Thyroid Polyps vs Thyroid cancer

What is the screening process and when to worry

Typically, celebrities get fan mail and social media messages about their behavior, fashion sense, or lack of thereof. It’s definitely strange when a fan urges a celebrity to get their thyroid checked due to a large neck, or an unusual lump noticed during a television show. These strange requests from keen eyed fans have actually led to a diagnosis of thyroid cancer, and due to early detection, saved a life.

Thyroid cancer is the most rapidly increasing cancer in the west. In 2013, the incidence rate of thyroid cancer in the United States was 15.3 cases per 100 000 persons. Faster than any other cancer, thyroid detection has increased by 4.5% per year over the last 10 years. 

It’s Shaped Like A Butterfly

Located near the larynx and in front of the trachea, the thyroid is a small butterfly shaped gland. Two hormones are secreted by this gland which affects heart rate, body temperature, and many body processes that regulate metabolism. When the thyroid is not functioning correctly or is secreting too less or too many hormones, various abnormalities such as lumps, nodules and edema in the neck can occur. 

Thyroid Nodules

A thyroid nodule is a solid fluid filled lump. It’s caused by abnormal cells found on the thyroid gland. A patient may notice a thyroid nodule by noticing a lump in their neck while looking on the mirror or buttoning up their shirt. Many times, there are no symptoms, and someone else may notice a neck deformity and bring it to the patients attention, much like the television celebrities. Rarely does a thyroid nodule cause pain but can cause hoarseness or a tickle in the throat if the nodule is too close to the windpipe. 

Ninety percent of thyroid nodules found are considered to be benign (noncancerous). A small percentage do contain cancer causing cells. Most thyroid nodules need to be checked out by a healthcare practitioner. If aggressive thyroid nodules are left untreated, they will grow over time, metastasize (most often to the lymph nodes and lungs), and can ultimately result in death. The natural history varies by the three types of thyroid cancer: differentiated, medullary, and anaplastic.

Thyroid nodules generally don’t cause any symptoms. Thyroid tests are most typically normal even when cancer is present in the neck. The best way to detect a thyroid nodule is to have a healthcare practitioner check your neck. 

Types of Thyroid Cancer

There are 3 types different types of thyroid cancer: papillary thyroid cancer, follicular thyroid cancer and medullary thyroid cancer. 

Most thyroid cancers are papillary in origin and are both small and localized. Patients with these small localized papillary thyroid cancers have a 99% survival rate at 20 years. Papillary thyroid cancer can be caused by radiation therapy. These types of thyroid cancers are treated aggressively.

Follicular thyroid cancer is the second most common type of thyroid cancer, making up about 10 to up to 15% of all thyroid cancers. It’s also considered to be well differentiated like papillary thyroid cancer but is more malignant (aggressive). Follicular thyroid cancer is seen in an older papulation only rarely after radiation exposure. 

Medullary thyroid cancer also knows as medullary thyroid carcinoma. About 1/3 of patients with medullary thyroid cancer have a family history of a thyroid cancer have a family history of a thyroid cancer. Individuals with the inherited form of medullary cancer may not know that they inherited the type of cancer for many reasons. They may not know their effected relatives or they may be the first individual in their family to contract the cancer. Typically, medullary thyroid cancer starts within the thyroid as growth or bump (nodule) in the thyroid that grows out of the otherwise normal thyroid tissue. It’s most commonly diagnosed as a lump in the neck. 

Screening For Thyroid Cancer

Being on television is not the conventional way to diagnose thyroid cancer. A person may first notice a lump or neck swelling which makes them seek help from their healthcare provider. Palpable thyroid nodules are common, occurring in approximately 5 percent of U.S. adults age 50 years and older when screened by palpation. 

Although the USPSTF, (U.S. Preventative Services Task Force) recommends against screening in the general asymptomatic adult population, several factors substantially increase the risk for thyroid cancer, including a history of radiation exposure to the head and neck as a child, exposure to radioactive fallout, family history of thyroid cancer in a first-degree relative, and certain genetic conditions, such as familial medullary thyroid cancer or multiple endocrine neoplasia syndrome (type 2A or 2B). The American Cancer Society does not specifically recommend screening for thyroid cancer using neck palpation or any other method. 

Other thyroid cancers are found on a routine checkup. Imaging tests such as ultrasounds and CT scans are also able to diagnose thyroid cancers early on. Blood tests can find changes in the thyroid. They are not recommended to screen for thyroid cancer unless there is a family history. 

Medullary thyroid cancer has a clear genetic link and runs in families. Genetic testing is also recommended for all family members. For non-medullary thyroid cancer, an individual is considered to have a familial form of the cancer if he or she and two first-degree relatives have this diagnosis. 

A biopsy of the thyroid with ultrasound imaging to guide the needle is another method used diagnose thyroid cancer. A fine needle is inserted into thyroid to aspirate suspicious tissue. The tissue is then sent to the lab to be studied for abnormal cell growth. 

When To Worry

Any abnormality, swelling, throat hoarseness and or lump noted in the neck region should be examined by a healthcare professional as soon as it is detected. The celebrities on television who alerted by their fans to get their thyroid checked due to an abnormal lump were told by their previous healthcare practitioners that the lumps were benign. After being alerted by their fans, they sought a second onion and found out that their lumps were indeed cancerous. It’s safe to say to frequently get lumps checked especially if swelling continues and also to get a second opinion when necessary. 

References

 https://www.thyroid.org/patient-thyroid-information/ct-for-patients/november-2017/vol-10-issue-11-p-12-13/

https://www.heraldtribune.com/news/20190409/how-tv-stars-found-out-they-had-cancer-from-sharp-eyed-viewers/2

https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/thyroid-cancer-screening1

https://www.ncbi.nlm.nih.gov/books/NBK447371/

https://jamanetwork.com/journals/jama/fullarticle/2625325

https://www.cancer.org/cancer/thyroid-cancer/detection-diagnosis-staging/detection.html

https://www.thyroid.org/thyroid-nodules/

https://www.ncbi.nlm.nih.gov/pubmed/24935445

https://www.thyroidcancer.com/thyroid-cancer/follicular

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