Thyroid Cancer: What Women Should Know
The symptoms start slowly. Fatigue is the most common. There might be changes in hair, nails or skin, and other vague complaints that could be caused by aging, diet, stress or dozens of other factors.
Women in the prime of their lives, busy with work and families, may not even notice. When a doctor finally diagnoses an underactive thyroid due to cancer, it often comes as a shock.
Jonathon Russell, M.D., assistant professor of Otolaryngology – Head and Neck Surgery at The Johns Hopkins Hospital, says, “Typical thyroid cancer patients are women between the ages of 30 and 60—younger than many people would think. They’re likely to put off getting seen by a doctor and may blame their symptoms on other causes.”
Thyroid Cancer: Common in Women
Thyroid disorders are more common in women, probably due to the roles of hormones, which are different in females than in males.
Thyroid nodules (growths), Russell says, affect up to 80 percent of women, but only 5 percent to 15 percent of those lumps and bumps are malignant. Better testing means thyroid tumors are on the rise, he notes, saying that it’s projected to become the third most common cancer.
“Malignant” and “cancer” are scary words, but Russell says that most thyroid cancer is highly treatable, even when the cancer cells spread to nearby lymph nodes, which occurs frequently.
“With thyroid cancer we talk about prognosis in terms of 20-year survival instead of five years, as we do with most other cancers. It’s usually a slow-moving disease. There’s a 98 to 99 percent survival rate at 20 years,” he says.
“We treat it almost like a chronic condition where the patient gets treatment and visits her doctor regularly for follow-up.”
Diagnosing Thyroid Cancer
If a woman notices a lump in the base of her neck, or if a doctor notices a lesion on the thyroid on an X-ray or CT, the next diagnostic test is usually lab work, followed by an ultrasound, which Russell says provides a lot of information on the nodule.
Doctors may recommend watchful observation of small nodules. Larger growths may be tested with fine-needle aspiration, in which the doctor collects a sample of cells from the nodule with a needle and looks at them under a microscope.
Russell says that about 70 percent of nodule biopsies will show that the nodule is benign. Another 25 percent of biopsies are inconclusive, and the remaining 5 percent show that cancer is present.
Treatment for Thyroid Cancer
Surgery to remove the thyroid and any affected lymph nodes is the preferred treatment. Afterward, the patient will take thyroid hormones to cover the loss of the gland and radioactive iodine to treat any remaining cancer cells.
Traditional surgical removal of the thyroid gland, or thyroidectomy, leaves a prominent scar on the front of the neck. Russell notes that some thyroid cancer survivors are fine with their thyroidectomy scar and regard it as a badge of honor.
But plenty of patients don’t want the constant reminder of cancer surgery each time they look in the mirror. Or they don’t necessarily want a scar to be the first thing a stranger notices. “They say ‘It’s my business that I had a problem with my thyroid,’” Russell says.
Russell offers patients the option of a scarless thyroidectomy, in which the surgeon reaches the thyroid gland and removes it through the mouth, so there’s no cutting or scarring of the neck.
Though initially skeptical about the novel approach, Russell studied the technique in Thailand and saw that scarless thyroidectomy could be a valuable alternative to a traditional approach. Now Russell’s clinic is a leader in performing scarless thyroidectomies and trains surgeons from all over the world.
Working on Recovery
Even after successful surgery, recovery takes time, and some patients need weeks off of work. The body needs to adjust to the thyroid medication that’s replacing the hormone no longer provided by the now-absent thyroid.
His advice to women is to find a doctor who listens. “Women who have had thyroid problems can feel frustrated. They know something is wrong, and want to be taken seriously. At the busiest time in their lives, they want to regain their health and their energy.
“They’re looking to us for solutions, and the science is catching up, with better diagnosis and options for treatment.”
Webinar: Thyroid Disease, an Often Surprising Diagnosis
Join endocrinologist Paul Ladenson, M.D., as he outlines the signs and symptoms of the various thyroid disorders and discusses the interplay among other diseases and the thyroid. The webinar recording is presented as part of A Woman’s Journey Conversations That Matter webinar series.