Thyroid cancer

The thyroid gland (Glandula thyroidea) is located on the front of the neck slightly below the thyroid cartilage (see picture) and produces vital, iodine-containing hormones (messenger substances) for metabolism. The parathyroid glands produce parathyroid hormone, which regulates calcium levels. Thyroid diseases range from inflammation (=thyroiditis) to tumors. When it comes to tumors, a distinction is made between benign and malignant (malignant, popularly called “cancer”) thyroid tumors. Thyroid cancer is often what are known as well-differentiated papillary and follicular carcinomas with a favorable outcome. The more aggressive medullary and anaplastic carcinomas are rarer.

Signs

Nodular changes in the thyroid are possible signs of thyroid tumors and should be investigated. It can be a simple goiter disease (=enlargement of the thyroid gland, goiter), a benign or a malignant tumor. Other possible symptoms include difficulty swallowing, persistent hoarseness and unexplained weight loss.

Causes and Distribution in the Population

Thyroid nodules occur in 50% of adults over 50 years of age. However, thyroid cancer affects less than 2% of all new cancer cases. In Switzerland, around 300 people develop thyroid cancer every year. The causes for its development have not yet been clearly clarified (genetic, familial, iodine deficiency, previous exposure to radiation).

Examination

The investigation of thyroid nodules should confirm or eliminate the suspicion of a tumor. To plan treatment, the type and extent of the lump is assessed (ENT examination, neck ultrasound with puncture through a fine needle, laboratory tests). Depending on the findings, additional imaging procedures such as magnetic resonance imaging (MRI) and thyroid scintigraphy (=functional imaging) are carried out.

Treatment

The treatment of thyroid tumors is intended to cure the disease permanently and usually requires surgery. Depending on the type of tumor, only the affected side (=hemithyroidectomy) or the entire thyroid gland (=total thyroidectomy) and the lymph nodes in the neck are surgically removed. The parathyroid glands, which control calcium balance, are preserved whenever possible. A vocal cord nerve monitoring device is used during the procedure. Following the operation, radioiodine therapy is often carried out to destroy any remaining thyroid tissue in order to prevent the formation of offshoots (=metastasis). If left untreated, the tumor spreads to the throat and spreads throughout the body, which sooner or later leads to death.

Care and Aftercare

After the treatment has ended, the university clinics for nuclear medicine or endocrinology, diabetology and clinical nutrition take over the follow-up care in collaboration with the family doctor. Thyroid hormones often have to be taken for life. In the case of vocal cord paralysis, which can be caused by the cancer itself or, in less than 1%, by operations, care is also provided by the specialists in the Department of Voice, Language, Speech and Swallowing Disorders (Phoniatrics/Speech Therapy, University Hospital for Ear, nose and throat diseases, head and neck surgery, Inselspital, Bern University Hospital).

Where can You turn?

If the signs and symptoms mentioned above persist for more than 3 weeks, your family doctor should check the function and changes in the shape of the thyroid (medical and imaging examination). If any irregularities are discovered, we recommend that further clarification be carried out in the polyclinic of the University Hospital for Ear, Nose and Throat Diseases, Head and Neck Surgery, Inselspital, Bern University Hospital.