Thyroid Cancer

What is thyroid cancer? What are the types? Causes – What are the risk factors?

Throid Gland

The thyroid gland is an organ located in the front of the neck under the thyroid cartilage and has an internal secretory function. The thyroid gland is shaped like a butterfly, consisting of two lobes, on the right and on the left, and the istmus (canal) that connects them.

The thyroid gland consists of 2 main types of cells:

      1. Follicular cells regulate the entire metabolism of the body with a hormone that it produces using iodine. Excess thyroid hormone secretion (hyperthyroidism) can cause rapid or irregular heartbeats, insomnia, irritability, hunger, weight loss, and hot flashes. In contrast, if the thyroid hormone works poorly (hypothyroidism), the movements slow down, leading to fatigue and weight gain in the person. It regulates how much thyroid hormone is secreted, the thyroid stimulating hormone (TSH) produced by the pituitary gland located in the brain.
      2. C cells (parafolicular cells), on the other hand, produce calcitonin, which controls the body’s use of calcium. In addition, immune system cells (lymphocytes) and support (stromal) cells are other rare types of cells found in the thyroid gland. Different cancers develop in each cell type of the thyroid gland. These differences are important because they affect the spread and treatment of cancer.

What are malignant thyroid tumors?

A lump or nodule in the thyroid gland can be a harbinger of thyroid cancer. But in order to come to a final conclusion, the necessary tests must be carried out and the sample taken from the suspicious area must be examined in a laboratory environment. There are 4 different thyroid cancers according to their cell structure, appearance and type. These are called papillary, follicular, meduller and anaplastic thyroid cancer. Now let’s examine these types of cancer together.

Papillary thyroid cancer

About 80% of all thyroid cancers are papillary carcinoma. This type of cancer, which usually occurs only in one lobe of the thyroid gland, mostly spreads to the lymph nodes in the neck. It tends to develop quite slowly and can be improved when diagnosed early.

Follicular thyroid cancer

Follicular carcinoma is the second most common type of thyroid cancer. Follicular carcinoma, more common in people who do not get enough iodine, usually does not spread to the lymph nodes, but can progress to other parts of the body (bones or lungs). The course of this type of cancer is usually not as good as papillary carcinoma, but it can be successfully treated when diagnosed early.

Medullary thyroid cancer

This type of cancer includes about 5% of thyroid cancers. It develops from C cells in the thyroid gland, which make the hormone calcitonin, which controls the ratio of calcium in the blood. Medullary thyroid cancers secrete large amounts of calcitonin and a protein called carcinoembriogenic antigen into the blood. There is a chance that these substances can be detected by blood tests.

Medullary thyroid cancer can sometimes be seen as a type of familial transitive cancer. Changes in the gene, known as rejection, can be passed from parents to children. Almost everyone who carries the altered rejection gene can develop medullary thyroid cancer. If the disease develops alone, it is called medullary thyroid cancer, while if it develops together with other cancers, it qualifies as multiple endocrine neoplasia (MEN) syndrome.

Anaplastic thyroid cancer

Rarely seen anaplastic carcinoma occurs in less than 5% of all thyroid cancers. Cancer begins in the follicular cells of the thyroid gland. Anaplastic thyroid cancer, which spreads rapidly to the neck and other parts of the body and shows an aggressive course, is quite difficult to treat.

Causes of thyroid cancer – what are the risk factors?

Anything that changes the chances of contracting the disease is a risk factor for us. For this reason, it is possible to reduce the risk factors that have an impact on cancer by paying attention to our lifestyle, habits that we have acquired, and all the environmental factors that we are exposed to. Some risk factors, such as smoking, drinking alcohol, are habits that we acquire in life and can be changed. There are also some risk factors, such as a person’s age and family history, that cannot be changed. On the other hand, just because you have a risk doesn’t mean you’ll get cancer. Or it can be said that you have cancer without any risk factors. For this reason, it is important to know the active risk factors for thyroid cancer. In this way, you can reduce the risk with small changes that you will make in your life. If you have some risk factors related to thyroid cancer, you should not neglect your routine checks at frequent intervals. In this way, you can have an early diagnosis and effective treatment of cancer.

There are some risk factors that play an active role in the development of thyroid cancer.

Age and gender

Thyroid cancer is three times more common in women than in men. Thyroid cancer, which can be seen at any age, occurs in women at the age of 40-50 years, while in men at the age of 60-70 years.

Insufficient level of iodine in the body

Follicular thyroid cancer is common in people with iodine deficiency. Foods containing iodized salt and iodine (saltwater fish: tuna, haddock; also shrimp and shellfish, etc.s.) consumption can be used to eliminate iodine deficiency.

Radiation

Radiation exposure has been proven to be a risk factor for thyroid cancer. Some drugs used, nuclear power plants or nuclear weapons are important sources of radiation. In the past, after the Chernobyl nuclear power plant accident in Russia, people living in that region have seen a large increase in thyroid cancer.

In addition, radiation therapy applied to the head and neck area in childhood is a risk factor for thyroid cancer. The Risk varies according to how much radiation is given and the age of the child receiving the treatment. High doses of radiation can increase the risk for children under age. If this type of treatment has been applied to you in the past, then you should definitely consult your doctor and ask for an examination of the thyroid gland.

The risk of thyroid cancer in adults exposed to radiation is not as high as in children. However, if you are exposed to radiation where you work because of the work you do, or if there is a nuclear or power plant in the area where you live, it is important to have a routine doctor’s check.

Hereditary disorders

It has been shown that some inherited disorders are associated with the development of different types of thyroid cancer. About one in three cases of meduller thyroid cancer have abnormal genes associated with a hereditary disorder. In such cases, cancer is called familial transitional meduller thyroid carcinoma. This type of hereditary cancer can be seen alone or in combination with other tumors.

A combination of familial transitional meduller thyroid carcinoma and tumors that develop in other endocrine glands is called a multipl (multiple) endocrine tumor type 2 (MEN2). Men2 has two subspecies: MEN2a and MEN2b. It occurs as a result of a mutation in the gene called rejection in both subspecies.

MEN2a is a meduller thyroid carcinoma that occurs with pheochromocytomas (adrenaline-forming tumors) and parathyroid gland tumors. MEN2b is a modularized thyroid cancer associated with benign tumors that develop in the tongue and nerve tissues elsewhere in the body, again called pheochromocytomas and neuroma.

In addition, some hereditary diseases, such as Gardner syndrome, Cowden’s disease, familial adenomatous polyposis, qualify as risk factors for thyroid cancer.

What are the symptoms of thyroid cancer? What is thyrocele?

The symptoms seen play a factor role in the early detection of many thyroid cancers.

      • Swelling in the neck or a fast-growing lump,
      • pain in the front of the neck, sometimes from the neck to the ears,
      • hoarseness,
      • difficulty swallowing,
      • persistent cough,
      • shortness of breath is a common symptom of thyroid cancer.

However, it is not true that these symptoms are directly associated with thyroid cancer. Other non-serious health problems can also lead to such symptoms. In this case, it is up to you to consult a specialist doctor without wasting time. In this way, it will be possible to find a quick solution to the health problem detected early.

What is thyrocele? What are the symptoms, how is it treated?

thyrocele is the growth of the thyroid gland. A person with thyrocele may have a normal level of thyroid hormone (T3 and T4 hormones), as well as a higher rate of thyroid hormone (hyperthyroidism) or less (hypotroidism) than the amount we need.

What are the symptoms of thyrocele?

      • If the thyroid gland grows too large, the swelling that occurs on the neck clearly indicates a thyrocele.
      • In some cases, the symptoms of thyrocele can only be headaches or itching for no reason.
      • Even some thyrocele patients do not have any symptoms.

However, the most common sign of thyrocele is swelling of the thyroid gland. Because of the growth of the gland, sudden swelling or swelling may occur in the neck area.In rare cases, an overblown thyroid gland can put pressure on the trachea, making it difficult to breathe. As a result of the same pressure, coughing, wheezing and swallowing difficulties may occur.

Other Symptoms

Other symptoms of thyrocele include:

      • heart palpitations,
      • swelling of the eyes,
      • shaking,
      • diarrhea,
      • nausea,
      • vomiting and
      • sweating is present.

How is thyrocele diagnosed?

During a physical examination, the doctor checks the area of the neck with his fingertips. During this examination, the swollen thyroid gland can be detected. A blood test is performed for thyrocele that cannot be felt manually and to determine the level of thyroid hormone production.In order to determine whether there is cancer in and around the swelling that occurs in the thyroid gland, thyroid tests and ultrasound film of the thyroid gland are used.If nodules are found in this film and screening, they are examined in the laboratory by taking a sample of these nodules (biopsy) and looking for thyroid cancer.

What are the types of thyrocele?

A simple thyrocele (endemic): a simple thyrocele can be observed without any cause or due to the inability of the thyroid gland to produce enough thyroid hormones. The thyroid gland begins to grow to be able to produce the hormone that the body needs.Simple thyrocele, also known as” endemic thyrocele”, is the most common type of thyrocele in women, women and men over the age of 40, people with thyrocele problems in their family.

Toxic nodular thyrocele: In this type of thyrocele, round nodules appear on the growing thyroid gland. These nodules lead to excessive production of thyroid hormones.

What are the causes of thyrocele?

Iodine malnutrition: thyrocele is more common in geographies where there is not enough iodine. In some countries, iodine deficiency is the main cause of thyrocele. Hormone production of the thyroid gland decreases when iodine taken with seafood, vegetables and dairy products found in the sea and soil and consumed.In the 1990s, iodine supplements to table salts began to be made in the United States and the United Kingdom to prevent iodine deficiency. But it should be noted that consuming too much iodine also increases the risk of thyrocele.

Age: the risk of thyrocele increases in adults over the age of 40.

Gender: women are more prone to thyrocele than men.

Immune system: those who have experienced or experienced immune system problems have a higher risk of thyrocele.

Pregnancy and menopause: the risk of thyrocele increases during pregnancy and menopause.

Some drugs: lithium, antiretrovirals, immunosuppressants,

immunomodulators (some of the next generation of cancer drugs), drugs such as amiodarone (heart drug) increase the risk of thyrocele.

Radiation: thyrocele is more common in people who are exposed to radiation in the neck and chest area (for example, due to radiation therapy).

Hyperthyroidism: if the thyroid gland is overactive, the gland may expand.

Hypothyroidism: if the thyroid hormone needed by the body cannot be produced in sufficient quantities, the thyroid gland can grow to respond to demand.

Smoking: studies show that those who smoke and experience iodine deficiency have a significant increased risk of thyrocele.

Some infections: some parasites and bacteria increase the risk of thyrocele.

Some foods: foods such as peanuts, soybeans, tofu and spinach increase the risk of thyrocele in some people.

How is thyrocele treated?

      • Different treatment methods can be applied depending on the size of the thyroid gland and the level of thyroid hormone. There are some drugs for shrinking the thyroid gland with hormone therapy.
      • Iodine and potassium supplements can be used to treat thyrocele caused by iodine deficiency.
      • Radioactive iodine therapy can be used to reduce the thyroid gland. This method is preferred in cases where the thyroid gland produces excessive hormones.
      • The thyroid gland, which cannot be reduced with drugs, can be removed in later stages by surgery called

Is early diagnosis and screening possible for thyroid cancer? What are thyroid function tests? How is it diagnosed?

Medical history and physical examination

During a physical examination, the symptoms of thyroid cancer are investigated by looking at the nose, mouth, throat, facial muscles and lymph nodes in the neck in the head and neck area, and the person’s history of this disease is examined and the family history of thyroid cancer is questioned.

Thyroid function test

It is possible to measure the values of Thyroid Stimulating Hormone by blood test (TSH or thyrotropin). In this way, the functioning of the thyroid gland is controlled. When the level of TSH held in balance by the pituitary gland is high, it means that the thyroid cannot produce enough hormones. In this case, the thyroid is checked by resorting to imaging tests (ultrasound or radioiodine imaging). It should be noted that the level of TSH in thyroid cancer is usually normal.

T3 and T4 (thyroid hormones)

The hormones T3 and T4 are produced by the thyroid gland. A change in these hormone levels may indicate an abnormality in the functioning of the thyroid gland. It should be remembered that T3 and T4 levels are normal in thyroid cancer.

Thyroglobulin

The first treatment option referenced in thyroid cancer is surgery. It is then aimed to destroy possible remaining thyroid cancer using radioactive iodine. These treatments greatly reduce the level of thyroglobulin in the blood. However, the fact that the level of thyroglobulin did not drop after treatment is a sign that thyroid cancer still exists.

Calcitonin

Calcitonin is a hormone that controls the use of calcium in the body. This hormone, produced by C cells found in the thyroid, can cause the development of medullary thyroid cancer. In this case, by looking at the level of calcitonin in the blood, the presence of medullary thyroid cancer or the recurrence status of this type of cancer can be controlled after treatment.

Imaging tests

Imaging tests use X-rays, magnetic fields, sound waves, or radioactive material. Imaging tests are tests performed to determine whether the suspicious area has cancer, to detect the spread of cancer, to determine the effectiveness of treatment, and to examine the tendency of cancer to recur. Ultrasound, chest X-ray, radio-iodine imaging, computed tomography (CT), magnetic resonance imaging (MRI), and PET tomography are commonly used imaging tests to diagnose thyroid cancer.

Ultrasound

Ultrasound displays internal organs using sound waves. In this imaging test, a small microphone-like instrument is placed on the front of the throat by applying gel over the skin near the thyroid. This instrument emits sound waves and records echoes coming out of thyroid tissues. These echoes are converted by the computer into sectional images. This test does not cause pain and does not contain radiation. Ultrasound can help determine whether a thyroid nodule is solid or full of fluid inside (nodules that are solid are usually cancer). In addition, it helps to accurately determine the location of the sample by performing imaging in the performed biopsy and shows the spread of cancer to nearby lymph nodes, if any.

Radio-iodine imaging

Radioactive iodine (Iodine-131) Test is a method used to evaluate the functions of the thyroid gland. It is mainly used to diagnose and detect the spread of thyroid cancers (papillary and follicular) that hold radioactive iodine. By giving a drug containing radioactive iodine, thyroid cancer is expected to retain iodine. Then, using a special camera, the area where the radioactivity is concentrated is examined. A camera placed on the front of the neck measures the amount of radiation in the thyroid glands. There is less radioactivity in the abnormal areas of the thyroid than in the surrounding tissues. These are called cold nodules. In contrast, if there is more radiation in the area under study, they are called hot nodules, and these nodules are usually not cancer. But cold nodules often appear as cancer.

Radioiodine imaging also shows the possible spread of thyroid cancer after surgery. If the entire thyroid gland is surgically removed, this method is useful in determining the possible thyroid cancer cells that are left behind. In addition, this test gives very good results in patients with high levels of Thyroid Stimulating Hormone (TSH or thyrotropin) in the blood. Stopping thyroid hormone drugs 1-2 weeks before the test is administered in a person who has received the thyroid gland will increase the TSH level. A decrease in the level of thyroid hormones as a result of stopping thyroid hormone medications leads to the pituitary gland releasing more TSH. Buddha causes existing thyroid cancer cells to retain radioactive iodine. In addition, another way to increase TSH levels is to give the patient intravenous thyrotropine before imaging.

Chest x-ray

One of the most common places where the spread of many types of cancer occurs is the lungs. For this reason, when thyroid cancer is diagnosed (or suspected), a chest X-ray is taken to check the spread of the cancer to the lungs. But if the cancer is limited to the area where it is located and does not progress, it cannot be seen in remote areas.

Computed tomography (CT)

Computed tomography takes cross-sectional images of the body using X-rays. Unlike a chest X-ray, a CT scan provides a clear view of the suspicious area by injecting contrast material into the body, and then a large number of more detailed images are taken from different angles. CT imaging gives information about the location, shape and size of the tumor and allows you to detect the growing lymph nodes associated with cancer and the spread of cancer. It also helps in taking samples from the suspicious area by accompanying the biopsy.

However, the contrast agent given to the patient during CT scan imaging contains iodine, which can prevent the radioactive iodine test. For this reason, MRI (magnetic resonance imaging) is preferred instead of CT (computed tomography) in the diagnosis of thyroid cancer.

Magnetic resonance imaging (MRI)

MRI takes a detailed image of the soft tissues in the body. It uses radio waves and powerful magnets instead of X-rays when performing imaging. Energy from radio waves is absorbed and sent to the suspect area. The computer converts the resulting image into detailed sectional images. It is possible to get a more detailed image with the contrast agent given before viewing.

MRI can be used to determine the possible development of cancer in and around the thyroid gland. Although the first method of thyroid imaging is usually ultrasound, a detailed image of soft tissues such as the thyroid gland can be obtained with an MRI test.

Positron emission tomography (PET)

A radioactive isotope (fluorodeoxyglucose) called FDG, which is a sugar derivative and emits positron radiation, is injected into the patient through a vein to show functional changes that occur in organs and tissues. Cancer cells adhere to the injected isotope by sensing this sugar from which they feed. The Pet machine detects these cancer cells that stick. A PET that displays the entire body is an imaging test that detects the spread of cancer to the lymph nodes and other areas. This test is very useful for detecting thyroid cancers (meduller thyroid cancers) that do not hold radioactive iodine.

Some technological machines can perform both PET and BT imaging (PET/BT imaging). More detailed imaging is possible with this technique.

Vocal cord examination (laryngoscopy)

Thyroid tumors occasionally affect the vocal cords. If surgery is to be performed to treat thyroid cancer, a laryngoscopy is performed to see if the vocal cords can be removed in a healthy way. In this examination, a thin, illuminated tube with a camera at the end is inserted through the throat, while a special mirror or laryngoscope displays the vocal cords.

Biopsy

If there is swelling and/or nodule in the neck, there are some tests performed before the biopsy. Tests such as blood tests, ultrasound, or radioiodine imaging (radioactive iodine test) can detect thyroid cancer. But the definitive diagnosis occurs with a biopsy. The size of the nodule will determine the shape of the biopsy. In a thin needle biopsy, usually performed using local anesthesia, a thin needle with a hole in the middle is inserted directly into the nodule, accompanied by ultrasound, and a cell sample is taken and diagnosed by examining it in a laboratory environment. But in a fine needle biopsy, the results may sometimes not be decisive. In this case, it is considered whether there is a mutation (change) in the BRAF or RET/PTC genes to be sure of the result. A mutation (changes) proves the presence of thyroid cancer, which allows you to determine the most accurate treatment.

If the results of a thin needle biopsy indicate the presence of cancer, then a thick needle biopsy (a thicker needle with a hole in the middle can be performed to remove the nodule) or an open biopsy can be performed, or half of the thyroid gland can be removed by lobectomy. Although it is necessary to remove all thyroid glands (complementary thyroidectomy) to treat many types of cancer, lobectomy can still be used as the main treatment for some types of early-stage cancer.

How is thyroid cancer staged?

When thyroid cancer is diagnosed, it needs to be staged or its spread status determined. In this way, the treatment plan to be applied is shaped. Staging is determined by the state of the cancer’s spread to the thyroid or other parts of the body, and if it has spread, which parts of the body it has spread to. In other words, it can also be called Measuring the depth and breadth of the disease. Sometimes the stage of cancer can be determined during diagnosis, or additional tests [such as ultrasound, chest X-ray, CT(computed tomography), MRI (magnetic resonance imaging), PET CT] may be required to be sure. After that, effective treatment planning is done by looking at the state of the spread of the thyroid and cancer.

It is important to know the area of spread of the disease and how aggressive it is when staging. Stages sorted from 0 to IV show the degree of cancer progression. The most advanced stage of cancer is expressed by the number IV. Stage 0 indicates that the cancer is at an early stage. In thyroid cancer, staging is performed depending on the age and subtype of the patient, unlike other types of cancer.

According to the type of thyroid cancer, we can briefly explain the properties expressed by each universe as follows:

Staging of papillary and Follicular Thyroid Cancer under the age of 45

Stage I: the tumor can be of any size and may or may not be present in the thyroid or in nearby tissues and lymph nodes. But there is no spread in remote areas.

Stage II: the tumor can be of any size, and the cancer spreads to areas far from the thyroid (lungs or bones). It may or may not spread to the lymph nodes.

Staging of papillary and Follicular Thyroid cancer aged 45 and older

Stage I: the tumor is 2 cm or smaller and has not progressed beyond the thyroid gland.

Stage II: the tumor is between 2 and 4 cm and has not progressed beyond the thyroid gland.

Stage III of papillary and Follicular Thyroid Cancer

Stage IIIA: the tumor is larger than 4 cm and is only in the thyroid gland. Or the tumor can be of any size, and the cancer has immediately spread to tissues outside the thyroid, but it does not appear in the lymph nodes.

Stage IIIB: the tumor can be of any size, and the cancer can immediately spread to tissues other than the thyroid, as well as to the lymph nodes near the windpipe or larynx.

Stage IV of papillary and Follicular Thyroid Cancer

Stage IVA: the tumor can be of any size and develops beyond the thyroid gland and in the close tissues of the neck. It may or may not spread to nearby lymph nodes. Or the tumor can be of any size and has slightly progressed beyond the thyroid. It has spread to some lymph nodes in the neck, the lymph nodes at the top of the chest or at the back of the throat.

Stage IVB: cancer develops in the tissues at the front of the spine or in the veins located in the area between the lungs. It may or may not spread to nearby lymph nodes.

Stage IVC: the tumor can be of any size and spread to remote areas of the body (lungs and bones), may or may not progress to the lymph nodes.

Staging of medullary thyroid cancer

Stage I: the tumor is 2 cm or smaller and has not progressed beyond the thyroid.

Stage II: the tumor is larger than 2 cm and has not progressed beyond the thyroid gland. Or, the tumor is of any size and immediately progresses to tissues other than the thyroid, but does not spread to the lymph nodes.

Stage III: the tumor can be of any size and spreads to the lymph nodes near the trachea and larynx. It may also progress or not to tissues just outside the thyroid.

Stage IV of medullary thyroid cancer

Stage IVA: the tumor can be of any size and develops beyond the thyroid and in close tissues in the neck. Or the tumor can be of any size and has slightly progressed beyond the thyroid. It spreads to the lymph nodes in the neck or to the lymph nodes in the upper chest or back of the throat.

Stage IVB: cancer develops in the tissues at the front of the spine or in the veins located in the area between the lungs. It may or may not spread to nearby lymph nodes.

Stage IVC: the tumor can be of any size and spread to remote areas of the body (lungs and bones), may or may not progress to the lymph nodes.

Staging in anaplastic thyroid cancer

Anaplastic thyroid cancer develops quickly and usually spreads in the neck area when diagnosed. For this reason, it is considered to be at the minimum Stage IV when diagnosed.

Stage IVA: the tumor is in the thyroid gland. It may or may not spread to the lymph nodes.

Stage IVB: the tumor has progressed to tissues just outside the thyroid. It may or may not spread to the lymph nodes.

Stage IVC: cancer is found in other parts of the body (lungs and bones, etc.) advances. It may or may not spread to the lymph nodes.

How is thyroid cancer treated?

The first method of treatment for thyroid cancer is surgery. After surgery, radiation therapy and then hormone therapy are other effective methods of treating thyroid cancer.

Most thyroid cancers that do not spread to remote areas of the body can be completely cured by surgery. By removing all or close to the entire thyroid gland where the cancer is located, the risk of the spread and recurrence of the disease will be prevented. But when the thyroid gland is completely removed, it is important to protect the nerves leading to the vocal cords and the parathyroid glands located behind the throat, which secrete a hormone that regulates the level of calcium in the blood.

After surgery,radioactive iodine therapy is aimed at eliminating the possible cancer that remains after surgery. In addition, as a result of surgical removal of the thyroid gland, the patient cannot produce thyroid hormone. In this case, thyroid hormone therapy will be applied to the patient to compensate for hormone loss.

Chemotherapy is not a very effective treatment for most types of thyroid cancer. In rare cases, it is used in combination with external radiation therapy to treat anaplastic thyroid cancer. It is a method that is sometimes referred to in advanced stage thyroid cancer, which cannot be responded to by other cancer treatments.

Targeted therapies such as Sorafenib (Neksavar®) and Lenvatinib (Lenvima®), called Intelligent therapy, are used to stop the development of the disease in papillary and follicular thyroid cancers that cannot be responded to with radioactive iodine therapy. Lenvatinib received FDA (U.S. Food and Drug Administration) approval on February 13, 2015.

Detailed information about treatment methods can be found in our next topics.

Surgery for thyroid cancer

Surgery is applied as the main treatment in almost all types of thyroid cancers.

In addition, if cancer is diagnosed during a biopsy, it is possible to perform surgery to remove the entire or cancerous part of the thyroid gland.

Lobectomy

Lobectomy is a method used to treat (regional) papillary and follicular thyroid cancers that do not spread outside the thyroid gland. Sometimes it can be applied for diagnosis in cases where clear results cannot be obtained by biopsy.

A 2-3 cm incision is opened from the front of the neck and the thyroid is reached. If the presence of cancer is detected, the isthmus (channel connecting the right and left lobe) is taken along with the lobe in which it is located. In addition, if the spread to the lymph nodes in the neck is determined during surgery, these lymph nodes that grow with the cancer area are also removed.

An advantage of lobectomy is that the patient does not need to undergo additional hormone therapy thanks to the thyroid hormone produced by the thyroid gland, which is left behind. However, the hormone secreted by the remaining thyroid gland can prevent regular radio-iodine imaging and thyroglobulin blood tests against the risk of possible recurrence of cancer after treatment.

Thyroidectomy

Thyroidectomy is the most commonly used surgical method for removing the thyroid gland. In the method applied by opening an incision of 1-2 cm from the front of the neck, all or close to the thyroid gland can be removed. In addition, if the spread to the lymph nodes in the neck is detected during surgery, these lymph nodes that grow with the cancer area are also removed.

After a thyroidectomy, it is most likely that radioactive iodine therapy will be performed, and then the patient will be given thyroid hormone. This hormone pill (levothyroxine), given to regulate the level of hormones, is taken as one every day.

The advantage of this surgical method compared to lobectomy is that the risk of cancer recurrence can be observed with radioactive iodine imaging and thyroglobulin blood test.

Radioactive iodine treatment and radiation therapy for thyroid cancer

Radioactive iodine therapy is used to destroy thyroid cancer that is left behind after surgery. It seems that this method of treatment contributes significantly to the life expectancy of patients with papillary and Follicular Thyroid cancer, especially.

Radioactive iodine [I-131 (RAI)], given orally as a liquid or as a pill after surgery, is collected in the cells of the thyroid gland and the radiation it emits stops the growth of thyroid cells and prevents them from functioning without too much damage to other parts of the body. In this way, cancerous thyroid tissues are destroyed.

It is aimed to increase the effectiveness of treatment by stopping the use of hormone pills 2-4 weeks before treatment with radioactive iodine. But this condition can cause the patient to face thyroid insufficiency (hypothyroidism). A plan after treatment to compensate for this condition improves the patient’s quality of life after treatment. Also, a 10-15-day iodine-poor diet will contribute to treatment success.

External radiation therapy

External radiation therapy is a treatment method used to kill cancer cells by sending high radiation energy from outside the body. This method of radiation therapy is a treatment that benefits anaplastic and medullary thyroid cancers that do not respond to radioactive iodine therapy because they do not hold iodine.

Hormone therapy

After removing part or all of the thyroid gland, there will be no production of hormones that will regulate the body’s metabolism. This, in turn, means insufficient thyroid (hypothyroidism) and causes side effects such as excessive fatigue, weight gain and drying of the skin. To compensate for this, the patient should regularly use thyroid hormone medication as long as he or she lives. After surgery, a thyroid hormone drug called levothyroxine can be prescribed for use once a day after treatment with radioactive iodine. In addition, it is necessary to check the levels of thyroid hormones with regular blood tests.

Chemotherapy and treatment with targeted drugs for thyroid cancer

Chemotherapy is a drug therapy used to kill cancer cells. Chemotherapy treatment includes cancer drugs used by oral or intravenous injection. These drugs are effective in treating all cancers that circulate throughout the body through the bloodstream and spread throughout the body beyond the head and neck area of the cancer.

Chemotherapy is not a very effective treatment for most types of thyroid cancer. In rare cases, it is used in combination with external radiation therapy to treat anaplastic thyroid cancer. It is a method that is sometimes referred to in advanced stage thyroid cancer, which cannot be responded to by other cancer treatments.

Targeted treatment

As we learn more about cancer-causing changes within the cell, new drugs are being developed that target these changes. These targeted drugs work differently than standard chemotherapy drugs. In cases where chemotherapy drugs cannot be effective in treatment, targeted drugs may be preferred.

Targeted drugs for papillary and Follicular Thyroid Cancer

These two types of cancer that develop in the thyroid can be treated by surgery and radioactive iodine. But there are some targeted treatments that are applied when there is no response to such treatments.

Sorafenib (Neksavar®) and lenvatinib (Lenvima®), an inhibitor of tyrosine kinase, inhibit the formation of new blood vessels that enable the development of tumors; they target certain proteins produced by cancer cells that enable the development of these cells.

These targeted treatments are used to stop the development of the disease in papillary and follicular thyroid cancers that cannot be responded to with radioactive iodine therapy. But the contribution of these treatments to the life expectancy of patients is still not clear. In addition, the effect of sunitinib (Sutent®), pazopanib (Votrient®) and vandetanib treatments on these types of thyroid cancers is still a promising fact, although it is still the subject of research.

Targeted drugs for the treatment of medullary thyroid cancer

Because hormonal treatments (such as radioactive iodine therapy) are not very effective in medullary thyroid cancer, weight has been given to targeted treatment studies.

A targeted drug called Vandetanib (Caprelsa®) has been observed to briefly stop the development of advanced medullary thyroid cancer. But the contribution of this drug to the life expectancy of patients is still the subject of research. In addition, Cabozantinib (Cometriq®) medullary has been observed to stop the development of thyroid cancer for longer, but its contribution to the life expectancy of patients is not yet clear.

Several other targeted drugs are available that are promising in the treatment of medullary thyroid cancer. Sorafenib (Neksavar®) and sunitinib (Sutent®) are other targeted treatments used when there is no response from other treatments (such as surgery, radioactive iodine therapy) or when vandetanib and kabozantinib treatments do not produce results.

Immunotherapy in thyroid cancer

In thyroid cancer, there is no immunotherapy method that has yet received approval. On the other hand, the mostly complete treatment of thyroid cancer with surgery and, if necessary, radioactive iodine therapy has partially pushed the study of immunotherapies in this area back. We will be following the developments on this issue closely and sharing them with you if there is a positive development.

Immunotherapies are relatively new generation cancer treatments. Although there are many varieties, the most effective immunotherapy drugs are drugs called immune checkpoint suppressors (today, this group of drugs that receive FDA approval for use in the treatment of various cancers are ipilimumab, nivolumab, pembrolizumab, atezolizumab).

Immunotherapies are drugs that indirectly act on our immune system to take on this work, rather than directly kill cancer cells. Unlike conventional chemotherapy drugs, they have longer-term Disease Control and fewer side effects.