What is it about ?
The thyroid is a small, butterfly-shaped gland that sits at the base of the neck, just below the Adam’s apple. It produces thyroid hormones (T3 (triiodothyronine) and T4 (thyroxine)) which stimulate metabolism.
If a malignant tumor develops in the thyroid, it is called thyroid cancer.
There are several forms of thyroid cancer. The majority of thyroid cancers are papillary cancers and follicular cancers (more or less 9 times out of 10). These two types of thyroid cancer usually grow slowly and have a good prognosis: after 10 years, 9 in 10 people are still alive with papillary cancer and around 7 in 10 with follicular cancer.
If after treatment foci of malignant cells are found elsewhere in the body (metastases), it is usually within 3 years after the first treatment. With papillary cancer, metastases are most often found in the lymph nodes (usually the neck area) and lungs, while with follicular cancer they develop in other organs such as the lungs and bones. .
What is its frequency?
Thyroid cancer is rare, but it is the most common cancer of the hormonal system. The number of diagnoses has increased in recent years, and in Belgium and many other European countries it is one of the most increasing cancers. In 2017, the Cancer Registry Foundation registered 1,038 new cancer cases in Belgium, including 751 in women and 287 in men.
How is it treated?
Standard treatment most often involves surgery to remove the thyroid gland (= ablation) almost completely. Radioactive iodine treatment is started 3 to 12 weeks after the operation.
Thyroid cells are the only cells in the body that absorb iodine from the blood. By using radioactive iodine, thyroid cells can be irradiated in a very targeted manner, including metastases. The iodine that is not absorbed is simply eliminated with the urine. If it is a small tumor (with a diameter of less than 1 cm), an operation is sufficient, and treatment with radioactive iodine is often not necessary.
After surgical removal of the thyroid, you must take thyroid hormone (thyroxine) for life. You will start this treatment with the endocrinologist. He will follow you for the first 5 years. The dose is adjusted according to the level of certain thyroid hormones in the blood: TSH (thyroid stimulating hormone), free T4 and sometimes also free T3.
How is the follow-up carried out?
By the specialist
For the follow-up of patients with thyroid cancer, there are specialized care follow-up protocols. All patients are in any case followed by a specialist endocrinologist for 5 years after the first treatment. This follow-up consists mainly of blood samples, to check the thyroid values, and an ultrasound of the neck region, to detect local recurrences or metastases. If the first treatment did not eliminate the disease, additional doses of thyroxine are given to stop the growth of the remaining cancer cells.
By the general practitioner
The general practitioner can take over after, once you are considered to have recovered from papillary or follicular-type thyroid cancer. The general practitioner should regularly renew the prescription for thyroxine and, during consultations, monitor the patient’s general state of health and detect any symptoms or signs of too high a dose of thyroxine.
The signs of a overactive thyroid (hyperthyroidism) are the following :
- Hypersensitivity to heat,
- Sweat,
- Tired,
- Weak muscles,
- Poor physical condition,
- Hand tremors,
- Weight loss (even with a good appetite),
- Hot and humid skin,
- Diarrhea,
- Accelerated heart rate,
- Irritability, nervousness,
- Insomnia.
Each year, the general practitioner also measures the following values in the blood: TSH, free T4 and thyroglobulin (Tg). The blood levels of TSH and free T4 are monitored. Their values indicate whether the medicine (thyroxine) that replaces the body’s thyroid hormone is being given at the correct dose. Thyroglobulin (Tg) is a type of tumor marker; an increase in the level of thyroglobulin indicates a recurrence of the tumor.
In addition to the annual blood test, the general practitioner also examines the neck every year for abnormalities. During the first 5 years of follow-up by the general practitioner, an ultrasound of the neck area is performed every 2 to 3 years. Then an ultrasound every 5 years is enough.
If the level of thyroglobulin in the blood increases or if the general practitioner finds abnormalities when examining the neck or during an ultrasound, he will refer the patient to the specialist.
Want to know more?
- Thyroid cancer – Cancer Foundation
- Ultrasound here Where to find on this page of Cliniques St Luc UCL
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