First, the medical history is taken and the thyroid gland is examined by palpation. The attending doctor initiates the appropriate examinations (blood test, scintigraphy, etc. ) as necessary.
The main therapeutic options are surgery and radioiodine treatment.
How is thyroid cancer diagnosed?
Various examination options are available to clarify thyroid diseases – from blood tests to fine-needle aspiration.
In each case, the thyroid hormones T3 and T4 as well as TSH are determined to check the thyroid function. However, only medullary thyroid carcinoma can be detected by an increase in the calcitonin level in the blood. Calcium levels are also determined. Further information on laboratory values can be found in the laboratory values table.
Most thyroid diseases show typical abnormalities in the Ultrasonic. If thyroid cancer is suspected or during follow-up care after an operation, the cervical lymph nodes are also checked in the same examination. If abnormalities are found in the ultrasound, further examinations such as scintigraphy or, if necessary, a fine needle puncture are arranged.
In thyroid scintigraphy, a radioactively labeled carrier, a radiopharmaceutical, is injected into a vein and then enters the thyroid through the bloodstream. With a special gamma camera, the radiation emitted by this carrier substance can be measured and an image of the thyroid function can be generated. Depending on the metabolic activity of the organ, the image produced, the scintigram, is more or less intense. If the ultrasound examination reveals lumps in the thyroid gland. They can be assessed in terms of their function:
- “Warm” nodes: do not differ from the rest of the thyroid tissue and take part in normal hormone production.
- “Hot” nodes (autonomous nodes): produce too many thyroid hormones regardless of the body’s own control.
- “Cold” nodes: do not participate in the metabolism. About five percent of cold lumps are due to thyroid cancer.
Fine needle puncture
If the suspicion of thyroid cancer is confirmed, a cytological examination of the affected tissue must be carried out. With the ultrasound-targeted fine needle puncture of a thyroid nodule, its cells can be assessed under the microscope. Degenerate cells are an indication of thyroid cancer. After disinfecting the skin and locating the lump with the ultrasound head, a needle is inserted through the skin directly into the lump. With the help of an attached syringe, cells or cell clusters are obtained. These are examined by the pathologist.
The examination is not entirely painless, but in most cases, local anesthesia is not required. The cells or cell aggregates obtained by a puncture can sometimes also be examined at the molecular level and thus provide important information for targeted therapy – for example in the case of undifferentiated (anaplastic) thyroid carcinoma.
A laryngoscopy is also performed before and after an operation because of the risk of vocal cord paralysis. Further investigations may be necessary.
With poorly differentiated thyroid carcinoma as well as the medullary thyroid carcinoma is also increasing PET-CTs used for diagnostics.
As with other types of tumors, the stage of the tumor is determined according to the so-called TNM classification. Further examinations are carried out to clarify the spread of the tumor, e.g. throat ultrasound and radioiodine whole-body scintigraphy, CT of neck and thorax Rib cage
Continue reading, rarely one Skeletal scintigraphy.
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How is thyroid cancer treated?
Depending on the type of cancer, the thyroid gland may be completely or partially surgically removed, including the cervical lymph nodes. In either case, the entire tumor must be removed. To remove residual thyroid tissue and possibly tumor residues or MetastasesTo to destroy the tumor, radioiodine therapy with iodine-131 is carried out after the operation, depending on the stage of the tumor. This must be done in an inpatient setting, the patient is isolated due to the radiation.
Chemotherapy and radiation therapy are used in the late stages, for aggressive tumors. After the operation and radioiodine therapy, thyroid hormone replacement therapy – often lifelong – is essential. Treatment plans should be discussed in a so-called tumor board, which is made up of specialists in the respective field. Lymphomas, teratomas (germ cell tumors), or fibrosarcomas (connective tissue tumors) of the thyroid gland are rare and require specific therapeutic measures depending on the type and spread of the tumor.
If a cure for thyroid cancer is no longer possible, measures are taken by Palliative medicine taken to support and keep the quality of life as high as possible.
Helpful questions for the doctor’s visit
The evidence-based, English-language support system for clinical decisions UpToDate has put together helpful questions about therapy that can be clarified with the treating physicians in its information on thyroid cancer for patients
- What are the benefits of the treatment? Will I live longer through this? Are symptoms decreasing or are they being prevented?
- What are the side effects of the treatment?
- Are there any other treatment options?
- What will the consequences be if I do not take the suggested treatmen
Which type of operation is used depends on the type and extent of the tumor. In many cases, the thyroid gland is completely removed (total thyroidectomy). If necessary, only part of the thyroid is removed, for which there are several types of surgery. It may also be necessary to remove nearby lymph nodes. In any case, the entire tumor must be removed.
If the thyroid gland is removed, thyroid hormones must be taken for life to be adequately supplied with these hormones. Calcium intake may also be necessary if the parathyroid glands have also been removed. Before the operation, your doctor will explain the procedure and possible risks to you. After the operation. Blood values will be checked at close intervals.
When treating with radioiodine (radioiodine therapy), remnants of thyroid tissue and any existing metastases should be destroyed after the operation. Even after the thyroid gland has been completely removed, remnants of this hormonal gland can be detected. In radio-iodine therapy, a capsule containing radioactive iodine-131 is taken. The radioactive iodine is absorbed in the intestine and reaches the thyroid gland or the remaining thyroid cells via the blood. The dosage of radioactive iodine-131 is adapted to the respective patient. Stored there, it irradiates the thyroid gland or the remaining thyroid cells “from the inside”. This destroys the affected thyroid tissue.
This therapy is particularly useful for papillary and follicular thyroid carcinoma. I.e. differentiated thyroid carcinoma, since these types of tumors store iodine and thus specifically damage the cells concerned – while protecting other organs as much as possible. Your doctor will advise you on the exact course of the therapy. Which also requires an adaptation of the thyroid medication. As well as possible side effects ( e.g. reduced salivation). Radioiodine therapy can also be used in the course of further illness and, if necessary, also for diagnostic purposes. The treatment takes place in the hospital in a specially equipped station for nuclear medicine. Blood values will be checked regularly after the treatment
Radiotherapy (radiation therapy)
Radiotherapy (radiation therapy) means irradiation with ionizing radiation from the outside. Radiation therapy is used to destroy tumor cells or metastases that may have remained in the operating area. Radiotherapy also takes place if the tumor foci that remained after the operation could not be adequately combated with radioiodine therapy. The radiation should only kill the tumor tissue but spare the surrounding tissue as much as possible. The irradiation is therefore carried out in a very targeted manner according to precise calculations. Radiation therapy can be carried out on an outpatient or inpatient basis. If this makes sense, it is sometimes combined with chemotherapy. Your doctor will inform you precisely about the course and side effects of the therapy.
Tyrosine kinase inhibitors
Tyrosine kinase inhibitors (TKI for tyrosine kinase inhibitor) are among the more recent drugs for combating advanced thyroid cancer. They are taken up by the tumor cells and blood vessel cells. There they are supposed to block signaling pathways that are required for tumor growth. The tumor is no longer adequately supplied with blood; in the ideal case, it no longer grows or can even regress. Tyrosine kinase inhibitors for the treatment of thyroid cancer inhibit several signaling pathways and are therefore called multi-tyrosine kinase inhibitors. They are taken as a tablet.
Lenvatinib and sorafenib are currently used for differentiated thyroid cancer that does not respond adequately to radioiodine therapy; Cabozantinib and vandetanib in medullary thyroid cancer. It has not yet been scientifically proven that TKI increases survival time in advanced thyroid cancer. The decision about this therapy should therefore be carefully considered. Your doctor will inform you precisely about the course and side effects of the therapy.
Chemotherapy plays a rather subordinate role in the treatment of thyroid cancer. It is currently only used for anaplastic thyroid carcinoma or when tyrosine kinase inhibitors do not affect advanced thyroid carcinomas. Since “classic” chemotherapy is rather unspecific. It not only damages the tumor but also other cells. Your doctor will discuss with you how the chemotherapy is carried out and which appears to be useful – as well as the side effects and how they can be alleviated. In anaplastic thyroid carcinoma, for example, doxorubicin, docetaxel, or cisplatin are currently used. However, further clinical studies are necessary for the most effective treatment possible.
How is follow-up care for thyroid cancer carried out?
After surgery and possible radio-iodine therapy of a malignant thyroid tumor, close follow-up checks are necessary to prevent or identify in good time a recurrence or spread of the disease. Thyroid cancer tends to recur, so follow-up care is necessary for life. In addition to the determination of thyroid hormones and an ultrasound of the neck region, the tumor markers thyroglobulin and thyroglobulin antibodies for differentiated thyroid carcinomas and calcitonin for medullary thyroid carcinomas serve as parameters for a recurrence of cancer. Further information on laboratory values can be found in the laboratory values table.
Whom can I ask?
Several medical specialties are involved in the diagnosis and treatment of thyroid cancer. If you have any abnormalities or warning signals, contact your general practitioner. The latter initiates further clarification, in which, among other things, specialists in nuclear medicine, internal medicine, and surgery are called in. If you are already undergoing treatment or follow-up care, regular appointments will be made with the treating doctor.
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