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Introduction

The Thyroid is a small, butterfly-shaped gland at the front of the neck. It is an endocrine gland and makes thyroid hormones, which are released into the bloodstream and affect cells and tissues in other parts of the body, helping them to function normally. 

Nodules (lumps) within the thyroid gland are very common.  Most turn out to be benign (non-cancerous).

Thyroid Cancer is rare, but numbers are rising. There are approximately 160 new cases in Ireland each year. It is more common in women than men, at a ratio of 2 to 1. Thyroid cancer is the most common endocrine malignancy.

Prognosis for patients with differentiated thyroid cancer is excellent, with an 80–90% cure rate. Most can be treated very successfully with surgery, radioactive iodine or a combination of both.

The Endocrinology Unit at St James’s Hospital provides a complete diagnostic, treatment and follow-up service for patients with thyroid cancer. This service works within the multidisciplinary thyroid cancer team, which includes endocrinologists, surgeons, physicists and nursing support. Every year, 40 to 50 new patients are diagnosed and treatment for differentiated thyroid cancer at our unit in the hospital. After surgery, each case is discussed at the multidisciplinary meeting to decide on an appropriate treatment plan.

  • Cancer of the thyroid gland is rare. It can now be diagnosed early due to better diagnostic techniques. The most common thyroid cancers are known as “differentiated”. These include papillary and follicular cancers. These types of cancer are usually treated with surgery and radioactive iodine treatment (RAI).

    Other less common types of thyroid cancers are medullary, anaplastic and lymphoma. These have a different treatment protocol. Papillary carcinoma is the most common thyroid cancer. It is more common in younger people, particularly women. Follicular carcinoma is less common and tends to occur in slightly older people. Medullary carcinoma is a rare cancer that is sometimes hereditary (passed down through a family from one generation to the next). Most thyroid cancers are very treatable and curable, but it is possible that they will recur. A recurrence can be treated successfully, so lifelong follow up is most important.

  • Diagnosis

    • Ultrasound scanning checks the size and shape of the thyroid and picks up any nodules (lumps) in the thyroid gland.
    • Thyroid scanning checks the size and shape of the nodules and whether they are overactive, “hot”, or underactive, “cold”.
    • Fine Needle Aspiration Cytology (FNAC): If a nodule is large or has any suspicious features, a fine needle is used to remove cells for investigation.

    Treatment

    • Surgery: To remove part or all of the thyroid gland.
    • Radioactive Iodine when appropriate: To ensure that all the thyroid cancer cells are destroyed. After treatment with radioactive iodine, women should avoid conceiving for six months and men should avoid fathering children for six months.
    • Levothyroxine: To replace missing thyroid hormone and suppress the rate of growth of any remaining thyroid cells.

    Surgery (Thyroidectomy)

    Surgery is normally the first line of treatment for thyroid cancer.  Usually, the whole thyroid gland will need to be removed (total thyroidectomy), although sometimes only one node has to be removed. After a thyroidectomy, it is necessary to take Thyroxine tablets. Regular blood tests are needed to ensure that thyroid hormone levels are correct.

    Radioactive Iodine Treatment

    Following surgery, Dr Marie Louise Healy, Consultant Endocrinologist, meets with the patient to discuss whether radio-iodine (I131) should be used. An appointment is made with Dr Jennie Cooke and Dr Geraldine O’Reilly to discuss special precautions that need to be taken after the treatment. The decision to use radioiodine (I131) treatment after surgery is made based on the size of the cancer and the risk of a recurrence. The multidisciplinary thyroid cancer team uses international guidelines to help make an individual decision for each patient.  

    Radioactive iodine treatment is painless; it involves taking a capsule by mouth.  The iodine131 (I131) goes into the bloodstream and kills only thyroid cells.  No other cells in the body are harmed because they cannot take up iodine.  

    Thyroid Stimulating Hormone (TSH) encourages thyroid cells to take up the I131.  It is necessary to have a high TSH level to make the treatment successful. There are two ways to achieve this: to stop taking Levothyroxine a few weeks before the therapy or to take TSH as an injection on each of the two days before the I131 is taken.  This second option avoids the need to stop thyroid hormone replacement. 

    Treatment Timetable
    Treatment is administered in the iodine suite. Because I131 is a form of radiation, special precautions must be taken to prevent other people from being exposed and the patient is cared for in isolation for up to four days. The physicist measures radiation daily to ensure that levels have dropped to a safe level before the patient leaves the hospital.  Advice is given on avoiding close contact with other people on returning home.  

    Follow Up and Outlook
    Once the treatment has been administered, patients return at three-monthly intervals to Dr Healy’s Endocrine Outpatient Clinic. As part of the follow up, regular blood tests are necessary. Thyroglobulin (Tg) is a substance only made by thyroid cells. Patients with thyroid cancer who have been treated with surgery and radio iodine should have very little or no Tg in their blood stream. If the cancer comes back, the Tg becomes positive long before the cancer causes symptoms. So the Tg blood test is a marker of thyroid cancer and can pick up recurrence early, allowing for early treatment. One year after treatment, a full work-up (surveillance), with TSH stimulated blood tests and scans, takes place to determine whether the disease has been fully cleared. Patients will have regular checkups for life.

    • Dr Marie Louise Healy, Consultant Endocrinologist
    • Dr Jennie Cooke, Physicist
    • Ms Carolyn Treacy, CNM III Endocrinology
  • The decision to use radio iodine (I131) treatment after surgery is made based on the size of the cancer and the risk of a recurrence. The multidisciplinary thyroid cancer team uses international guidelines to help make an individual decision for each patient.  

    Radioactive iodine treatment is painless; it involves taking a capsule by mouth.  The iodine131 goes into the bloodstream and kills only thyroid cells.  No other cells in the body are harmed because they cannot take up iodine.  

    Thyroid Stimulating Hormone (TSH) encourages thyroid cells to take up the I131.  It is necessary to have a high TSH level to make the treatment successful. There are two ways to achieve this: to stop taking Levothyroxine a few weeks before the therapy or to take TSH as an injection on each of the two days before the I131 is taken.  This second option avoids the need to stop thyroid hormone replacement. 

  • Irish Cancer Society: http://www.cancer.ie

    Butterfly Thyroid Cancer Trust: www.butterfly.org.uk

    NHS Choices: www.nhs.uk

    Macmillan Cancer Support: www.macmillan.org.uk

    British Thyroid Association: www.british-thyroid-association.org

    British Thyroid Foundation: www.btf-thyroid.org