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Cancer of the ThyroidDr Kingsley’s comments Cancer of the thyroid is relatively uncommon in the UK, but occurs more often in other countries. It is generally more common in women than in men. One type, follicular carcinoma, is associated with iodine deficiency, whereas papillary carcinoma is strangely associated with an iodine-rich diet. There is a very long-term risk from radiation, up to 40 years after an atomic bomb explosion nearby, but there doesn’t seem to be any increased risk of cancer from radioiodine for thyrotoxicosis, although there may be from radiotherapy to the neck given for Hodgkin’s disease. A third type, medullary carcinoma, may be partially inherited. Symptoms and Signs. Without any noticeable symptoms, a swelling may appear in the neck, which can take a long time to develop. Eventually, and in addition if the situation develops rapidly, there may be symptoms suggesting that the tumour is pressing on nearby organs. This may cause a hoarse voice, difficulty swallowing, rough-sounding breath sounds or a dry irritating cough. Investigations. Strangely enough, blood tests for thyroid function are often within the so-called normal laboratory range. However, in my experience, this does not necessarily prove that the whole thyroid system is working well. To be fair, there may not be any of the usual clinical indications of a high or a low thyroid state. Antibodies against thyroid tissue will be tested for, to exclude a condition called Hashimoto’s disease. Apart from routine blood tests of full haematology and biochemistry, a tube may be passed down the throat (‘to have a look’, especially if there is hoarseness), an ultrasound scan, a CT/MRI scan, chest X-ray and barium swallow may all be carried out to assess the extent of the tumour. Special radioactive scanning may also be done in specialised units. Conventional Treatment. Surgical removal of the whole of the lobe in which the tumour has grown is commonly carried out for a solitary cancerous growth of the thyroid gland. Many surgeons prefer to remove the whole of the thyroid in the first instance, to prevent cancer appearing in any thyroid tissue not removed in the first place. It is considered perfectly adequate to give a suitable dose of thyroxine after the total thyroidectomy to keep the level of thyroid stimulating hormone suppressed. Unfortunately, some patients don’t do very well on this supplement, occasionally because they react to the lactose in the tablet, or because they need whole thyroid extract. When the thyroid gland is removed, care needs to be taken to try to conserve the parathyroid glands and a nerve called the recurrent laryngeal nerve, to avoid additional unwanted effects. Sometimes local lymph nodes are removed at the time, if they are found to be involved. Radiotherapy, or radioactive iodine-131, is given if it is not practical to remove the whole of the thyroid gland by surgery, as destruction of the whole gland by one means or another is considered essential for cancer of the thyroid. If this cancer spreads to the local tissues, nearby lymph nodes, the lungs and bones, chemotherapy will be administered. If there is a possibility that the parathyroid glands were either damaged or removed at operation, the status of body calcium will need to be assessed. An Explanation by Dr Kingsley Before Your Consultation about your Prostate Cancer “Most consultations with doctors are fairly quick affairs, lasting perhaps five minutes, even if you are suspected of having cancer of your thyroid. You may be lucky to have more time spent on you, but when you have your consultation with me, I will spend as much time as you want. There is no time limit. We will take as long as you want. Often when I see some people for the first time, they are in a state of panic. They haven’t a clue what it is all about. No one has explained anything to them. Perhaps in the past they have been admitted for an emergency operation, or they had simply been told to come into hospital on such-and-such a day when they were either operated on or started a course of chemotherapy or radiotherapy. Once in hospital some sort of explanation may have been given, and you were probably seen by a junior doctor who not only took a short history of any symptoms you had, but also examined you to look for any signs of your thyroid cancer, but, by then, you were already captive and didn’t really have much choice in the matter. To be fair to doctors, they assume that their advice is the best on offer. After all, they are the experts. Virtually all doctors would treat your thyroid cancer in roughly the same way, so it seldom occurs to them that you just might not want to follow their advice. In any case, most patients have been frightened by their diagnosis and want to get on with the treatment, assuming that the doctor can deal with it for them. Most people put their faith in their doctor, assuming he knows what he is doing. There is absolutely no intention on my part to tell you whether to follow your doctor’s advice or not. That is a decision you have to make. No one can make it for you, but I will help you make up your mind. The Consultation The virtual consultation with me has been planned as though you are with me in my consulting room. I will go though your history, or the history that I come across so often, explaining the parts of it that give me clues to the cause of people’s problems. The chances are that, having taken a medical history from many thousands of patients over nearly forty years of medical practice, especially in the detail that I find so valuable, it is likely that much of it will be appropriate to you. The consultation is one of the longest parts of this programme, as you would imagine, and it is full of fascinating information. Periodically I lecture to medical colleagues on the subject of ‘What a clinical history and the clinical examination can tell me’. All this information is the result of my many years of listening to patients, letting them tell their stories, believing in their observations that have often been ignored, and learning by experience. So, enjoy yourself, feel enlightened, smile, be happy and radiate confidence in what you are going to do. Be positive and forget the doom and gloom merchants. If someone has given you a poor prognosis, forget it. You no longer fit into their statistics. You are going to do something for yourself. You are now in charge. ---------------------------------------- What you do now is in your own hands. 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