Thyroid Cancer

"Since the presence of a thyroid nodule does not necessarily mean that the affected person has a thyroid cancer, the most important thing to confirm it is that the patient be examined by an interdisciplinary team".

DR. JUAN CARLOS GALOFRÉ FERRATER
SPECIALIST. THYROID DISEASE AREA

Thyroid cancer is the most common endocrine cancer although most tumors are curable by surgical treatment.

The main symptom of thyroid cancer is a lump in the neck. In the event of any irregularity, it is important to see a specialist, although in many cases the presence of this symptom does not imply the existence of a tumoural disease.

The Clinic has set up the Thyroid Cancer Committee with the aim of offering quality and personalized care from diagnosis to cure of the disease endorsed by the experience of the team of specialists.

We have been the first center in Spain to use robotic and endoscopic surgery in thyroid interventions from the armpit, without scarring in the neck.

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What are the symptoms of thyroid cancer?

Most thyroid cancers do not usually produce any symptoms. Occasionally, the main symptom noticed is a hard lump in the gland, that is, in the front part of the neck.

Other symptoms

  • Cervical nodes: Pain in the neck, jaw or ear.
  • If the cancer is large enough, it may cause difficulty swallowing, tickling in the throat, or difficulty breathing if it is pressing on the windpipe.
  • If the cancer irritates a nerve leading to the voice box, it may cause hoarseness.

Do you have any of these symptoms?

You may have thyroid cancer

Types of thyroid cancer

  • Papillary cancer. It is the most frequent, representing between 70% to 80% of all these cancers, although it is also the one with the best prognosis. If diagnosed early and with adequate treatment, complete cures are achieved in more than 90-95% of cases, despite its tendency to spread to the neck nodes.
  • Follicular cancer. It accounts for 10% to 15% of thyroid cancers. It also has a good prognosis, with complete cures being achieved in 70-80% of cases, although it has a greater tendency to metastasize to the lung and bones.
  • Medullary cancer. It is a rare cancer that has its origin in parafollicular cells. It can be part of a multiple endocrine neoplasia type 2 or develop spontaneously. It has a more complex prognosis than the previous ones.
  • Anaplastic or undifferentiated cancer. Its incidence is exceptional and, unfortunately, its prognosis is unfavorable. It generally affects older people and can appear as a result of the evolution of papillary and follicular cancers.
  • Thyroid lymphoma: This is a rare neoplasm. It originates in the cells of the thyroid immune system and grows very fast.

What are the risk factors for thyroid cancer?

  • Sex and age: it is more frequent in women between 30 and 50 years of age.
  • Radiation: patients who have received radiotherapy to the head or neck have a higher risk than the general population.
  • Genetic factors: in medullary carcinoma, there is a familial form that increases the predisposition to suffer it.
  • Diet poor in iodine: it favors the appearance of papillary and follicular thyroid cancer.

How is thyroid cancer diagnosed?

Imagen de Microscopía electrónica. Clínica Universidad de Navarra

At the Clínica Universidad de Navarra a diagnostic study is carried out when thyroid cancer is suspected, which is usually performed in 4 hours through the Fast Track protocol.

In the Endocrinology Department, a clinical history is taken and a detailed physical examination is performed. One of the diagnostic tests performed at the Clinic is thyroid ultrasound. It uses ultrasound and determines the size of the thyroid, whether there are nodules, their size and consistency and whether other areas of the neck are affected.

The definitive diagnosis of thyroid cancer is made by minimally invasive techniques: ultrasound with fine needle aspiration-puncture (FNA) for cytological study. It has high sensitivity and specificity to diagnose thyroid cancer subtypes and allows regional staging. It is also useful for the diagnosis of benign thyroid pathology and allows a preoperative assessment of thyroid lesions.

How is thyroid cancer treated?

In most cases, thyroid cancer is cured, with surgery being the main treatment. For this, it is necessary for the surgical team to have extensive experience. Surgery is adapted to the type of tumor. 

If the cytology is compatible with a papillary carcinoma, surgical treatment is recommended, the extent of which will depend on the involvement in each case and assessed in the diagnostic studies. The postoperative period is usually 48 hours. 

In cases in which the cytological study is indeterminate, a hemithyroidectomy is performed, removing the part of the thyroid in which the nodule is lodged. If the post-surgical result analyzed in Anatomical Pathology indicates that it is a carcinoma (which happens in 20-70% of cases), it is usually recommended to reintervene to complete the thyroidectomy.

After thyroid removal, the patient needs to take levothyroxine for life.

Treatment with Iodine-131 is used as an adjunct to surgery for the destruction of thyroid remnants or as the treatment of choice for involvement close to the resected area and at a distance (metastasis) of the carcinoma.

This treatment is carried out, in cases where it is indicated, approximately two months after surgery.

Iodine is eliminated mainly through the urine.

After 72 hours, a scintigraphy or whole body scan is performed to determine whether or not metastases are present.

After surgery it is necessary, in most cases, to complete the treatment with hormone therapy, chemotherapy and/or radiotherapy.

Hormone therapy: Administration of synthetic thyroid hormone to supplement the physiological function of the thyroid. It is applied after surgical removal of the thyroid or administration with radioactive iodine.

Chemotherapy: Only indicated if there is disseminated metastatic disease or other treatments have failed.

Radiotherapy: Sometimes for palliative purposes, to destroy tumor cells. It is applied in case of incomplete surgery, extension around the thyroid or lymph node involvement. It can also be administered in inoperable recurrences or those that do not respond to radioiodine. In addition, external irradiation is indicated as a palliative treatment to destroy tumor cells implanted in other locations.

At the Clinic, an individualized assessment of each patient's situation is made.

After the initial treatment (either surgery or radioiodine), the multidisciplinary team will decide the best therapeutic option following the indications of the latest international consensus.

The patient receives a report after each visit indicating the response to treatment (according to the dynamic risk staging), the follow-up objectives and a recommendation as to when the next check-up should be carried out.

In the event of recurrences, the physician in charge, in accordance with the indications of the multidisciplinary team, will advise on the best treatment options, adapting the therapeutic tools available to the patient's personal situation.

Where do we treat it?

IN NAVARRE AND MADRID

The Thyroid Pathology Area
of the Clínica Universidad de Navarra

The Thyroid Pathology Area is made up of a multidisciplinary team of specialists who work together to offer patients with thyroid problems an accurate diagnosis.

After the diagnosis, the patient is indicated the most appropriate treatment for his or her case and a continuous follow-up is carried out to achieve the desired objectives.

The Clinic is a pioneer in the implementation of medical techniques in Spain and worldwide, and is an international reference in highly specialized procedures.

Imagen de la fachada de consultas de la sede en Pamplona de la Clínica Universidad de Navarra

Why at the Clinica?

  • Prestigious professionals who are a national reference.
  • In 24-48 hours we make the diagnosis and we can start the most appropriate treatment for each patient.

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