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Thyroid Nodules & Thyroid Cancer

Thyroid Nodules and Thyroid Cancer

The thyroid gland is butterfly shaped and is important in regulating metabolism and energy. When a thyroid nodule is detected it is often necessary to have an ultrasound of the thyroid and at times a biopsy to assess for cancer.

At ENT Specialty Group, our team of experienced thyroid surgeons and endocrinologists have expertise in the workup and management of thyroid nodules. We understand the anxiety associated with discovering a thyroid tumour and the importance of a proper work up. This may involve a thyroid morphology ultrasound examination, an ultrasound guided thyroid biopsy (USFNA), and when indicated, molecular testing of thyroid nodules (Afirma, ThyroseqV3, ThyGenext/Thyramir). When thyroid surgery is indicated it is performed at one of the McGill University hospitals (Jewish General Hospital, MUHC/Glen), McGill Univeristy affiliated hospitals, or University of Montreal affiliated hospitals. The team also has an extensive experience with the management and surgery of the parathyroid glands for elevated calcium levels (hypercalcemia).

Our team includes specialists in endocrinology and thyroid surgery who have published many articles and studies on thyroid cancer. This includes presentations of research both nationally and internationally. The thyroid team is involved with teaching medical students, medical/surgical residents, and medical/fellows at academic centres. Our team members have been invited guest lecturers at universities and hospitals throughout the world.

Our aim is to provide patients with compassion, attention, and timely care from the moment that a thyroid nodule is discovered until treatment is no longer required.

FAQ's for Thyroid Cancer

1. What is thyroid cancer?

Thyroid nodules (or tumours) are either benign or malignant. The difference between benign and malignant tumours lies in the potential for cancers to spread outside of the thyroid gland to local structures (such as lymph nodes) and distant sites (such as the lungs). Fortunately the spread of thyroid cancer to distant sites is rare.

Common types of thyroid cancer include:

-Papillary thyroid carcinoma

-Follicular thyroid carcinoma

-Hurthle cell thyroid carcinoma

-Medullary thyroid carcinoma

-Anaplastic thyroid carcinoma


2. Whom does thyroid cancer affect?

Thyroid cancer occurs in men and women of all ages. Nonetheless, it typically affects young adults and middle-aged women. Women are affected more often than men. While some forms of thyroid cancer are inherited, the majority are not.


3. What are symptoms of thyroid cancer?

Many individuals with thyroid cancer do not have symptoms. Others complain of a “bump” in their neck. Sometimes people complain of voice change or difficulty swallowing, but these symptoms are not specific for thyroid cancer and are caused by many other medical conditions.


4. When should you see a doctor about thyroid cancer?

When you have a concern that you may have thyroid cancer, you should consult your doctor.


5. Which doctor do you see for thyroid cancer?

Your doctor will typically send you to an endocrinologist, an ENT specialist, or an endocrine surgeon when there is a concern about thyroid cancer.


6. How is thyroid cancer diagnosed?

When an individual feels a “bump” in their neck at the level of the thyroid gland (where a bow tie is worn) or when a thyroid nodule is detected incidentally during a scan, a workup is often warranted. There are several tests that are commonly performed when thyroid cancer is suspected. Blood tests are usually performed along with an ultrasound to visualize the thyroid tumour. An ultrasound guided fine needle biopsy is then required to get a tissue sample. Sometimes molecular testing is used when the diagnosis is uncertain or when more information is required prior to making management decisions.


7. What caused me to have thyroid cancer?

The cause of most forms of thyroid cancer is unknown. The most important identifiable risk factor is radiation exposure. A family history of thyroid cancer is also a risk factor for some forms. Certain ethnic groups may be more likely than others to develop thyroid cancer.


8. What therapeutic options are available to me now that thyroid cancer is suspected?

Thyroid cancer is usually treated with surgery, since removal of part or all of the thyroid gland (thyroidectomy) with or without excision of lymph nodes typically offers the best chance of cure.
Radioactive iodine therapy, external beam radiation therapy, chemotherapy and levothyroxine therapy (often prescribed as Synthroid ®) are forms of treatment that are sometimes used following surgery. These forms of treatment, when applied in the appropriate clinical setting, have been shown to reduce the risk of tumor recurrence and improve survival.


9. After thyroid cancer is treated, will I be followed for this disease and for how long?

Yes, clinical follow-up for life is strongly recommended. Although most recurrences are detected within 10 years, sometimes tumors are detected later.


10. What test(s) might I expect to undergo during this prolonged follow-up period?

Typically patients are seen twice yearly by their specialist for a physical examination and blood tests. In addition to verifying the adequacy of the levothyroxine dosage, the blood is usually tested for tumor markers such as thyroglobulin or calcitonin. If thyroglobulin or calcitonin is detected and is rising it will lead to a search of possible tumor recurrence. General surveillance for tumor recurrence also involves an ultrasound of the thyroid bed and neck. In select cases other tests are necessary such as a whole body scan, a CT scan, or a PET scan.


11. What are my chances of cure?

The majority of patients treated for thyroid cancer do not have a recurrence. Nevertheless, the prognosis depends on certain specific factors, such as how advanced the cancer was when it was detected, the exact type of malignancy, and the treatment that was given.