Thyroid Cancer

Dr. Kevin Brumund performing an ultrasound on a patient.

With access to leading-edge technology in one location, our experts can perform the diagnostic ultrasound, fine needle aspiration (FNA) and on-the-spot evaluation of thyroid nodules in the same visit. Pictured here is surgical oncologist Kevin Brumund, MD.

Our patients with thyroid cancer receive customized care from an experienced team of endocrinologists, oncologists and surgeons. UC San Diego Health System is a recognized leader in the latest methods of diagnosing and managing thyroid cancer, which increases your chances of successful treatment.

Expert Diagnosis Makes A Difference

Thyroid nodules are common – nearly half of everyone in the U.S. will have at least one thyroid nodule by the age of 60. Fortunately, 90 percent of thyroid nodules are not cancerous.

Determining if a thyroid nodule is cancerous can be difficult. The thyroid cancer experts at UC San Diego Health System reduce the need for unnecessary thyroid surgery through the thoughtful and selective use of molecular and genetic testing. By using gene testing on thyroid biopsies, we can more accurately predict the likelihood that a thyroid nodule is benign or cancerous. And with access to leading-edge technology in one location, our physicians can perform a diagnostic ultrasound, fine needle aspiration (FNA) and on-the-spot evaluation of thyroid nodules in the same visit.

Thyroid cancer is usually slow-growing. It is often detected in its early stages, when the five-year survival rate is near 100 percent. For these reasons, thyroid cancer is considered one of the least dangerous cancers.

Our Services

Moores Cancer Center provides expertise in all aspects of thyroid cancer care, including:

  • State-of-the-art diagnostic tools and advanced imaging to assess thyroid cancer
  • Experienced endocrinologists, surgeons and oncologists to ensure an accurate diagnosis
  • Dedicated head and neck surgeons with extensive experience in minimally invasive thyroid surgery.
  • Access to leading-edge clinical trials and innovative therapies, some which are unique to our center
  • Fewer appointments thanks to our ability to perform the ultrasound, fine-needle biopsy and on-the-spot thyroid nodule evaluation in the same visit
  • All the resources of a world-class cancer center, including nutrition advice, support groups, and mind/body classes

For more information on how UC San Diego diagnoses and treats thyroid cancer, see the tabs below.

Thyroid cancer begins in the thyroid gland, located in the front area of the neck, above the collarbone. Part of the endocrine system, the thyroid gland is responsible for making hormones that support important body functions such as heart rate, blood pressure, metabolism, and temperature.

Sometimes abnormal growths of cells, or nodules, occur on the thyroid. While most nodules are benign, approximately five to ten percent of nodules are malignant, or cancerous.

Recovery from thyroid cancer depends on factors such as:

  • The type of thyroid cancer.
  • Whether it is in the thyroid only or has spread to other parts of the body (stage).
  • The patient’s age and overall health. The prognosis is better for patients younger than 40 years who have cancer that has not spread beyond the thyroid.

    There are approximately 60,000 new cases of thyroid cancer in the U.S. every year. Most of these occur in people between the ages of 20 and 55, and nearly 75 percent are women.

Risk Factors

Certain factors may increase your risk of thyroid cancer, including:

  • Ionizing radiation exposure or external beam radiation to the neck during childhood.
  • Family history of thyroid cancer, especially in first degree relatives.
  • Family history of other endocrine tumors.
  • Gender (more common in women).
  • A thyroid mass that is rapidly growing.

While a family history of thyroid cancer may increase your risk, most cases of thyroid cancer are not inherited.

Symptoms

Thyroid cancer may not have any early warning signs. Sometimes it is first detected during a regular physical exam. Symptoms may occur when the tumor increases in size. Since symptoms overlap with other conditions, it’s important that you’re examined by a doctor.

Symptoms you may experience include:

  • Difficulty swallowing
  • Hoarseness
  • A lump in the neck
  • Trouble breathing

There are several different types of thyroid cancer, based on the type of thyroid cells where your cancer began.

There are two kinds of cells in the thyroid:

  1. Follicular cells: These cells make thyroid hormone. Thyroid cancer that originates in these cells include papillary, follicular, and anaplastic.
  2. Parafollicular cells: Also called C cells, these cells make the hormone, calcitonin. Most C cells are located in the upper third of the lobe. Medullary thyroid cancer is the only type that originates in the parafollicular cells.

Types of thyroid cancer:

  1. Papillary: Papillary thyroid cancer accounts for roughly 80 percent of all thyroid cancer. It is a slow-growing tumor that can develop in both lobes and spread to the lymph nodes.
  2. Follicular: Follicular thyroid cancer accounts for only 10 percent of all thyroid cancer. It is a slow-growing tumor that can spread to other areas in the body (e.g., bone, lungs).
  3. Medullary: This rare type of thyroid cancer accounts for less than ten percent of all thyroid cancers. Medullary thyroid cancer (MTC) is divided into two types: sporadic MTC and familial MTC. Sporadic MTC accounts for 85 percent of all MTC. Familial MTC is hereditary and usually develops early in life.
  4. Anaplastic: This is an aggressive, fast-growing tumor that can spread rapidly throughout the neck and to other body tissues and organs. It accounts for only 1 percent of all thyroid cancers and cannot be cured with surgery.
  5. Thyroid lymphoma: A rare type of lymphoma that originates in the thyroid.

The best nonsurgical way to determine whether or not the nodule is cancerous is with fine needle aspiration (FNA). In this biopsy, an extremely thin needle is used to remove (or aspirate) a small amount of cells from the thyroid nodule. The aspirated samples are sent to the lab where they are carefully examined for abnormalities.

During the FNA, an ultrasound is used to make sure that samples are removed from the right place. Ultrasound-guided FNA biopsies are especially useful in cases where the thyroid nodule is small.

Our surgeons are able to perform an ultrasound, fine needle aspiration (FNA), and complete patient evaluation in the same visit.

Other tests that may be used to diagnose a cancerous thyroid nodule:

  • Physical exam: The first test to look for thyroid cancer is a physical examination of your thyroid, lymph nodes, and throat.
  • Surgical biopsy: A surgical biopsy may be needed depending on the FNA results. This type of biopsy is done under general anesthesia.
  • Blood tests: Blood tests may be used to measure your levels of T3 and T4 (thyroid hormones), calcitonin, and thyroid stimulating hormone (TSH). Other blood tests include one that looks for mutations of the RET gene, a factor that can cause papillary thyroid cancer and medullary thyroid cancer (MTC).

Imaging diagnostic techniques that may be used include:

  • Thyroid ultrasound: Solid nodules are more likely to be cancerous. An ultrasound can help determine if a thyroid nodule is solid or filled with fluid.
  • Computed tomography (CT) scan: The CT scan is an X-ray test that takes many pictures of body tissue to produce detailed, cross-sectional images. This scan can help identify the size and location of the thyroid cancer and if it has spread.
  • PET scan: A positron emission topography scan can be used to look for cancerous tumor cells and see if it has spread beyond the thyroid.
  • Radioactive iodine uptake scan: This nuclear medicine test involves swallowing a small amount of radioactive iodine (it may also be injected). Once the iodine is given time to be absorbed by the thyroid gland, a special camera is used to pinpoint the location of radioactivity. Radioiodine scanning can be used after surgery to prevent cancer recurrence in papillary and follicular thyroid cancer. This is not used with medullary thyroid cancer since the cells are unable to take up radioactive iodine; however, it may be used to help destroy the rest of the thyroid tissue.
  • Octreotide scan: People with suspected medullary thyroid cancer are injected with octreotide and a radioactive substance. Imaging tests are then performed to see how much of the octreotide has been absorbed. This test is helpful in showing if a tumor is present and, if so, its size.

Our endocrinologists have received Endocrine Certification in Neck Ultrasound (ECNU) from the American College of Endocrinology (ACE). This is an advanced professional certification for physicians who perform consultations and diagnostic evaluations for patients with thyroid and parathyroid disorders using ultrasound and ultrasound-guided fine needle aspiration (FNA).

Surgery for Thyroid Cancer

Surgical removal of all or part of the thyroid gland is the most common treatment for almost all cases of thyroid cancer.

Our skilled surgeons use delicate, minimally invasive surgical techniques to remove the thyroid. This means smaller incisions, shorter recovery time, and an outpatient surgery rather than a hospital stay.

We are currently offering a number of clinical trials in thyroid cancer treatment. Learn more.

The treatment option(s) that’s best for you depends on:

  • The stage of cancer
  • Size of nodule
  • Age and health
  • Type of thyroid cancer

In many cases, complete removal of the thyroid (total thyroidectomy) is recommended. This is because the likelihood that the cancer will return in the remaining thyroid tissue is high (exception: less than one centimeter of cancer is found).

If less than 1 centimeter of cancer is found, a partial thyroidectomy may be a viable option. Benefits of a partial thyroidectomy include a lower chance that hormone therapy will be needed – compared to a total thyroidectomy which results in hypothyroidism, a condition that requires hormone replacement medication for life.

The downside to a partial thyroidectomy is that if the cancer returns, a second surgery on the thyroid gland will be needed.

Radioactive Iodine Ablation

Small amounts of thyroid tissue are sometimes left over after the initial thyroid surgery. This is done to protect your parathyroid glands as well as the nerve that controls your voice box (the laryngeal nerve). Radioactive iodine ablation is used to eliminate this remaining healthy thyroid tissue.

Radiation therapy kills cancer cells and keeps them from growing. Current methods allow doctors to precisely target cancer cells for radiation treatment. As a result, we are able to deliver the maximum amount of radiation without damaging healthy cells. Radioactive iodine is taken by mouth or injected into the body and absorbed by the thyroid tissue. Because thyroid tissue is the only thing that takes up iodine, only thyroid cancer cells and thyroid tissue are destroyed.

Nonsurgical Treatment Options

External Beam Radiation: External beam radiation accurately delivers radiation using a machine that generates high-energy rays. This type of therapy is only given in rare instances of recurrent or advanced cancer.

Chemotherapy: During chemotherapy, anti-cancer drugs are taken by mouth or injected, and reach cancer cells through the bloodstream. Chemotherapy is sometimes combined with external beam radiation therapy to treat anaplastic thyroid cancer.

Targeted Therapy: A unique type of chemotherapy, targeted therapy drugs identify the programming of cancer cells that make them different than normal cells. Targeted therapy helps prevent cancer recurrence and also keeps the cancer from spreading. It is often used in conjunction with other cancer treatments.

Our team is dedicated to clinical research. Your physician may discuss with you the possibility of joining a clinical trial, which could offer new treatment approaches that are not otherwise available.