Thyroid cancer is a form of cancer that affects approximately 53,000 Americans annually. The thyroid is a small gland at the base of your neck responsible for creating thyroid hormones. These hormones’ primary function is to help control your metabolism, specifically your metabolism’s speed – called metabolic rate.

Detecting thyroid cancer

Unfortunately, thyroid cancer can be difficult to detect as a majority of people with thyroid cancer are asymptomatic at the time of presentation. “We most frequently discover thyroid cancer on imaging for another reason,” says surgical oncologist Abbey Fingeret, MD. “These are called incidental findings, where we were looking for something completely unrelated and discover thyroid cancer.”

Still, patients who have thyroid cancer that’s grown or progressed to a larger size without being detected may experience:

• Neck pressure
• Difficulty swallowing
• Changes in voice

Types of thyroid cancer

Because several different kinds of cells comprise the thyroid, there are multiple types of thyroid cancer. “The type of thyroid cancer you have depends on the specific cell type that has turned into cancer,” says Dr. Fingeret.

The most common types of thyroid cancer are part of what’s called the well-differentiated cancer family. Types of well-differentiated thyroid cancers include:

• Papillary
• Follicular
• Oncocytic

Medullary thyroid cancer is another common type of thyroid cancer that’s often associated with inherited disorders, especially compared to other well-differentiated thyroid cancers.

Risk factors for thyroid cancer

“Compared to most other cancers, thyroid cancer is a cancer of younger people,” says Dr. Fingeret. “The highest proportion of people who get thyroid cancer are in their 40s and 50s, with the most common age for a diagnosis being approximately 51.”

Most people think of cancer as primarily a disease in older people. Still, according to Dr. Fingeret, providers often find thyroid cancer in people in their teens and 20s. However, it’s most common in middle-aged people. Thyroid cancer is also more common in women than in men. “We see thyroid cancer affect women approximately four times more frequently than men,” says Dr. Fingeret.

Another significant risk factor for thyroid cancer is radiation exposure. Note that this exposure isn’t from X-rays or CT scans. Instead, it applies to people who have had radiation for a medical treatment, specifically to the head or neck area. Likewise, this risk is relevant for those who’ve had occupational radiation exposure, like those who’ve worked in a nuclear power plant.

Finally, people with a strong family history of thyroid cancer are more at risk, specifically for the types of thyroid cancer linked to genetics, like medullary thyroid cancer.

Detecting thyroid cancer

There are two ways to evaluate the thyroid gland: a blood test and imaging. “The blood test checks for hormone levels to tell us whether the thyroid is functioning,” says Dr. Fingeret. “But the blood test can’t tell us about the thyroid’s shape or if it has nodules that may be cancerous.”

“That’s why the most important test for detecting thyroid cancer is an ultrasound,” says Dr. Fingeret. “Through an ultrasound, we can look at your thyroid’s shape and the presence of any nodules, which could have cancer.”

A nodule is any spot on the thyroid that looks different than the surrounding thyroid on imaging – either an ultrasound or CT scan. These nodules are quite common, with about half of adults developing a thyroid nodule later in life. Still, the presence of nodules doesn’t always indicate the presence of thyroid cancer. “Only about 10% of thyroid nodules are cancer,” says Dr. Fingeret.

Treating thyroid cancer

Your health care provider can form a treatment plan after imaging your neck, thyroid and surrounding lymph nodes. “Almost all thyroid cancer, when detected, is confined to the neck and potentially the lymph nodes,” says Dr. Fingeret. “It is uncommon to have spread to another place in your body.”

Because of the typically confined nature of thyroid cancer, the primary treatment is surgery. “This surgery involves the removal of at least the half of the thyroid that contains the cancer,” says Dr. Fingeret. “With small, low, or intermediate thyroid cancers – cancers less than four centimeters, with no growth outside the thyroid, and no obvious lymph node involvement – we can safely treat these patients by removing half of their thyroid.”

While some patients may require a complete removal of their thyroid, there are benefits to removing only half. “Removing half the thyroid results in slightly fewer surgical complications, and your remaining thyroid tissue can continue making thyroid hormones,” says Dr. Fingeret.

If surgeons remove your entire thyroid gland, you’ll need to take medication to replace the function of your missing thyroid. Even if you retain half your thyroid gland, you may still need medication to supplement what your thyroid is producing.

The downside of removing only half of your thyroid is that, at some point, you may need to have the other half removed. “At Nebraska Medical Center, about 10% of patients in whom we remove half their thyroid gland for cancer must eventually return to have the other half removed,” says Dr. Fingeret.

“Typically, we will bring a patient back because there’s something on their final pathology report that shows they have a higher-risk cancer than we first suspected based on initial imaging,” says Dr. Fingeret.

When determining whether you need a half or total thyroidectomy, your Nebraska Medicine team will concentrate on your specific needs and desires. “We focus on what’s right for every individual based on their goals and risk profile,” says Dr. Fingeret. “We really individualize the approach to treating thyroid cancer as an entire team, which includes the patient and their family.”

Treating thyroid cancer at Nebraska Medical Center

It’s essential to understand most thyroid cancers are asymptomatic. “So, symptoms of low thyroid function aren’t necessarily symptoms of thyroid cancer and vice versa,” says Dr. Fingeret.

If your thyroid evaluation identifies something that requires an operation, it's vital you see a high-volume thyroid surgeon for the procedure. "Removing the thyroid is a very delicate operation and requires a ton of skill and experience," says Dr. Fingeret. Because of this difficulty, the complication rates are much higher for providers who don't perform the operation regularly.

“Seeing a surgeon who performs this operation more than 50 times per year puts you in the lowest complication rates and the best overall outcomes," says Dr. Fingeret. "At Nebraska Medical Center, we currently have five surgeons who do thyroidectomies this often, and as a group, we perform over 400 operations annually on the thyroid.”

“We have the knowledge, skill and experience to offer people the highest quality of care,” says Dr. Fingeret.