What You Should Know About Thyroid Cancer

Tiny thyroid growths in your throat may be over-treated. But you still need to see your doctor about symptoms of thyroid cancer, such as lumps or hoarseness.

You’ve heard the advice: It’s best to find and treat cancer at the earliest possible stage. That said, some early-stage tumors may never spread or threaten your health.

Thyroid cancer is a case in point.

That’s one reason the United States Preventive Services Task Force (USPSTF) recommends against screening for thyroid cancers. Your doctor doesn’t need to check your neck by hand (or use ultrasound) to find lumps — unless you report discomfort.

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Sitting at the base of your throat, the thyroid gland produces hormones to help regulate your heart rate, blood pressure, body temperature, and weight. It tends to develop tiny asymptomatic lumps.  

Any lump could go on to grow, often leading to a biopsy and surgery. In one survey, endocrinologists, worried about overtreatment, said any thyroid cancer discovery "opens Pandora's box." Patients hear “cancer” and assume they need surgery.

In fact, the USPSTF concluded that screening led to overtreatment, since most thyroid cancers don’t need to be removed. Although diagnoses tripled after doctors began using ultrasound diagnostic devices and needle biopsies, the ensuing treatment hasn’t appeared to save lives.

Later research demonstrated that women are more than four times as likely as men to be diagnosed with small papillary thyroid cancers that are unlikely to cause problems during their lives.  

They’re often teens and women in their 20s, and any side effects from unnecessary treatment can affect their lives for decades. “There’s definitely a risk for harms to these women,” says Megan Haymart, MD, an endocrinologist and thyroid cancer specialist at the University of Michigan.

If a woman undergoes surgery to remove part or all of the thyroid gland (a thyroidectomy), she may need hormone replacement indefinitely. The surgery could damage her vocal cords or nearby salivary glands, causing chronic dry mouth.

Meanwhile, if the cancer hadn’t been diagnosed, she might have died at a ripe old age without knowing it existed.

As the task force points out, autopsy studies show that a third of adults who die from other causes have small, unnoticed thyroid cancers. Although doctors think thyroid cancer is more common in women, that’s not the case in autopsy studies. The prevalence of aggressive, deadly thyroid cancers is also the same in men.  

There is still debate about screening for lumps that create no symptoms and about how aggressive treatment of early cancers should be.

Experts do, however, agree that you should see your doctor as soon as possible if you do have any danger signs.

Symptoms of thyroid cancer include:

• A lump in your neck, which could be a swollen lymph node associated with an infection
• Swelling in your neck
• Pain in the front of your neck
• Hoarseness or other unexplained voice changes that don’t go away (Laryngitis tends to get better in about a week.)
• Difficulty swallowing
• Trouble breathing
• A chronic cough not linked to any cold or flu symptoms, such as gastrointestinal reflux disease

You might have a growth that isn’t cancer, and even if you do your doctor will likely decide just to monitor the growth over time.

If you have a malignancy that needs treatment, thyroid cancer is highly treatable. Five-year survival rates are high for all types, except the rarest form.

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