Thyroid cancer... Is surgery the best answer if diagnosed??

Are there many people around you who have had thyroid cancer surgery?

 

Something about when I was young, thyroid? The name also seemed unfamiliar, but at some point, I realized that there were so many people around me who had thyroid cancer or had already undergone surgery.

I have already had more than 10 people around me undergo thyroid cancer surgery, and one of them is my mother.

In my mother's case, in 2006, she felt a lump in her neck and had an ultrasound at a local hospital, which suggested it might be thyroid cancer. She immediately went to a larger hospital for a detailed examination, and the doctor warned that it could be serious if not operated on. She scheduled and underwent surgery right away.

When ordinary people heard the word cancer at that time, I think they were immediately... terrified as if they were going to die.

I have a tumor in my body, and I worry about it spreading everywhere immediately.

Since it's cancer surgery, I still wanted to have the operation at a well-known large hospital, so I looked into major hospitals, but I was told I would have to wait at least six months even if I made a reservation at that time...

I wonder what to do if I wait six months, only for the cancer to spread and worsen...

I also remember being very angry at the overly complacent words of the doctors...

Since it was still early stage and the size was small, and they said only half needed to be removed instead of a full incision, I ultimately decided to have the surgery done at a hospital that could perform it quickly, even if it was a smaller hospital, due to my fear.

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However, even though more than 17 years have passed since the surgery, I still have doubts about whether immediate surgery is the right course of action if one is diagnosed with thyroid cancer.

These days, thyroid cancer is so common and has such a good prognosis that it feels like catching appendicitis... I don't really worry much even if I do get it.

Still, since this is cancer... young people have a higher chance of metastasis, so it's better to undergo surgery as soon as possible.

Among my acquaintances, there are friends or younger siblings who have undergone thyroid cancer surgery 2 to 4 times due to metastasis even after the initial surgery... There are also cases of people who have died from a rare type of thyroid cancer, which accounts for only 1% of all thyroid cancers...

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In the case of elderly individuals, the progression of cancer tends to be very slow, doesn't it?

In particular, in the case of thyroid cancer, it is so slow-progressing that it is nicknamed "turtle cancer," especially among older people.

As mentioned in the explanation of thyroid cancer below, thyroid cancer is really a type of cancer that hardly shows any symptoms.

Many people accidentally discover a tumor while undergoing a health checkup or become grateful when they feel a lump in their neck and realize it's a tumor.

 

The issue is the various side effects after thyroid cancer surgery.

 

First of all, it is a hormone medication that must be taken until death, regardless of whether it is a partial or complete resection.

You need to take hormone medications such as synthroid or synthrolockin, and regularly monitor and adjust the dosage through tests every few months.

Since the thyroid gland plays an important role in promoting the body's metabolism and properly regulating the functions of all organs, it cannot perform its functions after removal, so hormone therapy must be used to regulate it. But taking medication every day... it's really such a hassle, isn't it??

But as soon as you stop taking the hormone medication, various side effects occur, so you must take it without fail...

And as I will mention later, most people notice a change in their voice. In my mother's case, her voice changed drastically before and after surgery, and not only did her voice change, but she also started having difficulty swallowing saliva, her throat frequently became dry, causing her voice to crack or come out unevenly, and she experienced discomfort. Additionally, when she eats spicy food, her throat suddenly feels burning and stuffy, leading to frequent sneezing and coughing, and she seems to often choke on her own saliva.

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In addition, she is experiencing various side effects such as discomfort in temperature regulation (frequently feeling cold and hot, similar to menopause), frequent emotional changes (becoming more sensitive and fearful), and a sudden decline in physical strength.

Unfortunately, it seems that the parathyroid was also slightly damaged during the surgery, so you are experiencing symptoms like numbness in your hands and feet as well as hypocalcemia. The scar from the surgery is also quite prominent on your neck, possibly because it has healed as it used to.

I'm so sorry to hear that you want to hide it even during the hot summer with a scarf.

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After several years following my mom's surgery, I kept hearing a lot of news about how indiscriminately thyroid cancer surgeries are being recommended. A friend's father was diagnosed with thyroid cancer, but since he is elderly and living comfortably, the doctor advised that unless it's very uncomfortable for him, he shouldn't go through the trouble of surgery and that it would be better to just monitor his condition every six months.

Thinking about it, when my mom had thyroid surgery, it was like a straightforward question of cancer? = immediate surgery, something like that.

Recently, it seems that perceptions have changed a bit.

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As I mentioned earlier, of course, in young people, due to hormonal influence, the disease can spread and progress quickly, so prompt treatment may be the best option. However, for older individuals, I think the same approach to treatment may not be appropriate.

Thyroid cancer is really very common around here, isn't it?

 

How do you feel? If your parents were diagnosed with thyroid cancer or if I were to get it, what do you think the treatment should be?

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Everything About Thyroid Cancer

A lump in the thyroid is called a thyroid nodule, and 5-10% of all thyroid nodules are diagnosed as thyroid cancer. Unlike benign nodules, thyroid cancer generally enlarges, invades surrounding tissues, and can cause lymph node metastasis or distant metastasis. Over 95% of thyroid cancers are papillary carcinomas, with other types including follicular carcinoma, poorly differentiated carcinoma, undifferentiated carcinoma, and medullary carcinoma.

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Position and structure of the thyroid gland

The thyroid gland is located in the front middle of the neck, just below the prominent area called the Adam's apple or the thyroid cartilage ('shield cartilage'), approximately 2 to 3 cm below it. The thyroid is butterfly-shaped and consists of a left lobe, a right lobe, and an isthmus connecting the two lobes. The length of one lobe is 4 to 5 cm, the width is 1 to 2 cm, the thickness is 2 to 3 cm, and the total weight is 15 to 20 grams.

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Thyroid function

The thyroid gland, also called the thyroid or neck gland, is an endocrine organ that produces and stores thyroid hormones, releasing them into the bloodstream as needed. Thyroid hormones are essential substances for humans, promoting the body's metabolic processes and appropriately regulating the functions of all organs. For example, they help generate heat to maintain a constant body temperature or assist in the growth and development of the brain and bones in fetuses and newborns. (Metabolism, also called 'metabolic process,' refers to the process of breaking down and synthesizing nutrients ingested from outside the body within the body to produce biological components, substances for life activities, and energy, and excreting unnecessary substances outside the body.)

Meanwhile, just behind the thyroid gland, there are two parathyroid glands (parathyroid glands) on each side, about the size of a pea. The hormones secreted from here play a role in regulating the levels of calcium and phosphorus in the blood. Blood calcium is crucial for the normal functioning of our muscles.

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Thyroid cancer statistics

According to data published by the Korea Central Cancer Registry in 2022, there were 247,952 new cases of cancer in South Korea in 2020. Among these, thyroid cancer (C73) accounted for 29,180 cases, ranking first with 11.8% of all cancer cases, combining both men and women. The crude incidence rate per 100,000 population during the observation period was 56.8 cases.

The gender ratio was 0.3:1, with significantly more women. The number of cases was 7,458 for men, ranking sixth among male cancers, and 21,722 for women, ranking second among female cancers. When combining men and women and looking by age group, the 40s accounted for the largest proportion at 26.7%, followed by the 50s at 24.3%, and the 30s at 20.8%.

Histologically, out of the total 29,180 cases of thyroid cancer in 2020, carcinomas accounted for 99.6%. The remaining 0.4% were unspecified malignant neoplasms. Among the carcinomas, papillary carcinoma accounted for 96.4%, and follicular carcinoma accounted for 2.1%.

Carcinoma refers to a type that accounts for almost all cancers, which are malignant tumors originating from epithelial tissues such as the epidermis, mucous membranes, or glandular tissues. Sarcoma refers to malignant tumors arising from non-epithelial tissues. Although 'carcinoma' and 'cancer' are originally the same term, 'cancer' is used in a broader sense that includes sarcoma.

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Factors of thyroid cancer

 

Radiation: Among the risk factors for thyroid cancer, the most well-established to date is exposure to radiation. Over 95% of radiation-induced thyroid cancers are papillary carcinomas. Radiation damages DNA structures and induces abnormalities in the RET/PTC gene, increasing the incidence of thyroid cancer. In the past, radiation was used to treat benign conditions such as tonsillitis, thymic hypertrophy, asthma, and acne, which increased the risk of developing thyroid cancer. Recently, many patients receive radiation therapy for malignant tumors of the head and neck, such as malignant lymphoma and laryngeal cancer, which also increases the risk of hypothyroidism as well as the development of thyroid nodules and cancer. Conversely, in the case of breast cancer radiation therapy, despite the high doses of radiation used, the risk of thyroid cancer does not appear to increase.

Genetic factors

Familial medullary thyroid carcinoma syndrome occurs when a mutation happens in the RET gene, which can lead to medullary thyroid cancer. This accounts for 20% of all medullary thyroid cancers. When parents have papillary or follicular thyroid carcinoma, the risk of thyroid cancer in their children increases by 7.8 times for sons and 2.8 times for daughters. In our country, it is reported that about 10% of differentiated thyroid cancers have a family history.

Other existing thyroid diseases, hormonal factors, dietary factors, benign breast diseases, obesity, etc.

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Symptoms of the thyroid gland

 

Most have no symptoms. Thyroid cancer is usually a painless neck mass (tumor lump) that is discovered incidentally by oneself, others, or during a physical examination by a doctor.

If there is a lump (mass) in the front part of the neck, it is examined to determine whether it is thyroid cancer or not. In cases like the following, the likelihood can be considered very high.

· When the nodule is large or has recently grown suddenly

When the mass is large enough to press on the airway or esophagus, causing symptoms of breathing difficulty or difficulty swallowing food.

When there is a lump in the thyroid and a change in voice

When a lump is attached to surrounding tissues and does not move easily

When the nodule feels very hard to the touch

When lymph nodes on the same side as the nodule are palpable

When there is a thyroid cancer patient in the family and a nodule can be felt in the thyroid

When the age is 20 or below or 60 or above

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Side effects of thyroid surgery

 

Bleeding at the surgical site, voice changes, hypoparathyroidism (hypocalcemia), hypothyroidism, postoperative scars, side effects of radioactive iodine therapy

Hypoparathyroidism (Hypocalcemia)

The parathyroid glands are organs usually attached in pairs behind the thyroid gland, with typically two above and two below, and they secrete parathyroid hormone (about 5% of people have more than five parathyroid glands, and some have only two). The length of a single parathyroid gland is 5 to 9 mm, the width is 3 to 5 mm, the thickness is 1 to 2 mm, and the weight is 25 to 40 mg.

Parathyroid hormone is involved in calcium metabolism. During thyroid surgery, the parathyroid glands may be partially damaged, leading to abnormally low calcium levels in the blood, known as hypocalcemia. Symptoms include numbness or tingling in the fingertips and around the mouth, muscle weakness, cramps, tremors, fatigue, and weakness. Most cases are temporary, and the function recovers within 1 to 2 months, but in about 1-2% of cases, hypoparathyroidism persists for life. In such cases, lifelong intake of calcium and vitamin D supplements is necessary.

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Recurrence and metastasis of thyroid cancer

Thyroid cancer is known to be well-treated with a high cure rate, but there is always a possibility of recurrence or spread to other organs. Although the recurrence rate of thyroid cancer is not high, patients can experience recurrence after a long period of survival, and when it recurs, it is most likely to occur in the lymph nodes around the neck, residual thyroid tissue, muscles, or airways. However, the possibility of metastasis to other organs also increases, making initial treatment and follow-up monitoring extremely important. In particular, differentiated thyroid cancer can recur even years or decades after primary treatment. Therefore, lifelong follow-up is necessary, and patients should not neglect taking thyroid hormone medication and should regularly undergo check-ups. Even if recurrence occurs, early detection can lead to favorable treatment outcomes.