Thyroid cancer, in general is slow growing and carries a good prognosis. However, some thyroid cancers are quite aggressive and carry a poor prognosis. One such aggressive form is medullary thyroid cancer which is usually familial.
Diagnosis of Thyroid Cancer
Most thyroid cancer patients do not experience any symptoms except for a lump in the thyroid area. An Ultrasound of thyroid is the next step to evaluate any thyroid nodule. If a thyroid nodule looks suspicious, your endocrinologist will likely recommend a Fine Needle Aspiration – FNA – biopsy, which may give the diagnosis of a thyroid cancer.
Treatment of Thyroid Cancer
In most cases, thyroid surgery is performed to remove all the thyroid tissue. Subsequently, many patients usually recieve a dose of radioactive iodine which serves two purposes:
A. It destroys any remaining thyroid cells, cancerous as well as non-cancerous.
B. Once all the thyroid cells are destroyed, the body can no longer produce a substance called thyroglobulin,which is normally produced only by the thyroid tissue. Therefore, measurement of thyroglobulin becomes an excellent tool to detect the recurrence of cancer in most patients. An increase in thyroglobulin level indicates that the cancer may have recurred.
Follow-Up Of Thyroid Cancer Patients
Follow-up of most patients includes:
1. Thyroid hormone such as Levothyroxine and Liothyronine to treat your hypothyroidism, as well as to suppress serum TSH (thyroid stimulating hormone ) to prevent recurrence of cancer.
2. Measuring serum thyroglobulin on a yearly basis to detect any recurrence of cancer.
3. Total body scan to detect any recurrence of the cancer.
Withdrawal Scan VS Thyrogen Scan
In the past, we had to stop a patient’s thyroid hormone pills for several weeks before doing the whole body scan. That’s why the term Withdrawal Scan.
The patient had to got through a miserable period of several weeks of hypothyroid symptoms.
However, there is a relatively new way of doing the whole body scan in which patient does not have to stop thyroid pills.
This is called Thyrogen Scan. However, it is very expensive.
Thyrogen is a synthetic form of TSH (thyroid stimulating hormone). It comes as intramuscular injection, which patient eceieves on two consecutive days.
24-hour after the last injection of Thyrogen, patient ingests Radioactive iodine.
48-hour later, whole body scan is obtained .
Thyrogen injections may cause side-effects such as headache, Flu like symptoms, breathing difficulties, even heart attacks and deaths.
Therefore, the physician administering Thyrogen injections (usually a radiologist) should discuss potential side-effects of Thyrogen with the patient before giving Thyrogen.