Understanding Thyroid Cancer
Members of the Philippine Thyroid Cancer Survivor Inc. pose for a photo op in one of the gatherings they usually hold to show its support to its members who are undergoing treatments for thyroid cancer or its symptoms.
Thyroid cancer may have a low incidence
rate worldwide but here in the Philippines it is the 7th leading form of cancer
among Filipinos with an estimated 3,024 new cases in 2012.
According to the World Health
Organization’s International Agency for Research, in 2012 the country has
recorded at least 865 deaths due to thyroid cancer, which accounts for the 1.5
percent of cancer related deaths, and in five years new thyroid cancer cases
will reach to 11,280 each year.
Though it can occur in any age group,
thyroid cancer is most common among women between 20 to 44 years old. It is three
times more common in females than in males and its aggressiveness significantly
increases at age 30 and in older patients.
Importance of early diagnosis and treatment
Thyroid cancer is a malignant growth of
tumor in the thyroid gland. The thyroid is a small, butterfly-shaped gland
located at the front of the neck right below the throat. The thyroid gland secretes
thyroxine, a hormone responsible for the regulation of metabolic rate, blood
sugar, heartbeat and renal functions.
According to the Thyroid Cancer
Association, Inc., (TCAI), “Many patients, especially in the early stages of
thyroid cancer, do not experience symptoms. However, as the cancer develops,
symptoms can include a lump or nodule in the front of the neck, hoarseness or
difficulty speaking, swollen lymph nodes, difficulty swallowing or breathing,
and pain in the throat or neck.”
Although thyroid cancer is generally
slow-growing and curable,2,3 up to 30% of patients can still experience recurrence.
Together with early diagnosis and appropriate treatment, life-long compliance
to follow-up is critical to detect persistent and recurrent disease.
There are different types of thyroid
cancer, the most common being the Papillary variant, which accounts for around
80% of cases. The other types are Follicular (around 10% of cases), Medullary
(around 4%) and Anaplastic (2%).
Disease management
The primary treatment for thyroid cancer is
thyroidectomy, which is the surgical removal of the thyroid gland.
After the removal of the thyroid, to
effectively wipe out remnants of cancer tissues and any other thyroid gland
tissue, doctors usually advise radioactive iodine (RAI) treatment.
To effectively monitor for persistence and recurrence
of disease, patients undergo follow-up using Thyroglogulin (Tg) blood tests,
neck ultrasound tests and diagnostic RAI whole-body scans.
It must be noted that since patients already
have the thyroid gland removed, the body will no longer produce thyroid
hormones, hence patients will need thyroid hormone replacement therapy with
levothyroxine to prevent hypothyroidism for the rest of their lives, in order
to compensate for the loss of thyroxine in their bodies.
However, in preparation for procedures
involving RAI (treatment and diagnostic whole-body scan), doctors require
patients to undergo thyroid hormone withdrawal (THW), or the suspension of
levothyroxine, in order to elevate levels of thyroid stimulating hormone or
TSH. Elevated levels of TSH enables effective absorption of RAI in the thyroid
bed.
RAI destroys remnant tissues and is useful in monitoring for cancer tissue
recurrence THW for patients usually takes 4-6 weeks. With the absence of a national consensus
across the different healthcare professionals involved in thyroid cancer
management, approaches in the care of patients vary per institution and per clinic.
Hence, standardized and optimized treatment8 might not be offered to all thyroid
cancer patients.
HYPOTHYROIDISM
Symptoms to watch out for during THW9
Aside from health consequence, hypothyroidism
may affect a patient’s life in different ways —work performance, decision
making, self-image, social activities, and the long term effect on the
patient’s body.
The most common symptoms to watch out for
are:
Physical
Less energy, fatigue
Cold intolerance
Drier skin and coarser hair
Mild weight gain (5-20 lbs)
Puffiness around the face (especially the
eyes), hands, ankles, due to fluid build up
Mental
Slower mental function, irritability
New or worsening depression
Cardiovascular
Slowing of heart rate
Slightly higher blood pressure
Higher cholesterol levels
Hypothyroidism does not just cause
symptoms; it can make other health conditions worse.
Treatment options
To avoid the consequences of hypothyroidism,
patients have the option to use synthetic TSH* to keep them on levothyroxine
thus preventing the symptoms and complications caused by hypothyroidism The effect of synthetic TSH is the same as the
natural elevation of TSH following THW.
It can stimulate remnant thyroid cells (whether normal or malignant) and
to absorb iodine that is found in the blood stream, including RAI.
Patient support
*Synthetic TSH is a prescription medicine
which can only be given by a doctor after assessments are done to patients in
order to determine disease condition, suitability and other relevant factors.
Dr. Roberto Mirasol, a well-respected
endocrinologist, and the Chief of the Section of Endocrinology, Diabetes and
Metabolism at St Luke's Medical Center poses with thyroid cancer survivor Janis
Franchesca Celicious. Mirasol shares his knowledge about thyroid cancer,
available treatment options, and hypothyroidism during a press conference held
recently in Manila. Mirasol is also the Chief of the Section of Endocrinolgy,
Diabetes and Metabolism at the Manila Doctors Hospital and the Head of the
Diabetes and Thyroid Clinic at the Rizal Medical Center. Meanwhile, Celicious
also shares with the media the ordeal she went through when she was diagnosed
with thryroid cancer, and how she survived and triumph over her illness.
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