Thyroid Glands Cancer Symptoms

This article describes the symptoms that are associated with a potential thyroid cancer.  Thyroid cancer is rare and accounts for less than 1% of all cancers of men and women in the United States.  Non-cancerous disease of the thyroid is far more common than cancer.  Conditions such as Graves’ disease, Goiter, and Hashimoto’s thyroiditis are much more common than thyroid cancer.  The reason thyroid cancer deserves mention is because it is usually very treatable and often curable if detected within a reasonable amount of time.  The prognosis for thyroid cancer is much better than most other cancers except perhaps for non-melanoma skin cancers like basal cell skin cancer.

The thyroid gland plays a key role in regulation of metabolism and produces thyroid hormone.  The thyroid hormone is made from iodine and proteins.  The thyroid hormones are secreted in several forms and they have a long duration of action in the body.  While it is possible to have an overactive or underactive thyroid gland these are usually not associated with thyroid cancer.  The most common way thyroid cancer is discovered is through evaluation of a thyroid nodule.

There are several different kinds of thyroid cancer:

  • Papillary thyroid cancer (the most common thyroid cancer and has the best prognosis)
  • Follicular thyroid cancer
  • Hurthle cell cancer
  • Anaplastic Cancer
  • Lymphoma of the thyroid
  • Medullary thyroid cancer

These different kinds of thyroid cancers will cause a similar set of problems, with some being more severe such as medullary or anaplastic cancer.

Thyroid Nodule:  Felling a lump on the thyroid gland is abnormal and should not be ignored.  The average person may not be able to distinguish between a lump on the thyroid or an enlarged lymph node in the neck but both of these are abnormal and require the same level of investigation.  The thyroid gland is a shield shaped structure that sits in the front of the neck on top of the airway.  The name thyroid is derived from a Greek term for shield as it looks a bit like an ancient warrior’s shield.  A normal thyroid is about the size of a silver dollar and should feel smooth.  Excessive palpation of the thyroid gland may make it sore and is not recommended.  A nodule felt on the surface of the thyroid or a lump within the thyroid gland is abnormal and should be investigated.  Most thyroid nodules are not cancer.  Some of these will prove to be just cysts filled with fluid and not true tumors.  Nodules that feel very hard or fixed to underlying structures are more concerning.  A thyroid tumor with enlarged firm lymph nodes in the lateral neck is concerning for spread of a cancer to the lymph nodes.  When finding a nodule, it should not be ignored and should be brought to the attention of your doctor for further investigation.  This will usually involve an ultrasound to get more information about the nodule and possible a needle sampling of the cells within the nodule.  The cells can then be examined under the microscope to see if they are cancer or not.  This type of biopsy is not 100% accurate but can give valuable information and is the recommended way to start the investigation usually.

Goiter:  Enlargement of the thyroid gland or a tender swollen gland is synonymous with goiter.  People who live in an area with low iodine levels or who have dietary deficiencies can get huge goiters that look like grapefruits sittings in front of the neck.  A small percentage of these will have a small cancer within the goiter but most do not.  Usually the person also has low thyroid hormone levels as well.  This condition is known as hypothyroidism and is common with goiter.  There are several thyroid cancers that could simulate goiter.  Thyroid lymphoma may cause a diffuse firm enlargement of the thyroid gland.  Anaplastic thyroid cancer will cause a firm enlargement of the thyroid gland.  Goiter should not be ignored and should have a similar investigation as above including measurement of thyroid hormone levels.

Thyroid hormone disturbance:  The most common consideration for thyroid hormone levels with thyroid cancer arises after removal of all or part of the thyroid for treatment of a cancer.  Rarely, an overactive thyroid nodule may be cancerous.  Production of excessive amounts of thyroid hormone will cause weight loss, sweating, a jumpy and nervous feeling, rapid heart rate and bulging of the eyes.  This collection of symptoms is referred to as hyperthyroidism.  Low levels of thyroid hormone will cause weight gain, lethargy, a feeling of coldness and problems with the skin and hair.  This opposite effect is known as hypothyroidism.  Measurement of blood levels of thyroid hormones as well as the brain hormone TSH (thyroid stimulating hormone) is the most accurate way to establish thyroid hormone disturbance.  Knowledge of these seemingly unrelated symptoms may assist in recognition of one of these conditions.

After evaluation and diagnosis of thyroid cancer, the overall outlook is usually good.  Thyroid cancer is unusual in that age plays an important role in prognosis.  Older age makes for a worse prognosis.  The other unusual feature of common types of thyroid cancer is that spread to lymph nodes does not carry the same significance as other cancers.

REFERENCES:

  1. www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002193/
  2. www.cancer.gov/cancertopics/types/thyroid
  3. Townsend Jr, CM; Beauchamp RD; Evers BM; Mattox KL. (2008) Townsend: Sabiston Textbook of Surgery, 18th ed.  Chapter36 .  New York, NY: Saunders.
  4. Cameron JL; Cameron AM.  (2010) Cameron: Current Surgical Therapy, 10th ed. Chapter 602. Philadelphia, PA: Elsevier Saunders
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.