Thyroid cancer is the malignancy of nodules in the thyroid gland. Thyroid cancer, which is rarer than different types of cancer, is more common in women. In addition to gender, some factors cause thyroid cancer. Thyroid cancer can occur at an early age and it is a type of cancer that has a high success rate and can be cured with the right treatment. For this reason, the mortality rate of thyroid cancer is lower than other cancers.
What is Thyroid Cancer, What are the Symptoms?
Thyroid cancer is a disease with a high success rate when diagnosed and treated correctly. It is a type of cancer that occurs when the cells in the thyroid gland evolve into cancer. Thyroid cancer often occurs as a mass in the neck area or a nodule in the thyroid gland.
Nodule is the name given to the disease that can be the size of a pea grain to a walnut, formed by clusters of cells creating communities. It can be divided into cold (non-hormone secretion) and hot (hormone secretion).
Althoughthyroid gland diseases are quite common in the society, thyroid cancers are extremely rare compared to the incidence of thyroid cancer . All these diseases present themselves as thyroid nodules, which are defined as a diffuse and uniform enlargement of the thyroid gland.
The incidence of thyroid nodules in the normal population is 5-10%. This rate increases to -46% with ultrasound studies that can detect nodules smaller than 1-1.5 cm that cannot be detected by hand. The fact that 70-90% of patients with thyroid cancer present with thyroid nodules seems to be the most important symptom that increases their importance. On the other hand, thyroid cancer is detected in only 5-10% of thyroid nodules. The vast majority are benign. The majority of thyroid nodules do not cause any complaints. They are usually noticed incidentally by the patient or his/her relatives during a routine examination by the physician or while shaving or applying make-up. We can list the symptoms of thyroid nodules as follows;
- Age
- Type
- Inception and growth rate
- Radiation exposure
- Family story
- Hoarseness
- Cough
- Dysphagia should be questioned.
People under the age of 15 and over the age of 60 are in the risk group in terms of cancer. Thyroid nodules are very rare in children. Therefore, detection of thyroid nodules under the age of 15 is very important in terms of thyroid cancer. All thyroid diseases are more common in women. The growth rate of nodules should be met with suspicion in elderly patients or patients with a family history of thyroid cancer or those who were exposed to radiation in childhood. Radiation exposure is very important for thyroid pathology. Shortness of breath, difficulty swallowing and coughing, weight loss, trembling hands, heat and sweating are symptoms that should be questioned.
How is Thyroid Cancer Diagnosed?
In a patient presenting with thyroid gland pathology, clinical evaluation, taking a comprehensive history and physical examination is the most important start. Afterwards, it can be listed as follows according to the necessity;
Biochemical tests: Functional hormone tests such as TSH, T4, Antibody studies, Antithyroid peroxidosis (TPO), Antithyroglobulin antibody, thyroid stimulating immunoglobulin (TSI) or thyroid stimulating antibody (TSA), Serum calcitonin level, Serum thyroglobulin level (Tg), (CEA) Consinoembryonic antigen.
Imaging methods: Radio isotope scintigraphy: It can be performed when necessary to recognize an autonomous nodule, to identify substernal goiter, and to recognize developmental anomalies. Radiologic examinations, plain radiographs, ultrasongraphy, MRI in advanced stages, CT Ultroscongraphy has become an ideal method to investigate the thyroid gland, which is a very superficial organ. Disappearance of halo sign, solid lesion or hypoechogenicity, hetrogenous echo structure, irregular edges, calcification, extension outside the gland, presence of lymphadenopathy with the same echo and blood supply as the thyroid gland are important USG findings.
Biopsy: (Fine needle aspiration biopsy) is the gold standard for the diagnosis of thyroid gland pathologies. There is no serious risk. Nodules are listed as follows;
- Each hard or fixed nodule
- Each nodule within the radiation field
- Each nodule showing rapid growth
- FNAB should be performed in mixed nodules larger than 3-4 cm.
- The sensitivity of FNAB has been found to be 83% with a syphificity of 92%.
How is Thyroid Cancer Treated?
Necessary surgical intervention is performed by evaluating the diagnosis, stage, spread and comorbidities. Daily medication is planned for thyroid hormone needs.
In cases where non-surgical treatment (RAI) is required, radioactive iodine treatment can be applied with the aim of eliminating residual thyroid tissue and micrometastases.
Patients should be followed up and monitored for life. Physical examination should be performed every 6 months for the first 3 years and once a year for the following years. Serum troglobulin (Tg) values should be measured. Body scintigraphy with I131 can be performed if necessary.
