Thyroid Cancer

• Gerard M. Doherty, MD
  Surgeon-in-Chief, Brigham and Women's Hospital & Dana-Farber Cancer Institute
  Crowley Family Distinguished Chair, Department of Surgery, Brigham and Women's Hospital
  Moseley Professor of Surgery, Harvard Medical School
• Nancy L. Cho, MD
• Matthew Nehs, MD

There are several types of thyroid cancer:

• Papillary thyroid cancer is the most common form of thyroid cancer, accounting for about 80 percent of all cases. It affects more women than men.
• Follicular thyroid cancer accounts for roughly 10 percent of thyroid cancer cases. It is more aggressive and tends to spread through the bloodstream to other parts of the body. Still, the prognosis (outlook) is very good in most cases.
• Anaplastic thyroid cancer occurs most often among women and accounts for about two percent of thyroid cancer cases. This quick-growing cancer usually results in a large growth in the neck. It often arises in previously undiagnosed cases of papillary or follicular cancer. It has often spread to other parts of the body by the time it is found and is hard to treat effectively.
• Medullary thyroid cancer accounts for about four percent of thyroid cancers. It tends to spread through the lymphatic system and the bloodstream to other parts of the body, producing excessive amounts of the hormone calcitonin. It often has a genetic basis, and can be screened for with a blood test. This disease is curable only by surgery, and the initial surgery should be aggressive.
• Lymphoma is highly treatable with chemotherapy and radiation.

Learn more about the specific types of thyroid tumors and cancer.

Researchers have found risk factors that make you more likely to develop thyroid cancer. These include:

• Aged 25 to 65
• Female
• Family history of thyroid cancer
• History of colon growths
• Goiter
• Iodine deficiency
• Radiation exposure

Learn if you are at risk for thyroid cancer.

These are the most common symptoms of thyroid cancer:

• A lump or swelling over your thyroid or elsewhere in your neck
• A persistent cough, without symptoms of a cold
• Hoarseness or other changes in your voice that are persistent
• Neck pain, especially in the front of your neck that can radiate up to your ears
• Swollen lymph nodes
• Swollen neck
• Trouble breathing that feels like you are breathing through a straw
• Trouble swallowing

Your endocrine surgeon may conduct the following tests to diagnose thyroid cancer:

• Neck exam
• Ultrasound
• Biopsy
• Blood Tests
• Thyroid Scan

Learn more about the above diagnostic tests and procedures for thyroid cancer.

Thyroid cancer presents differently in each person. Your doctor uses staging tests, such as imaging scans and biopsies, to determine if and how far it has spread. With the results of these studies, your doctor will assign your cancer a stage.

The stage of cancer is based on the size of a cancerous tumor at the time of diagnosis and whether or not the cancer has spread to lymph nodes or to other organs. The first area cancer is found in the body is called the primary site or primary tumor. Cancer that has spread to distant parts of the body is called metastatic.

Read a summary of the stages for different types of thyroid cancer.

Your endocrine surgeon will determine your treatment plan based on the type of thyroid cancer you have and if it has spread. The majority of thyroid cancers are slow to grow and to metastasize, but there are thyroid cancer types that can be very aggressive. Your doctor will treat these differently. Your doctor will also consider your age, your health, the size and location of your tumor, and other factors.

In general, there are three elements to the treatment of a thyroid cancer:

• Surgical removal of the thyroid and involved lymph nodes
• Thyroid hormone replacement after surgery
• Radioactive iodine to ablate remnants of remaining thyroid tissue several months after surgery.

Surgical Treatment

Surgery is the first and main treatment for most thyroid cancers. Your endocrine surgeon may use one of the following methods:

• Total thyroidectomy is the removal of the whole thyroid gland
• Near-total thyroidectomy is the removal of nearly all of the thyroid gland
• Subtotal thyroidectomy is the removal of most of the thyroid gland
• Lymph node excision is the removal of nearby lymph nodes
• Thyroid lobectomy is the removal of one lobe of the thyroid and the isthmus

Your surgeon may also remove lymph nodes near the cancer if they have known cancer cells or look suspicious. This procedure is called either a central compartment neck dissection or a modified radical neck dissection depending on the extent of lymph node removal.

Learn more about thyroid cancer surgery.

Thyroidectomy surgery instructions for patients.

Thyroid lobectomy surgery instructions for patients.

Day surgery instructions for Boston and Foxborough patients:

• Boston
• Foxborough

Medical Treatment

Your doctor will use tissue removed during surgery to determine the cancer’s type and stage. This helps determine whether you need additional treatment. Medical treatments include:

• Hormone replacement therapy If you’ve had surgery to remove your thyroid gland and/or radioactive iodine therapy, your body may no longer make thyroid hormones. You may be prescribed thyroid hormone therapy, in the form of pills.
• Radioactive iodine therapy After surgery, you may have treatment with radioactive iodine (I-131).
• Chemotherapy
• Radiation

You will receive a thorough diagnostic examination to evaluate if you have thyroid cancer and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced endocrine surgeon are important to the successful outcome for patients with thyroid cancer.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be cared for in the operating room by endocrine surgeons, anesthesiologists and nurses who specialize in surgery for patients with thyroid cancer. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

The Thyroid Center at Brigham and Women’s Hospital provides innovative care for patients with thyroid diseases, including thyroid cancer. The multidisciplinary Thyroid Center Team includes endocrinologists, endocrine surgeons, pathologists, radiologists and medical and radiation oncologists. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

Contact one of our cancer surgeons in the list at the top of the page to make an appointment.

Cancer Surgery Locations