Comprehensive Thyroid Cancer Care
A cancer diagnosis can be devastating even if it does not end up causing
severe sickness or death. There is no such thing as a “good type
Our doctors at the Thyroid Institute of Utah are thyroid cancer experts
and are determined to achieve
Freedom from Thyroid Cancer for all of our patients. Not only free from cancer in the body, but also
free from the anxiety caused by being a thyroid cancer survivor.
How we care for you
Our doctors have developed tremendous experience and expertise in thyroid
cancer diagnosis and treatment. Our endocrinologists have performed
more than 5000 thyroid biopsies, and our surgeons have performed
thousands of thyroid surgeries.
We personalize the care to YOU, and do not use a one size fit all system. Recent advances in medicine
and genetics allow as to treat YOUR thyroid cancer specifically, and not
thyroid cancer in general. Due to the wealth and constant expansion of
only doctors specialized in thyroid cancer and thyroid diseases are able
to utilize the appropriate tools to provide you with the best outcomes.
We have a
team of experts from different specialties caring for you.
You can rest assured that the surveillance of your thyroid cancer will
be performed by a
thyroid cancer expert endocrinologist, who is also an expert ultrasonographer. Thus, big malignant neck metastases and recurrence (cancer coming back)
will not be missed and will be treated promptly. For reasons discussed
in the comprehensive thyroid nodule care section, the quality of ultrasound
is much lower if done by most radiology departments.
We are able
to offer the latest treatment that fits your needs, and are also able to recommend to
avoid treatment when it is not necessary. This is particularly important in our day and age, as overwhelming evidence
is pushing towards less surgery, less radioactive iodine, and more active
surveillance. You need an expert to know when you need treatment, but
also when you should not get treatment.
The vast majority of our patients get better, and are able to lead a
normal and joyful life.
See below for more details about the Comprehensive Thyroid Cancer Care
at the Thyroid Institute of Utah
What are the symptoms of Thyroid Cancer?
Most people with thyroid cancer will not notice any symptoms, until the
cancer is very big. The most common noticeable finding is a lump in the
thyroid (thyroid nodule), that is felt by you or your doctor (sometimes
it can be seen in the mirror).
When you have a thyroid nodule, symptoms that raise high suspicion for
thyroid cancer include:
- Hoarseness/Voice change
- Difficulty swallowing
- Breathing problems (especially when lying flat)
- Persistent pain in the lower part of the front of the neck
- Persistent unexplained cough
If you feel a lump in your neck, please see a thyroid specialist as soon
as possible, especially if you also have at least one of these symptoms.
Types of Thyroid Cancer
There are many types of thyroid cancer. Some of them are more aggressive
- Papillary Thyroid Cancer. This is by far the most common type, and has
many variants. It is usually (but not always) slow growing and curable.
- Follicular Thyroid Cancer. This is seen in much fewer people. It tends
to be a little more aggressive than papillary thyroid cancer, but is is
also usually slow growing and treatable.
- Hurthle Cell Carcinoma. This is rare, and can be harder to treat if not
- Medullary Thyroid Cancer. This is a unique type of thyroid cancer, as it
comes from neuroendocrine cells that do not produce thyroid hormone. Many
times, we see this cancer as part of genetic syndromes. It is less frequently
curable, but usually treatable, if treated by a thyroid cancer specialist.
- Anaplastic Thyroid Cancer. This usually develops from a papillary or follicular
thyroid cancer, and is extremely aggressive. It can lead to death in weeks
to months, but recent advances have decreased the number of people dying
from this. This diagnosis is an emergency, and treatment should not be
delayed even for 1 day.
There is no such thing as a “good type of cancer”. If you are
diagnosed with any of these types of thyroid cancer, or you are at high
risk for thyroid cancer, it is imperative that you see a thyroid cancer
specialist to receive appropriate care. We will work with you to identify
the best treatment strategy.
Am I at risk for thyroid cancer? Should I get thyroid cancer screening?
Each type of thyroid cancer has its own risk factors.
Risk factor for Papillary Thyroid Cancer
- Family history of papillary thyroid cancer, especially if more than 1 family
member has been affected.
- Radiation exposure (radiation treatments at or close to the neck, exposure
to nuclear fallout), especially during childhood
- Specific genetic syndromes, such as familial adenomatous polyposis, etc
- Gender (more common in women, but usually more aggressive in men)
Risk factors for Follicular and Hurthle Cell Thyroid Cancer
- Iodine deficiency, especially while growing up
- Specific genetic syndromes, such as Cowden’s syndrome, etc
Risk factors for Medullary Thyroid Cancer
- Family history of Medullary Thyroid Cancer, or a genetic syndrome called
MEN2 (a or b), due to an inherited mutation in a gene called RET
If you have any of the above risk factors, you are at higher risk for thyroid
cancer. The Thyroid Institute of Utah can help you diagnose and find the
best treatment strategy.
Diagnosis of Thyroid cancer
The diagnosis is made with Ultrasound Guided Fine Needle Aspiration (FNA)
Biopsy. Please see our “Comprehensive Thyroid Nodule Care”
(link) section for further details about thyroid cancer diagnosis.
Thyroid Cancer Treatment
At the Thyroid Institute of Utah, we individualize thyroid cancer treatment
to your needs. We review the characteristics of the tumor, we take into
account if the tumor has spread and at which locations, your overall health
and preferences, and, when needed, we evaluate the genetic makeup of the
tumor. We then provide you with treatment options based on those.
This is recommended for very small thyroid cancers, which are less than
1 cm in size. It is well known that 98-99% of these tumors will not get
bigger or spread, so surgery is not needed.
More recent evidence has shown that surveillance may be an option for larger
tumors, up to 2 cm. However, more research is needed before this can be
incorporated into practice, and we would only recommend this in select cases.
The first line treatment for thyroid cancer is thyroidectomy (surgery to
remove the thyroid). Recent data has shown that it is better to remove
the whole thyroid (total thyroidectomy) for larger cancers, but it is
ok to remove half the thyroid (hemithyroidectomy) for smaller non-aggressive
cancers without evidence of lymph node spread on ultrasound. Lymph nodes
have to be removed from the neck if they are suspicious for metastases.
The decision making process is complex, and it is best made in association
with a thyroid cancer specialist who performs and is experienced in in-office
ultrasound, and with an experienced thyroid surgeon.
Radioactive iodine (RAI) is a very important and useful treatment option
for patients with, or at high risk of recurrence. However, recent data
indicate that less patient’s need radioactive iodine treatment,
and increase expertise is required to identify which patient truly needs
RAI, and what dose. Read our article about Radioactive Iodine (link) for
Call (801) 396-0594 to talk to our medical staff about your thyroid problem.
Advanced Thyroid Cancer Treatment
Most people with thyroid cancer do very well after surgery +/- radioactive
iodine. However, so patients have a recurrence (tumor comes back) after
treatment. When there is recurrence, most tumors are slow growing, and
some don’t grow at all. Unfortunately, some of these tumors grow
faster as the cancer gets more advanced.
Treatments for advanced thyroid cancer include:
- Repeat surgery, if there is a good chance the tumor can be removed and
cure the patient
- High dose radioactive iodine
- External beam radiation therapy. This is different than radioactive iodine,
and is recommended if the cancer is only in one place, and it does not
get better with surgery or radioactive iodine treatment
- Targeted systemic therapy. In the past there was no good medicine for thyroid
cancer. However, there are now new medications that have been shown to
be very effective in controlling the thyroid cancer, and keeping it at
bay at least for a significant period of it.
- Chemoradiation. This is not very effective for regular thyroid cancer,
but it may be lifesaving for anaplastic thyroid cancer.
- Bone medication. These are osteoporosis medications at higher doses, and
can help prevent fractures, and treat thyroid cancer, if it has spread
to the bones.
At the Thyroid Institute of Utah, our specialists care for many patients
with Advanced Thyroid Cancer. Here, you can benefit from a team of doctors
who can offer all of the above treatments. You can also rest assured that
we can help you decide if you need treatment now, or if it is better to
delay treatment for a later time.
Long Term Follow up of Thyroid Cancer
After you have completed treatment for thyroid cancer, we perform surveillance
to make sure it does not come back. The frequency of the monitoring and
extent of the tests relies on the following factors:
Thyroid Cancer Risk Stratification
- Low-Risk Thyroid Cancer: These are typically small cancers that have not
spread outside the thyroid
- High-Risk Thyroid Cancer: These are typically cancers that have spread
beyond the thyroid, or cancers that grow fast
Response to Therapy
- Excellent response: An excellent response is when there is no evidence
of thyroid cancer during follow up (negative blood tests, ultrasounds,
Incomplete response: An incomplete response is when there is evidence of
thyroid cancer during follow up
- Biochemical incomplete response: Blood test is positive, but imaging is negative
- Structural incomplete response: Imaging is positive for thyroid cancer
No matter what is the Thyroid Cancer Risk, or the Response to Therapy,
our doctors will offer treatment options and a monitoring plan.
Shahzad Ahmad, MD.
Servicing Draper and Provo
Jules Aljammal, MD
Servicing Lehi and Salt Lake City
Konstantinos Segkos, MD
To discuss your case with our doctors, contact the Thyroid Institute of Utah.