Ear, Nose, Throat, Head and Neck Surgery Specialist
Prof. Dr. Murat Topdağ

Born in Malatya in 1978, Murat Topdağ completed his primary and secondary education, then attended high school in Istanbul. He graduated from the English program of Cerrahpaşa Tıp Fakültesi. Prof. Dr. Murat Topdağ is married and has two children.

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What is thyroid cancer?

Thyroid cancer is a type of cancer that begins in the thyroid gland, located at the front of the neck, responsible for hormone production. The disease originates from the parenchymal cells of the thyroid. The rate of progression and aggressiveness vary. Thyroid cancer often progresses slowly; however, some types can be particularly aggressive. Its incidence is increasing worldwide, yet mortality rates remain stable. There are two main categories of thyroid cancer:

• Differentiated Thyroid Cancer (DTC): This group accounts for about 90–95% of thyroid cancers. Within DTC, there are three subtypes:
  • Papillary Thyroid Cancer (PTC)
  • Follicular Thyroid Cancer (FTC)
  • Hurthle Cell Carcinoma
• Medullary Thyroid Cancer (MTC): This type accounts for about 1–2% of thyroid cancers and originates from parafollicular or C cells.

Anaplastic thyroid carcinoma comprises less than 1% of thyroid cancers and is the most aggressive type. There are several new treatments for advanced thyroid cancer. A comprehensive understanding of thyroid cancer types and management strategies is essential for determining the most appropriate therapy. Therefore, accurate diagnosis and available treatment options must be carefully considered.

What causes thyroid cancer?

Various risk factors contribute to the development of thyroid cancer. One of the most common is goiter. Particularly in regions with widespread iodine deficiency, goiter incidence is higher.

Inflammations of the thyroid gland can also increase the risk of cancer. Such inflammation can sometimes progress silently and lead to severe consequences. Nodules in the thyroid carry the risk of turning into cancer. The size and number of these nodules matter.

Some of the key risk factors include:

1. Goiter and iodine deficiency
2. Thyroid inflammation
3. Presence and characteristics of thyroid nodules

Women are more likely than men to develop this disease. This gender disparity plays a significant role in risk assessment. Early diagnosis and appropriate treatment are effective in controlling thyroid cancer. Hence, regular health check-ups and awareness of risk factors are of great importance.

Symptoms of Thyroid Disorders

An abnormal enlargement of the thyroid gland, known as goiter, can show itself through various symptoms. The most obvious sign is usually a swelling in the neck region. This swelling can cause difficulty swallowing and breathing.

As the disease progresses, irritability and fatigue may increase, which impacts daily life quality. Additionally, an unbalanced thyroid can negatively affect the body’s metabolism, revealing itself through the following symptoms:

1. Weight gain,
2. Hair weakening and loss,
3. Dry and sensitive skin.

The negative effects of thyroid dysfunction extend beyond physical health and can affect overall well-being. Irregular thyroid function can also adversely influence other organ systems in the body.

Particularly, abnormal changes in blood cholesterol levels may be observed. Furthermore, there is an increased risk of osteoporosis and adverse effects on sexual health. These symptoms indicate that the thyroid is not functioning properly and should be considered for early diagnosis and treatment.

Stages of Thyroid Cancer

• Stage 0 (Tis): Cancer cells are identified as carcinoma in situ (CIS) and have not invaded deeper tissues. There is no spread outside the thyroid gland.
• Stage I: The tumor is 2 cm or smaller and has not spread beyond the thyroid gland. There is no spread to lymph nodes or other areas.
• T1a: The tumor is 1 cm or smaller, confined to the thyroid gland.
• T1b: The tumor is between 1 and 2 cm, confined to the thyroid gland.
• T1aN0M0: The tumor is 1 cm or smaller, no lymph node involvement, no distant metastasis.
• T1bN0M0: The tumor is 1–2 cm, no lymph node involvement, no distant metastasis.
• Stage II: The tumor is larger than 2 cm but smaller than 4 cm and remains within the thyroid gland. There is no distant spread, though lymph node involvement may be present.
• T2: The tumor is larger than 2 cm but smaller than 4 cm and may have grown beyond the thyroid gland.
• T3: The tumor is 4 cm or larger and/or has grown outside the thyroid gland.
• T1a/T1bN1aM0: The tumor is 1–2 cm and has spread to the central lymph nodes of the neck, no distant metastasis.
• T2N0M0: The tumor is larger than 2 cm but smaller than 4 cm, no lymph node involvement, no distant metastasis.
• Stage III: The tumor is 4 cm or larger or has grown outside the thyroid gland and has spread to nearby lymph nodes but not to distant sites.
• T3N0M0: The tumor is 4 cm or larger, has grown beyond the thyroid, no lymph node involvement, no distant metastasis.
• T4a/T4bN1aM0: The tumor may be any size, has extensively grown beyond the thyroid, and spread to the central lymph nodes of the neck, but there is no distant metastasis.
• Stage IV: The cancer has spread beyond the thyroid gland to distant parts of the body, such as the lungs, bones, or liver.
• T4a/T4b: The tumor may be any size and has invaded surrounding tissues or structures outside the thyroid gland.
• Any T N1bM0: The tumor may be any size, has spread to lymph nodes beyond the central neck area, but there is no distant metastasis.
• Any T Any N M1: The tumor may be any size and has metastasized to distant lymph nodes or other parts of the body.

Diagnosis and Monitoring Process

In diagnosing thyroid cancer, the first step is often a physical examination. Subsequently, blood tests are performed to measure thyroid hormone levels (T3, T4, TSH). A thyroid scan may also be used to evaluate the gland’s function. These methods can effectively diagnose smaller goiters.

When the thyroid gland enlarges, known as goiter, it can sometimes be felt as a lump in the throat. This condition is called nodulation, and if left untreated, it can progress. Approximately 5% of thyroid nodules may be cancerous, yet most patients diagnosed with thyroid cancer can lead normal lives.

If goiter is suspected, consulting an endocrinologist is recommended. The diagnosis process usually involves a multidisciplinary approach:

1. Ultrasound imaging by radiologists
2. Needle biopsy and pathological examination of the extracted tissue

If suspicion remains or a cancer diagnosis is confirmed, surgery is recommended. Surgery may also be advised for benign nodules that cause discomfort. This process is vital to monitor disease progression and carry out timely interventions when necessary.

Treatment Options for Thyroid Cancer

Thyroid cancer treatment varies depending on the type and stage of the disease. Typically, the first step is surgery, aiming to remove all cancerous thyroid tissue.

In total thyroidectomy, the entire thyroid gland is removed. After surgery, if microscopic cancer is present, thyroid hormone therapy is applied to maintain hormonal balance in the body.

Following surgical intervention, radioactive iodine therapy might be necessary in some cases, especially if the cancer has spread to the lymph nodes or extended beyond the thyroid capsule. Radioactive iodine kills cancer cells and reduces the risk of further spread. During follow-up, TSH and thyroglobulin levels are important for evaluating treatment efficacy and monitoring disease status.

Main thyroid cancer types and relevant treatments:

1. Papillary Type: As the most common thyroid cancer, papillary type is treated by removing the entire thyroid gland. If the tumor is larger than 10 mm or has spread to lymph nodes, radioactive iodine therapy is recommended.
2. Follicular Type: Surgery is also the mainstay of treatment for follicular cancer. Regardless of tumor size, if there is invasive cancer, radioactive iodine therapy is considered.
3. Medullary Type: This type can be hereditary and familial. The standard treatment is total thyroidectomy with lymph node dissection. Radioactive iodine therapy is not effective for this type.
4. Anaplastic Type: The most aggressive form of thyroid cancer. Surgery is often not feasible, and radiotherapy is used for palliative purposes.

Each type of thyroid cancer requires a specific treatment approach. Post-treatment follow-up is crucial to detect any recurrence early and ensure prompt intervention.

Recovery Process After Surgery

Recovery after thyroid cancer surgery requires careful follow-up. Patients may experience temporary throat and neck pain, difficulty swallowing, or hoarseness in the initial postoperative period. They may have restricted dietary intake for the remainder of the day, but typically resume their normal diet by the next day. Before being discharged, patients receive a follow-up appointment and instructions for home care, including information on prescribed medications.

• In most cases, patients can be discharged within one day.
• A leave of about two weeks from work is generally recommended.
• During the first three weeks after surgery, the following should be avoided:
  • Heavy lifting
  • Other physical tasks that place strain on the neck
• Getting the incision site wet or scrubbing it is not advisable for about a week, as it can impair wound healing.
• Usually, a shower can be taken the day after surgery.

Pain at the surgical site usually decreases within a few days but may last longer than a week in some cases. If a sudden neck swelling occurs, patients should contact their doctor immediately. There is also a risk of damage to the parathyroid glands, which can disrupt calcium levels. This may cause numbness or tingling in the fingers or around the mouth. Regular blood tests are performed to monitor calcium levels, and supplements are prescribed if needed.

Dietary and Lifestyle Adjustments Post-Surgery

Certain changes in diet and lifestyle are necessary following thyroid cancer surgery. Especially in the early days, paying attention to these factors can alleviate discomfort and speed recovery. Eating slowly is recommended to reduce swallowing difficulties and prevent any blockage in the throat. Increasing fluid intake can facilitate swallowing and benefit overall health. In the first weeks, the consumption of soft foods is advised, such as:

• Pureed vegetables
• Soft grains like oatmeal
• Soups and smoothies

These foods minimize throat irritation and make meals easier to swallow. A blender can be helpful in preparing solid foods.

F.A.Q.

Where does thyroid cancer spread?

Thyroid cancer, especially the follicular type, may spread to various parts of the body through the bloodstream. The most common sites for this spread are the lungs and bones.

Rarely, the brain and liver may also be at risk. The disease’s progression to these sites directly impacts treatment planning and prognosis. Therefore, early diagnosis and appropriate treatment options are crucial.

• The lungs and bones are the most common sites of metastasis.
• The brain and liver are less frequently affected.

Is thyroid cancer fatal?

Thyroid cancer causes concern for many people. However, thanks to modern medicine, the disease is treatable. Initially, thyroid cancer usually appears in the form of benign nodules, making early diagnosis vital.

Treatment methods such as surgery, radioactive iodine, and hormone therapy are effective in controlling the disease.

With regular follow-up and appropriate treatment, the majority of patients with thyroid cancer can lead a normal life. Hence, thyroid cancer is regarded as treatable rather than invariably fatal, offering hope for patients.

Which department/doctor should I see for thyroid cancer?

Individuals diagnosed with thyroid cancer should first consult the General Surgery department. Following a thorough examination and necessary tests, the general surgeon will decide on the next steps.

If needed, the patient may be referred to the Ear, Nose, and Throat (ENT) and Endocrinology departments. A multidisciplinary approach is essential in thyroid cancer treatment, allowing these three departments to work closely together for a comprehensive assessment and a tailored treatment plan.

Is thyroid cancer genetic or contagious?

Thyroid cancer is not contagious between individuals. However, genetic factors can play a crucial role in the development of the disease. Research shows that certain genetic mutations increase the risk of thyroid cancer. At the same time, environmental factors can also be significant, especially:

• Inadequate iodine intake
• Exposure to high levels of radiation

These factors, combined with a genetic predisposition, can further heighten the risk of cancer. Consequently, both genetic and environmental elements are important in understanding thyroid cancer.

What happens if thyroid cancer is left untreated?

Thyroid cancer can be successfully treated if diagnosed and addressed early. If it remains untreated, cancer cells can spread from the thyroid gland to surrounding tissues in the neck and eventually travel through the bloodstream to distant organs, particularly the lungs and bones.

This progression makes treatment more complicated and can significantly reduce the patient’s lifespan. Therefore, early diagnosis and treatment are vital for improving recovery outcomes.

Does thyroid cancer heal on its own?

Thyroid cancer does not resolve spontaneously. It arises due to abnormal cell growth in the thyroid gland, requiring proper diagnosis and targeted therapy. The most common treatment methods include:

• Surgery
• Radioactive iodine therapy
• Hormone therapy
• Radiotherapy

Early-stage detection greatly increases the likelihood of successful treatment. Hence, regular health check-ups and attentiveness to symptoms are paramount.

At what ages does thyroid cancer occur?

Thyroid cancer can occur at any age, though it most commonly appears between 30 and 50. This type of cancer, particularly the papillary form, generally has a slow progression and a favorable prognosis.

Its spread to the lymph nodes does not pose as significant a concern compared to other cancers, meaning it typically does not drastically affect treatment outcomes or life expectancy.

Hence, thyroid cancer often follows a more positive course than other cancers, and early diagnosis plus appropriate treatment can result in a long and healthy life.

Does thyroid cancer completely heal?

When detected early, thyroid cancer often responds well to treatment. Early diagnosis reduces the risk of cancer spreading and increases the likelihood of successful therapy. The type and stage of cancer determine the most suitable treatment methods.

However, in many instances, if identified early, thyroid cancer can be successfully managed with an appropriate treatment plan, allowing patients to maintain their quality of life. Statistics consistently highlight the importance of early detection.

Regular follow-up after treatment helps reduce the risk of recurrence and monitors the patient’s health status. Therefore, through early diagnosis and effective treatment, patients can sustain a healthy life.

When is thyroid cancer dangerous?

Certain conditions make thyroid cancer, particularly the follicular type, more dangerous. It generally occurs more frequently in women over 50. Follicular thyroid cancer has a less favorable prognosis compared to papillary thyroid cancer.

Its risk increases especially when there is distant organ metastasis or vascular invasion.

Still, if the follicular tumor possesses only one of these characteristics, it is considered lower risk. Thus, individuals over 50 require closer observation and follow-up for this type of cancer.

Hence, the presence of risk factors and the degree of spread guide treatment decisions and monitoring strategies. Under such circumstances, follicular thyroid cancer can become a serious health concern.

Is chemotherapy used for thyroid cancer?

Chemotherapy for thyroid cancer is considered only in certain circumstances. It may be used when other treatments are insufficient or the cancer has aggressively spread to other organs.

Chemotherapy uses powerful drugs to target and destroy cancer cells, helping to control disease progression in metastatic thyroid cancer.

Generally, the main treatments for thyroid cancer include surgery and radioactive iodine therapy. The ultimate decision depends on the patient’s overall health and the specific characteristics of the cancer.

Is there a chance of survival in stage 4 thyroid cancer?

Stage 4 thyroid cancer does not necessarily mean there is no chance of survival. For advanced papillary, follicular, and medullary thyroid cancers, survival rates are about 51%, 50%, and 28% respectively. Anaplastic thyroid cancer is known to be the most aggressive, with a survival rate of about 7% at stage 4. Thus, the prognosis varies significantly depending on the cancer type.

Observing images of thyroid cancer patients to self-diagnose can be misleading. In case of any doubt, consult a specialist.