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Thyroid Cancer

Thyroid cancer is three times more common in women than in men. Before doctors knew that the excessive use of radiation therapy in children increases the risk of thyroid cancer later in life, radiation was used to treat acne and to reduce swelling and infection in organs such as the thymus, tonsils and lymph nodes.

The Johns Hopkins Thyroid Tumor Center offers comprehensive treatment provided by a team of medical specialists. Patients may benefit from delicate surgery for thyroid cancer pioneered at Johns Hopkins. Physicians remove cancerous tumors without destroying the vocal cord nerves, thereby preserving speech. At Hopkins, the overall cure rate for thyroid cancer is better than 90 percent.

Diagnostic Tests

Most thyroid cancers are diagnosed by fine needle aspiration, considered by our physicians to be the premier tool for thyroid tumor diagnosis. Thyroid cancers have distinct "cell architecture" and can be identified by cytopathologists at the cell level without the need for larger pieces of tissue often obtained through traditional surgical biopsy. The fine needle test is more convenient for patients; it involves minimal discomfort. The results of the biopsy help physicians determine which tumors should be removed surgically and which can be observed without surgical treatment.

A technology called a DMSA scan is available at the Kimmel Cancer Center. For the approximately 10 to 15 percent of all thyroid cancer patients who have the particular form of thyroid cancer known as medullary thyroid cancer, the test can detect it throughout the body, so doctors can treat the most minute disease. For patients with the inherited forms of medullary thyroid cancer, a simple blood test can determine whether their children have inherited the disease.

Current Treatments

The Thyroid Tumor Center regularly brings together many specialists to plan the best treatment for each patient. Endocrinologists, endocrine surgeons, endocrine pathologists, cytopathologists, anesthesiologists (who specialize in difficult airway surgeries), radiation oncologists, otolaryngologists and specialized nurses review each case. The Thyroid Tumor Center offers timely and coordinated care. In one appointment, a patient with a thyroid nodule can:

  • be seen by an endocrine surgeon and endocrinologist;
  • have a fine needle aspiration of the tumor (the most accurate tool for thyroid disease diagnosis);
  • have an on-site review of the test to make sure the specimen is accurate;
  • meet with an anesthesiologist and, if necessary, be scheduled for surgery.

Surgery to remove the cancerous tumor without damaging the vocal cord nerves or parathyroid glands on either side of the thyroid was developed at Johns Hopkins. This is delicate surgery. If one vocal cord nerve is damaged, the result is hoarseness; if both are damaged, speaking and breathing are seriously affected. Studies have documented that the incidence of nerve injury is directly related to the surgeon's level of experience. Radiation oncologists at the Thyroid Tumor Center also have extensive experience in administering radioactive iodine therapy, a treatment to eliminate all remaining thyroid tumor cells, reducing the likelihood of recurrence.

New Treatment Approaches

Our researchers are working on techniques to address the evaluation of thyroid nodules that cannot be diagnosed with fine needle aspiration.

Follicular thyroid cancer continues to pose diagnostic challenges. Our physicians are working on fine needle tests for diagnosis before surgery. Currently, if the lump or nodule is found to be a follicular tumor, half the thyroid is removed and tested. If the results show the tumor is malignant, another surgery is performed to remove the rest of the thyroid. With better presurgical testing, doctors hope to operate only on known malignancies. New molecular tests focusing on a specific enzyme, telomerase, are under development.

Gene therapy has the potential to offer solutions where current treatments fall short. Like research for many diseases, our cancer center is pursuing gene therapy for thyroid cancer. One study is focused on finding a mechanism to stop metastatic cancers that spread to other parts of the body. Another study is investigating chromosomal abnormalities in thyroid cancers to see how the mutations may be linked to malignant forms of the disease. We also have significant research studies under way with the drugs Taxol and topotecan.

 

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