Thyroid cancer – symptoms, treatment
Thyroid cancer detection pose serious challenges to early diagnosis because the clinical manifestations appear only in advanced stages of disease.
Thyroid cancer occurs more frequently in males, and young age.
Thyroid cancer takes differentiated forms (papillary, follicular, mixed) which represent approximately two-thirds of the cases and undifferentiated forms (anaplastic carcinoma, papillary carcinoma, sarcoma, lymphoma, metastases) that are more aggressive than differentiated forms of cancer.
This condition can occur on a healthy thyroid or on a previously affected thyroid (nodular goiter).
Thyroid cancer symptoms
The suspicion of thyroid cancer is required when there are thyroid nodules with certain features.
Suffering is manifested in two aspects:
– Solitary nodule;
– Multinodular goiter.
As clinical features, solitary nodule is characterized by sudden onset, firm consistency, in not mobile with swallowing, is not well separated from surrounding tissues and may be associated with local lymphadenopathy (enlarged lymph nodes).
Multinodular goiter is an old goiter, known by the patient, but one of the nodular formations increases in size more quickly.
During its evolution, the thyroid cancer may develop a series of compressions on adjacent structures, more or less specific. The most common are the recurrent nerve paresis, which clinically translates by dysphonia (disorder of phonation, hoarse voice), compression of the carotid arteries and jugular veins, compression on the trachea (dyspnoea = shortness of breath), compression on the esophagus (dysphagia – feeling of embarrassment or blocking during swallowing).
Thyroid cancer evolves with euthyroid (normal thyroid function). Exceptional may occur transient hyperthyroidism (with thyroid hormones in excess) in differentiated form.
Investigations necessary for the diagnosis of thyroid cancer are complex and require corroboration of the results.
Thyroid ultrasound may reveal a hipoecogen node, scratchy, poorly defined, with micro-calcifications inside;
The scintigram provides information about the location, shape, volume and thyroid activity. In thyroid cancer are highlighted, classic, a cold node;
Thyroid aspirative puncture – high diagnostic value especially in undifferentiated carcinomas;
CT is recommended in selected cases.
Treatment of thyroid cancer
Thyroid cancer treatment is complex and consists of surgical, radiation and medication.
Regarding surgery, there is performed thyroidectomy (thyroid removal) plus total surgical ablation of lymph nodes.
Radioiodine therapy is applied after surgery and aims the removal of remnants thyroid tissue after surgery. In thyroid carcinomas which are beyond thyroid and for nodal metastases, radioactive iodine therapy will be associated with external irradiation.
Drug therapy with thyroid hormones is done for the rest of life.
Evolution of differentiated carcinomas is estimated by repeated serum thyroglobulin measurements (tumor marker). After surgery its value decreases to 0. Further increases of its values suggests local recurrences or metastases.