body. Radioiodine is usually given as a capsule or in liquid form about 6 weeks after surgery. If you receive the usual dose, you will probably stay in the hospital for about 2 or 3 days while you are treated. If you receive a small dose, you will probably not have to stay in the hospital.

External beam radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. Most people are treated with EBRT for a few minutes 5 days a week for a few weeks or months as an outpatient.

Your doctor might also recommend chemotherapy, possibly in combination with radiation therapy. Chemotherapy drugs are used to kill cancer cells. Although there is no standard chemotherapy or combination of chemotherapy drugs, the following chemotherapies (alone or in combination) are sometimes used to treat recurrent thyroid cancer:

• Adriamycin^® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. Doxorubicin stops the growth of cancer cells, which kills them. This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer being treated. Your blood counts will be checked before each treatment; if they are too low, your treatment will be delayed.
• Blenoxane ^® (bleomycin) - Bleomycin belongs to the group of chemotherapy drugs known as antibiotics. Bleomycin interferes with cell division, which destroys the cells. Bleomycin is given by a shot into a vein, either over 10 minutes or as a continuous infusion for 24 hours, or as a shot into the muscle or under the skin. The dose is based on your size.
• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.

This content has been reviewed and approved by Myo Thant, MD. 

Updated: Thyroid Cancer Staging Guide

The stage of a cancer is a description (usually numbers I to IV with IV having more progression) of the extent the cancer has spread. The stage often takes into account the size of a tumor, how deeply it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasized to (if any), and whether it has spread to distant organs. Staging of cancer is the most important predictor of survival, and cancer treatment is primarily determined by staging. Thus, staging does not change with progression of the disease as it is used to assess prognosis. 

A patients' cancer, however, may be re-staged after treatment but the staging established at diagnosis is rarely changed. Cancer staging can be divided into a clinical stage and a pathologic stage. In the TNM (Tumor, Node, Metastasis) system, clinical stage and pathologic stage are denoted by a small "c" or "p" before the stage (e.g., cT3N1M0 or pT2N0).

• Clinical stage is based on all of the available information obtained before a surgery to remove the tumor. Thus, it may include information about the tumor obtained by physical examination, radiologic examination, and endoscopy.
• Pathologic stage adds additional information gained by examination of the tumor microscopically by a pathologist.

Because they use different criteria, clinical stage and pathologic stage often differ. Pathologic staging is usually considered the "better" or "truer" stage because it allows direct examination of the tumor and its spread, contrasted with clinical staging which is limited by the fact that the information is obtained by making indirect observations at a tumor which is still in the body. 

However, clinical staging and pathologic staging should complement each other. Not every tumor is treated surgically, therefore pathologic staging is not always available. Also, sometimes surgery is preceded by other treatments such as chemotherapy and radiation therapy which shrink the tumor, so the pathologic stage may underestimate the true stage. This staging system is used for most forms of cancer, except brain tumors and hematological malignancies. 

The American Joint Committee on Cancer (AJCC) created the following staging system for Thyroid Cancer Staging

• T1 - Tumor diameter 2 cm or smaller
• T2 - Primary tumor diameter greater than 2-4 cm
• T3 - Primary tumor diameter greater than 4 cm limited to the thyroid or with minimal extrathyroidal extension
• T4a - Tumor of any size extending beyond the thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve
• T4b - Tumor invades prevertebral fascia or encases carotid artery or mediastinal vessels
• TX - Primary tumor size unknown, but without extrathyroidal invasion
• NO - No metastatic nodes
• N1a - Metastases to level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes)
• N1b - Metastasis to unilateral, bilateral, contralateral cervical, or superior mediastinal mode metastases
• NX - Nodes not assessed at surgery
• MO - No distant metastases
• M1 - Distant metastases
• MX - Distant metastases not assessed

Stage I (any T, any N, M0)

Stage II (any T, any N, M1)


Author: Mark E Gerber, MD, FACS, FAAP  Clinical Assistant Professor of Otolaryngology, University of Chicago, Pritzker School of Medicine; Section Head, Pediatric Otolaryngology-Head and Neck Surgery, NorthShore University HealthSystem  


Co-Author: Brian Kip Reilly, MD  Assistant Professor of Otolaryngology and Pediatrics, Department of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine

Treatment for Anaplastic Thyroid Cancer

If your cancer is only in the neck, your doctor will probably recommend near-total or total thyroidectomy to reduce the symptoms caused by the cancer.

• Total thyroidectomy - The surgeon removes the entire thyroid, and sometimes nearby lymph nodes, through an incision in the neck. In some rare cases, the surgeon also takes out other tissues in the neck that have been affected by the cancer.

If you have anaplastic thyroid carcinoma, your doctor might recommend surgery to remove as much cancer as possible in the neck area. If the tumor is blocking your windpipe and making it hard for you to breathe, the doctor might perform a tracheotomy.

• Tracheotomy (tracheostomy) - The surgeon makes an opening in the trachea, or windpipe, and inserts a metal, plastic, or rubber tube to help you breathe. 

After surgery, you will be treated with thyroid hormone after surgery.

• Thyroid hormone replacement - These pills can give your body the natural thyroid hormone it can no longer make on its own. The generic name of the hormone is levothyroxine sodium. It is sold as Synthroid^®, Levoxyl^®, Levothroid^®, Unithroid^®, and other brand names.

You will probably be treated with external beam radiation therapy in addition to or instead of surgery. This treatment uses high-energy x-rays or other types of radiation to kill cancer cells. It is sometimes used to reduce the chance that the disease will come back (recur) in the neck.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. Most people are treated with EBRT for a few minutes 5 days a week for a few weeks or months as an outpatient.

You might also be treated with chemotherapy. Chemotherapy drugs are used to kill cancer cells. These drugs are used to destroy cancer that is still left after surgery, slow the tumor's growth, or reduce symptoms. Chemotherapy can help control any cancer that is left in the neck. It can also treat cancer that has spread (metastasized) outside the neck. Some of the chemotherapy drugs that might be used, either alone or in combination, are:

• Adriamycin^® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. Doxorubicin stops the growth of cancer cells, which kills them. This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer being treated. Your blood counts will be checked before each treatment; if they are too low, your treatment will be delayed.
• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.

This content has been reviewed and approved by Myo Thant, MD. 

Stage III through IV Medullary Thyroid Cancer Treatment

If you have Stage III or IV medullary thyroid carcinoma (MTC), you will probably be treated with total thyroidectomy. If your cancer has spread to the lymph nodes (tiny bean-shaped organs throughout the body that help fight infections), your doctor might recommend that you have a modified radical or radical neck dissection in addition to the thyroidectomy.

• Total thyroidectomy - The surgeon removes the entire thyroid, and sometimes nearby lymph nodes, through an incision in the neck. In some rare cases, the surgeon also takes out other tissues in the neck that have been affected by the cancer.
• Neck dissection - The surgeon removes lymph nodes in the front and side of the neck that may contain cancer. Neck dissection is sometimes the best way to prevent MTC from spreading or coming back after treatment (recurring).
• Modified radical - The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. However, the surgeon does not take out sections of muscle, nerve, and the large veins in the neck.
• Radical -  The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. The surgeon also takes out sections of muscle, nerve, and the large veins in the neck.

Regardless of the type of surgery you had, you will be treated with thyroid hormone after surgery.

• Thyroid hormone replacement - These pills can give your body the natural thyroid hormone it can no longer make on its own. The generic name of the hormone is levothyroxine sodium. It is sold as Synthroid^®, Levoxyl^®, Levothroid^®, Unithroid^®, and other brand names.

You will probably be treated with external beam radiation therapy, which uses high-energy x-rays or other types of radiation to kill cancer cells. It is often used in combination with chemotherapy.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. Most people are treated with EBRT for a few minutes 5 days a week for a few weeks or months as an outpatient.

Your doctor might also recommend chemotherapy, possibly in combination with radiation.  Chemotherapy drugs are used to kill cancer cells. They can sometimes reduce the symptoms of MTC. Although there is no standard chemotherapy or combination of chemotherapy drugs, the following chemotherapies (alone or in combination) are sometimes used to treat MTC:

• Adriamycin^® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. Doxorubicin stops the growth of cancer cells, which kills them.  This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer being treated. Your blood counts will be checked before each treatment; if they are too low, your treatment will be delayed.
• Adrucil ^® or Efudex ^® (5-fluorouracil or 5-FU) - 5-FU belongs to the group of chemotherapy drugs known as antimetabolites. 5-FU prevents cells from making DNA and RNA, which stops cells from growing. 5-FU is given as a shot in the vein over 5 to 10 minutes or 20 to 60 minutes, or continuously over 22 to 24 hours for 1 to 4 days or longer. The treatment can be repeated every week, every other week, or every 3 weeks. The dose depends on your size and blood counts.
• Blenoxane ^® (bleomycin) - Bleomycin belongs to the group of chemotherapy drugs known as antibiotics. Bleomycin interferes with cell division, which destroys the cells. Bleomycin is given by a shot into a vein, either over 10 minutes or as a continuous infusion for 24 hours, or as a shot into the muscle or under the skin. The dose is based on your size.
• Cytoxan ^® (cyclophosphamide) - Cyclophosphamide belongs to a group of chemotherapy drugs known as alkylating agents. It stops cancer cells from growing, which kills them. Cyclophosphamide can be given by mouth as a pill or liquid, or by a shot into a vein. The dose depends upon your size, your type of cancer, and your blood counts.
• DTIC-Dome ^® (dacarbazine) - Dacarbazine is a chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Dacarbazine is given by a shot in a vein over 20 minutes or longer. The dose and how often you get the medicine depend on your size, your blood counts, and the type of cancer being treated.
• Oncovin ^® (vincristine) - Vincristine belongs to the group of chemotherapy drugs known as plant (vinca) alkaloids. It stops cells from dividing, which kills them. Vincristine is given by an injection in a vein over 2 to 5 minutes. The dose and how often you get the medicine depend on your weight, how well your liver is working, and the type of cancer being treated.
• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.

This content has been reviewed and approved by Myo Thant, MD. 

Pediatric Thyroid Cancer Prognosis

Whereas the degree of invasion and metastases corresponds to prognosis in adults, this relationship is not seen in the pediatric population. In fact, the presence of lymph nodes does not affect the prognosis in children and adolescents. The reason for this is multifactorial and can be attributed to an overwhelming majority of well-differentiated cancers, low incidence of bone metastasis, and excellent response to RAI.

• Bone metastasis also has a low incidence in childhood thyroid cancers, occurring in less then 5% of patients.
• Individuals with radiation-induced thyroid cancer are at an increased risk for additional cancer later in life.

Pediatric patients have higher local and distant recurrence rates than adults, but they tend to respond rapidly to therapy. The prognosis is excellent in children, with mortality rates of less than 10%.

The overall 20-year survival rate is 92-100%.

Some studies report young age as the major determinant of recurrence in pediatric-differentiated thyroid carcinoma, which suggests a difference in tumor biology.

Rearrangements in the ret protooncogene have been observed in those exposed to radiation, with a reported ret rearrangement rate between 50 and 70%. Williams et al studied Chernobyl-induced thyroid tumor behavior and found that thyroid tumors associated with the ret and PTC3 oncogenes were more aggressive, faster growing, and less differentiated. Thyroid tumors with the ret/PTC1 oncogene had more benign characteristics and were slower growing.

Author: Mark E Gerber, MD, FACS, FAAP  Clinical Assistant Professor of Otolaryngology, University of Chicago, Pritzker School of Medicine; Section Head, Pediatric Otolaryngology-Head and Neck Surgery, NorthShore University HealthSystem  

Co-Author: Brian Kip Reilly, MD  Assistant Professor of Otolaryngology and Pediatrics, Department of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine 

Stage I and II Medullary Thyroid Cancer Treatment

If you have Stage I or II medullary thyroid carcinoma (MTC), you will  be treated with total thyroidectomy. If your cancer has spread to the lymph nodes (tiny bean-shaped organs throughout the body that help fight infections), your doctor might recommend that you have a modified radical or radical neck dissection in addition to the thyroidectomy.

• Total thyroidectomy - The surgeon removes the entire thyroid, and sometimes nearby lymph nodes, through an incision in the neck. In some rare cases, the surgeon also takes out other tissues in the neck that have been affected by the cancer.
• Neck dissection - The surgeon removes lymph nodes in the front and side of the neck that may contain cancer. Neck dissection is sometimes the best way to prevent MTC from spreading or coming back after treatment (recurring).
• Modified radical - The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. However, the surgeon does not take out sections of muscle, nerve, and the large veins in the neck.
• Radical -  The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. The surgeon also takes out sections of muscle, nerve, and the large veins in the neck.

Regardless of the type of surgery you had, you will be treated with thyroid hormone after surgery. However, if your doctor plans to treat you with radioactive iodine, you might not start taking thyroid hormone until after you finish your radioactive iodine treatments.

• Thyroid hormone replacement - These pills can give your body the natural thyroid hormone it can no longer make on its own. The generic name of the hormone is levothyroxine sodium. It is sold as Synthroid^®, Levoxyl^®, Levothroid^®, Unithroid^®, and other brand names.

Treatment for Follicular and Hurthle Cell Carcinomas

If you have Stage I to IV follicular or Hürthle cell carcinoma, you will probably be treated with total thyroidectomy. If your cancer has spread to the lymph nodes (tiny bean-shaped organs throughout the body that help fight infections), your doctor might recommend that you have a modified radical or radical neck dissection in addition to the thyroidectomy.

• Total thyroidectomy - The surgeon removes the entire thyroid, and sometimes nearby lymph nodes, through an incision in the neck. In some rare cases, the surgeon also takes out other tissues in the neck that have been affected by the cancer.
• Neck dissection - The surgeon removes lymph nodes in the front and side of the neck that may contain cancer.
• Modified radical - The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. However, the surgeon does not take out sections of muscle, nerve, and the large veins in the neck.
• Radical -  The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. The surgeon also takes out sections of muscle, nerve, and the large veins in the neck.

You will probably also be treated with radioactive iodine after the surgery. This treatment can destroy cancer cells not removed by surgery and those that have spread beyond the thyroid.

• Radioactive iodine (radioiodine) - Radioiodine can destroy the rest of the thyroid gland and thyroid cancer (if the cancer takes up iodine) without affecting the rest of your body. Radioiodine is usually given as a capsule or in liquid form about 6 weeks after surgery. If you receive the usual dose, you will probably stay in the hospital for about 2 or 3 days while you are treated. If you receive a small dose, you will probably not have to stay in the hospital.

If your metastases cannot be treated successfully with radioactive iodine, you might be treated with external beam radiation therapy, which uses high-energy x-rays or other types of radiation to kill cancer cells. It is sometimes used to reduce the chance that the disease will come back (recur) in the neck.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. Most people are treated with EBRT for a few minutes 5 days a week for a few weeks or months as an outpatient.

Regardless of the type of surgery you had, you will be treated with thyroid hormone after surgery. However, if your doctor plans to treat you with radioactive iodine, you might not start taking thyroid hormone until after you finish your radioactive iodine treatments.

• Thyroid hormone replacement - These pills can give your body the natural thyroid hormone it can no longer make on its own. The thyroid hormone pills can also slow down the growth of any cancer cells that are left in your body. The generic name of the hormone is levothyroxine sodium. It is sold as Synthroid^®, Levoxyl^®, Levothroid^®, Unithroid^®, and other brand names.

This content has been reviewed and approved by Myo Thant, MD. 

Stage II through IV Treatment for Papillary Thyroid Cancer

If you have Stage II to IV papillary carcinoma (advanced progression of disease), your surgery will probably be near-total (sub-total) or total thyroidectomy. Some doctors also recommend modified radical neck dissection to reduce the risk that your cancer will come back (recur) in the neck area and to help figure out the stage of your cancer. If your cancer has spread to other neck lymph nodes, you are likely to receive a radical neck dissection.

• Near-total (sub-total) thyroidectomy - This is the most common type of surgery for thyroid cancer. Because papillary thyroid cancer is often located in both left and right sides of the thyroid gland (multifocal), most surgeons will remove nearly all of the thyroid gland. However, the surgeon leaves small amounts of tissue around the parathyroid glands (which produce a hormone that helps the levels of calcium and phosphorus in the body) to reduce the risk of damage to these glands.
• Total thyroidectomy - The surgeon removes the entire thyroid, and sometimes nearby lymph nodes, through an incision in the neck. In some rare cases, the surgeon also takes out other tissues in the neck that have been affected by the cancer.
• Neck dissection - The surgeon removes lymph nodes in the front and side of the neck that may contain cancer.
• Modified radical - The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. However, the surgeon does not take out sections of muscle, nerve, and the large veins in the neck.
• Radical -  The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. The surgeon also takes out sections of muscle, nerve, and the large veins in the neck.

You will probably also be treated with radioactive iodine, which can destroy cancer cells not removed by surgery and those that have spread beyond the thyroid.

• Radioactive iodine (radioiodine) - Radioiodine can destroy the rest of the thyroid gland and thyroid cancer (if the cancer takes up iodine) without affecting the rest of your body. Radioiodine is usually given as a capsule or in liquid form about 6 weeks after surgery. If you receive the usual dose, you will probably stay in the hospital for about 2 or 3 days while you are treated. If you receive a small dose, you will probably not have to stay in the hospital.

If your metastases cannot be treated successfully with radioactive iodine, you might be treated with external beam radiation therapy, which uses high-energy x-rays or other types of radiation to kill cancer cells. It is sometimes used to reduce the chance that the disease will come back (recur) in the neck.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. Most people are treated with EBRT for a few minutes 5 days a week for a few weeks or months as an outpatient.

Regardless of the type of surgery you had, you will be treated with thyroid hormone after surgery. However, if your doctor plans to treat you with radioactive iodine, you might not start taking thyroid hormone until after you finish your radioactive iodine treatments. 

• Thyroid hormone replacement - These pills can give your body the natural thyroid hormone it can no longer make on its own. The thyroid hormone pills can also slow down the growth of any cancer cells that are left in your body. The generic name of the hormone is levothyroxine sodium. It is sold as Synthroid^®, Levoxyl^®, Levothroid^®, Unithroid^®, and other brand names.

This content has been reviewed and approved by Myo Thant, MD. 

Stage I Treatment for Papillary Thyroid Cancer

Surgery is the main treatment for Stage I papillary carcinoma (earliest possible stage of diagnosis). The cure rate with surgery alone is excellent.

Your surgeon might perform a lobectomy if your cancer is only in one lobe of your thyroid, the tumor is smaller than 1 centimeter (about ½ inch), and you have no signs of cancer in the lymph nodes (tiny bean-shaped organs throughout the body that help fight infections).

• Lobectomy - Lobectomy is the removal of only the affected side of the thyroid gland. If you have a papillary cancer that is smaller than 1 centimeter (about ½ inch) and there is no sign that it has spread beyond the thyroid gland, the surgeon may perform a lobectomy.

Your surgeon might perform a near-total (sub-total) thyroidectomy if your tumor is larger than 1 centimeter, it is growing outside the capsule that covers the thyroid gland, or it has spread to the lymph nodes.

• Near-total (sub-total) thyroidectomy - Because papillary thyroid cancer is often located in both left and right sides of the thyroid gland (multifocal), most surgeons will remove nearly all of the thyroid gland. However, the surgeon leaves small amounts of tissue around the parathyroid glands (which produce a hormone that helps the levels of calcium and phosphorus in the body) to reduce the risk of damage to these glands.

Some doctors recommend neck dissection in addition to lobectomy or near-total (sub-total) thyroidectomy. This treatment can reduce the risk that your cancer will come back (recur) in the neck area. It also makes it easier to figure out the stage of your cancer.  

• Modified radical neck dissection - The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone.

If you had a near-total (sub-total) thyroidectomy, especially if you are older than 45 or your tumor was larger than 1 centimeter, your doctor might recommend treatment with radioactive iodine. Radioactive iodine can destroy cancer cells not removed by surgery and those that have spread beyond the thyroid. This treatment is especially useful if you have a papillary cancer that is larger than 1.5 centimeters or has spread to the neck or other parts of the body. But it is not as effective for small cancers that are only located in the thyroid gland.

• Radioactive iodine (radioiodine) - Radioiodine can destroy the rest of the thyroid gland and thyroid cancer (if the cancer takes up iodine) without affecting the rest of your body. Radioiodine is usually given as a capsule or in liquid form about 6 weeks after surgery. If you receive the usual dose, you will probably stay in the hospital for about 2 or 3 days while you are treated. If you receive a small dose, you will probably not have to stay in the hospital.

Regardless of the type of surgery you had, you will be treated with thyroid hormone after surgery. However, if your doctor plans to treat you with radioactive iodine, you might not start taking thyroid hormone until after you finish your radioactive iodine treatments.

• Thyroid hormone replacement - These pills can give your body the natural thyroid hormone it can no longer make on its own. The thyroid hormone pills can also slow down the growth of any cancer cells that are left in your body. The generic name of the hormone is levothyroxine sodium. It is sold as Synthroid^®, Levoxyl^®, Levothroid^®, Unithroid^®, and other brand names.

This content has been reviewed and approved by Myo Thant, MD. 

Hormone Therapy for Thyroid Cancer

The thyroid gland makes a hormone (thyroid hormone) that helps control your heart rate, body temperature, and energy level. A gland in your brain (pituitary gland) constantly monitors the amount of thyroid hormone in your blood. 

If you do not have enough thyroid hormone, your pituitary releases extra thyroid-stimulating hormone (TSH), which tells your thyroid to absorb iodine from the blood and use it to make more thyroid hormone. Your thyroid gland then makes and releases the hormone directly into your bloodstream. Your pituitary gland senses that the right amount of thyroid hormone is moving through your body, so it slows its production of TSH back to normal.

After you have any kind of thyroid surgery, your body will no longer be able to make the thyroid hormone it needs. You will therefore need to take thyroid hormone replacement pills to give your body the natural thyroid hormone it can no longer make on its own. 

If you have follicular or papillary cancer, the thyroid hormone pills can also slow down the growth of any cancer cells that are left in your body. 

The generic name of the hormone is levothyroxine sodium. It is sold as Synthroid^®, Levoxyl^®, Levothroid^®, Unithroid^®, and other brand names.

This content has been reviewed and approved by Myo Thant, MD. 

Chemotherapy for Thyroid Cancer

Chemotherapy drugs are used to kill cancer cells. These drugs destroy cancer that is still left after surgery, slow the tumor's growth, or reduce symptoms.

Chemotherapy is not usually used to treat thyroid cancer. But certain chemotherapy drugs are useful in combination with external radiation beam therapy for anaplastic thyroid cancers. Chemotherapy is also used sometimes for thyroid cancers that have continued to grow after treatment with radioactive iodine or external beam radiation therapy. Some of the chemotherapy drugs that are used to treat thyroid cancer are listed below.

• Adriamycin^® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. Doxorubicin stops the growth of cancer cells, which kills them. This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer being treated. Your blood counts will be checked before each treatment; if they are too low, your treatment will be delayed.

• Adrucil ^® or Efudex ^® (5-fluorouracil or 5-FU) - 5-FU belongs to the group of chemotherapy drugs known as antimetabolites. 5-FU prevents cells from making DNA and RNA, which stops cells from growing. 5-FU is given as a shot in the vein over 5 to 10 minutes or 20 to 60 minutes, or continuously over 22 to 24 hours for 1 to 4 days or longer. The treatment can be repeated every week, every other week, or every 3 weeks. The dose depends on your size and blood count.

• Blenoxane ^® (bleomycin) - Bleomycin belongs to the group of chemotherapy drugs known as antibiotics. Bleomycin interferes with cell division, which destroys the cells. Bleomycin is given by a shot into a vein, either over 10 minutes or as a continuous infusion for 24 hours, or as a shot into the muscle or under the skin. The dose is based on your size.

• Cytoxan ^® (cyclophosphamide) - Cyclophosphamide belongs to a group of chemotherapy drugs known as alkylating agents. It stops cancer cells from growing, which kills them. Cyclophosphamide can be given by mouth as a pill or liquid, or by a shot into a vein. The dose depends on your size, your type of cancer, and blood count.

• DTIC-Dome ^® (dacarbazine) - Dacarbazine is a chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Dacarbazine is given by a shot in a vein over 20 minutes or longer. The dose and how often you get the medicine depend on your size, your blood counts, and the type of cancer being treated.

• Oncovin ^® (vincristine) - Vincristine belongs to the group of chemotherapy drugs known as plant (vinca) alkaloids. It stops cells from dividing, which kills them. Vincristine is given by an injection in a vein over 2 to 5 minutes. The dose and how often you get the medicine depend on your weight, how well your liver is working, and the type of cancer being treated.

• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.

• VePesid ^® or Etopophos ^® (etoposide) - Etoposide belongs to the class of chemotherapy drugs known as plant alkaloids. It stops cells from dividing, which kills them. Etoposide can be given by an injection in a vein over 30 to 60 minutes, or at higher doses over 1 to 4 hours. Etoposide can also be given by mouth as a capsule. The dose depends on your size, the type of cancer being treated, and your blood counts.

This content has been reviewed and approved by Myo Thant, MD. 

Radiation Therapy for Thyroid Cancer

Your thyroid gland absorbs nearly all of the iodine in your blood as part of its normal functioning. *Radioactive iodine can destroy cancer cells not removed by surgery and those that have spread beyond the thyroid. The cell takes up the iodine and the radiation in the iodine is released, delivering a lethal dose of radiation to the cancer cells. 

*This treatment is especially useful if you have a papillary or follicular cancer that is larger than 1.5 centimeters or has spread to the neck or other parts of the body. But it is not indicated for small cancers that are only located in the thyroid gland. It is not used for medullary or anaplastic thyroid cancers because these tumors do not take up iodine.

• Radioactive iodine (radioiodine) - Radioiodine can destroy the rest of the thyroid gland and thyroid cancer (if the cancer takes up iodine) without affecting the rest of your body. Radioiodine is usually given as a capsule or in liquid form about 6 weeks after surgery. If you receive the usual dose, you will probably stay in the hospital for about 2 or 3 days while you are treated. If you receive a small dose, you will probably not have to stay in the hospital.

External beam radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells. It is not used for thyroid cancers that take up iodine and can therefore be more effectively treated with radioiodine therapy. However, it is sometimes used to treat cancers that do not take up iodine (and therefore cannot be treated with radioactive iodine) and have spread beyond the thyroid capsule to reduce the chance that the disease will come back (recur) in the neck. In addition, radiation treatment is usually used to treat anaplastic thyroid cancer.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. Most people are treated with EBRT for a few minutes 5 days a week for a few weeks or months as an outpatient.

This content has been reviewed and approved by Myo Thant, MD. 

Surgery for Thyroid Cancer

Surgery is the main treatment for all types of thyroid cancer and is used in nearly every case, except anaplastic thyroid cancer. 

• Lobectomy - Lobectomy is the removal of only the affected side of the thyroid gland. If you have a papillary cancer that is smaller than 1 centimeter (about ½ inch) and there is no sign that it has spread beyond the thyroid gland, the surgeon may perform a lobectomy.

• Thyroidectomy - The surgeon removes most or all of the thyroid gland.

• Near-total (sub-total) - This is the most common type of surgery for thyroid cancer. Because papillary thyroid cancer is often located in both left and right sides of the thyroid gland (multifocal) and because follicular cancer is more aggressive, most surgeons will remove nearly all of the thyroid gland. However, the surgeon leaves small amounts of tissue around the parathyroid glands (which produce a hormone that helps control the levels of calcium and phosphorus in the body) to reduce the risk of damage to these glands.

• Total- The surgeon removes the entire thyroid, and sometimes nearby lymph nodes, through an incision in the neck. In some rare cases, the surgeon also takes out other tissues in the neck that have been affected by the cancer.

• Neck dissection - If you have a near-total (sub-total) or total thyroidectomy, your surgeon might also perform a neck dissection. The surgeon removes lymph nodes in the front and side of the neck that may contain cancer. Neck dissection is sometimes the best way to prevent medullary thyroid cancer (MTC) from spreading or coming back after treatment (recurring).

• Radical - The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. The surgeon also takes out sections of muscle, nerve, and the large veins in the neck.

• Modified radical - The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. However, the surgeon does not take out sections of muscle, nerve, and the large veins in the neck.

This content has been reviewed and approved by Myo Thant, MD. 

Thyroid Cancer Treatment Basics Update

Your stage of thyroid cancer  and your overall health will determine the method your doctor recommends for treating your illness. The mains ways of attacking thyroid cancer are surgery, radiation, chemotherapy (drugs), and thyroid hormone therapy.

Your doctor will work with you to choose the best treatment for your thyroid cancer based on:

• Your age, overall health, and medical history
• Type of thyroid cancer
• Extent of the disease
• Grade and stage of the cancer
• Your tolerance of specific medicines, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

All treatments have benefits and risks. You and your doctor should carefully balance the potential benefits of any cancer treatment with its potential risks. After the thyroid cancer is diagnosed and staged, your physician will recommend a treatment plan. 

Your treatment may include:

• Surgery - Surgery is the main treatment for all types of thyroid cancer and is used in almost every case, except anaplastic thyroid cancer. Doctors usually recommend surgery for thyroid cancer to remove the tumor and all or part of the remaining thyroid gland.

• Radioactive Iodine -  Your thyroid gland absorbs nearly all of the iodine in your blood. When a large enough dose of radioactive iodine (RAI), also known as I-131, is taken into the body, it can destroy the thyroid gland and any other thyroid cells (including cancer cells) that take up iodine, with little effect on the rest of your body. The radioactive iodine is usually given as a capsule or liquid. This treatment can be used to destroy (ablate) any thyroid tissue not removed by surgery or to treat thyroid cancer that has spread to lymph nodes and other parts of the body.

• Radiation therapy - Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors.

• Chemotherapy - Chemotherapy drugs are used to kill cancerous cells. In most cases, chemotherapy works by stopping cancer cells from growing or reproducing, which kills the cells. Different types of chemotherapy drugs work in different ways to kill cancer cells. Chemotherapy, often in combination with radiation therapy, is often used to treat anaplastic thyroid cancer, which is typically found too late for surgery. It is sometimes used to treat medullary thyroid cancer (MTC). But it is rarely helpful for other types of thyroid cancer.

• Thyroid hormone therapy - After you have thyroid surgery, your body will no longer be able to make the thyroid hormone it needs. You will therefore need to take thyroid hormone replacement pills to give your body the natural hormone that it cannot produce without a thyroid. Also, the thyroid pills slow down the growth of any papillary or follicular thyroid cancer cells that are still in your body, reducing the chance that these kinds of cancer will come back.

Support Stevie JoEllie's Cancer Care Fund: Shop Smart Do Good

WHAT: Great Fashion, Incredible Savings PLUS Financial Support for Stevie JoEllie's Cancer Care Fund!

WhERE: LORD and TAYLOR FASHION CENTER MALL, RIDGEWOOD, NJ 

WHEN: ALL DAY  Thursday, MARCH 29TH, 2012 

Exclusive Savings on Regular and Sale Priced Items Including your favorite cosmetics and fragrances, fashions and home goods.....

The best value for your dollar? Shop for the latest fashions at Lord & Taylor and support Thyroid Cancer Patients and Survivors through Stevie JoEllie's Cancer Care Fund programs and services at the same time. 

How does it work?

First, You purchase a special savings  pass for just $5 from Stevie JoEllie's Cancer Care Fund ...Your Pass can be purchased online here (You will find dropdown menu of local organizations) BE SURE TO CHOOSE Stevie JoEllie's Cancer Care Fund.

Next, bring your savings pass to Lord & Taylor at the Fashion Center in Ridgewood/Paramus on Thursday March 29, 2012 and be sure to drop off you admission stub at ballot boxes stationed at every store entrance.  These admission stubs will increase chances  Stevie JoEllie's Cancer Care Fund can win one of several contests for additional support and donations directly from Lord & Taylor.

What's in it for You?

• 
  

FUNDRAISING DAY - 25% Off Ladies' Sportswear, Dresses, Suits:

• This 25% coupon excludes ladies' intimate apparel, sleepwear and coats; Ugg, cosmetics, fragrances, beauty accessories; Smart Value items; charity-related merchandise; Beauty Salon, restaurants, store services and gift cards. Cannot be combined with any other offer. Not valid on Limited-Day prices; selected special sale events or prior purchases. Limit one item per Coupon. Bonus savings % applied to reduced prices. Not valid on telephone or internet orders. 

FUNDRAISING DAY - 25% Off  Almost everything for Men:

• This 25% coupon excludes Ugg, cosmetics, fragrances, beauty accessories & Smart Value items; charity-related merchandise; Beauty Salon, restaurants, store services and gift cards. Cannot be combined with any other offer. Not valid on Limited-Day Specials, selected special sale events or prior purchases. Limit one item per Coupon. Bonus savings % applied to reduced prices. Not valid on telephone or internet orders.

FUNDRAISING DAY - 20% Off  ANY ONE item:

• The 20% coupon excludes Ugg, cosmetics, fragrances and beauty accessories; diamond solitaire rings; Smart Value items; Beauty Salon, charity-related items, restaurants, store services and gift cards. Cannot be combined with any other offer, Not valid on Limited-Day Specials, selected special sale events or prior purchases. Limit one item per coupon. Bonus savings % applied to reduced prices. Not valid on telephone or internet orders. 

FUNDRAISING DAY - An additional 15% off throughout the day on the new Lord and Taylor HOME Store:

• The 15% Home Store Savings Pass excludes Furniture. Cannot be combined with any other offer. Not valid on Limited Day Specials, selected special sale events or prior purchases. Bonus savings % applied to reduced prices. Not valid on telephone or internet orders. 

FUNDRAISING DAY - 15% OFF throughout the day:

• The 15% savings pass excludes Ugg, Diamond solitaire rings; Smart Value items; charity-related merchandise, Beauty Salon, restaurants, store services and gift cards. Cannot be combined with any other offer. Not valid on Limited-Day Specials, selected special sale events or prior purchases. Bonus savings % applied to reduced prices. Not valid on telephone or internet orders. 

FUNDRAISING DAY - Get an  EXTRA 10% Off throughout the day using your Lord and Taylor Credit Card:

• The extra 10% with your L&T card *Excludes Coach, Juicy Couture, Merrell and Ugg; cosmetics, fragrances and beauty accessories; all Fine Watches, diamond solitaire rings; Smart Value items; selected special sale events; beauty salon, restaurants, store services and gift cards. Purchases subject to normal credit approval.

FUNDRAISING DAY - Don't have a Lord and Taylor Credit Card? Get and  EXTRA 15% Off throughout the day when opening a new Lord and Taylor Credit Account*:

• The extra 15% with your L&T card *Subject to normal credit approval. Excludes all Fine Watches, diamond solitaire rings, designer jewelry & special event promotions in Fine Jewelry; Smart Value items;  Limited-Day Specials, selected special sale events; L&T Outlet Store; Last Take Clearance Zone merchandise; Beauty Salon, restaurants, store services & gift cards.

• • Offer valid All Day Monday, March 29th  2012
• • • Lord and Taylor  Fashion Center Mall  Ridgewood, NJ
  PURCHASE YOUR SHOPPING PASS ONLINE TODAY 
  >>>click here<<<
  (You will find dropdown menu of local organizations) 
  
  
  PLEASE BE SURE TO CHOOSE 
  STEVIE JOELLIE'S CANCER CARE FUND
  
  
  THANK YOU!