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General Surgery

Thyroid Cancer

Thyroid cancer arises from the abnormal growth of cells in the thyroid gland, forming nodules or tumors that may affect hormone production. Most thyroid cancers, especially when detected early, have a very high cure rate.

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ℹWhat is Thyroid Cancer?

The thyroid gland is a butterfly-shaped endocrine gland located at the base of the neck, just below the Adam's apple. It produces thyroid hormones that regulate heart rate, blood pressure, body temperature, and metabolism.

Thyroid cancer develops from the uncontrolled proliferation of thyroid cells. The main subtypes include Papillary (most common), Follicular, Medullary, and Anaplastic carcinoma. Papillary and Follicular types, collectively known as differentiated thyroid carcinomas, generally carry a favorable prognosis. Anaplastic carcinoma is the most aggressive form.

Papillary and Follicular types originate from the follicular cells that produce T3 and T4 hormones. The papillary type is more common. Medullary Thyroid Cancer, on the other hand, originates from parafollicular C cells that secrete calcitonin, a hormone involved in calcium regulation.

Common Symptoms

Lump or Swelling in the Neck
The most common symptom. It is noticed as a rapidly growing, palpable hard nodule or lump in the front of the neck, below the Adam's apple.
Voice Changes
Hoarseness or cracking of the voice. This occurs when the tumor affects the nerves controlling the vocal cords.
Difficulty Swallowing (Dysphagia)
A sensation of something stuck in the throat or difficulty eating begins to be felt due to the pressure of the mass.
Shortness of Breath
Develops due to the pressure exerted by the tumor on the windpipe (trachea); wheezing may begin to be heard.
Pain in the Neck or Throat
Sometimes the pain can radiate as far as the ears.

Diagnosis Methods

Physical Examination
Assessment of size, hardness, and mobility of the mass in the neck and regional lymph nodes.
Thyroid Ultrasonography
The most important imaging method for evaluating the size, structure, margin regularity of the nodule, and the presence of microcalcifications.
Fine Needle Aspiration Biopsy (FNAB)
A cell sample is taken from the nodule with a needle for definitive diagnosis and examined pathologically.
Serum Thyroid Hormone Levels
Thyroid function is evaluated by measuring TSH, free T3, and free T4 levels.

Causes

Radiation Exposure
Radiotherapy applied to the head and neck region during childhood increases the risk of thyroid cancer.
Genetic Predisposition
A family history of thyroid cancer or MEN (Multiple Endocrine Neoplasia) syndromes are risk factors.
Iodine Deficiency or Excess
Imbalance in dietary iodine levels can affect the risk of certain types of thyroid cancer.
Gender and Age
It is seen 2-3 times more frequently in women than in men. The most common age range is between 25-65 years.

Treatments

Surgical Treatment (Total Thyroidectomy)
The complete removal of the thyroid gland. It is the most preferred method today. If the cancer is small and limited to one lobe, a lobectomy may also be performed.
Lymph Node Dissection
If the cancer has spread to the lymph nodes in the neck or if the risk of metastasis is high, the lymph nodes in the neck are removed.
Radioactive Iodine (RAI) Therapy
Used particularly in Papillary and Follicular Type Thyroid Cancer to destroy microscopic cancer cells remaining after surgery. The patient takes a capsule or liquid containing radioactive iodine.
Hormone Replacement Therapy
After the thyroid gland is removed, patients use Levothyroxine for life. This medication both meets the hormone requirement and reduces the risk of recurrence by suppressing TSH levels.
Radiotherapy and Chemotherapy
Generally preferred in advanced stages and Anaplastic Type cases where surgery and radioactive iodine therapy are insufficient.
Targeted Therapy (Smart Drugs)
These are Tyrosine Kinase Inhibitors that block specific growth factors (such as VEGF, RET, BRAF) that drive tumor growth. Lenvatinib and Sorafenib are used in RAI-resistant cases, Selpercatinib in Medullary Type, and Dabrafenib+Trametinib in Anaplastic Type.

Prevention

Regular Neck Check-ups
Regular neck examinations and ultrasonography are recommended, especially for individuals with a family history of thyroid cancer.
Radiation Protection
Exposure to unnecessary radiation should be avoided, and caution should be exercised regarding radiological procedures performed on the head and neck region, particularly during childhood.
Genetic Screening
RET gene mutation screening should be performed in those with a family history of Medullary Thyroid Cancer or MEN syndrome.
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