Kathryn E. Vinson, MS, CCRC

Causes of Thyroid Cancer- Differentiated thyroid cancers – also known as papillary and follicular thyroid cancers – don’t play by the same rules as other cancers. Although in advanced forms of the diseases, external beam radiation and chemotherapies may be called for, they tend to be treated with partial or complete thyroidectomies, and sometimes followed by radioactive iodine. While these treatments tend to be less harsh than other forms of cancer, trust me when I say that they are no walk in the park. To add to this, the medical community is at odds as to how long to follow patients for possible recurrences, as some recurrences have been documented to be as many as thirty-five years out!

With those issues in mind, let’s takes some time today to discuss what causes differentiated thyroid cancers (DTCs), how and how often they are diagnosed, and a glimpse at discussions in the medical community concerning what is termed “overdiagnosis.”

The simplest answer to this question is that scientists don’t really know what causes thyroid cancer. There are many theories and risk factors at play such as:

Iodine (too little may contribute to follicular thyroid cancer, while too much may contribute to papillary thyroid cancer)

I want to take a moment to visit about obesity and its role in the development of DTCs. In an article released in May 2020, Johnathan Fussey and his colleagues examined data from patients in Europe, to determine if obesity could be a cause of benign thyroid nodules or DTCs. Their research did not reveal a causal relationship between obesity and either condition; however, there was a link found between Type 2 Diabetes and thyroid cancer. It is important to note that a link does not imply a cause one way or the other – but it gives justification for more investigation.

Another interesting study was released in February 2021 by Cari Kitahara and her colleagues examining the effects of certain conditions of our mothers while we were babies in the womb. Looking at data from Norway, Denmark, Finland, and Sweeden over years spanning up to 1967-2015, they found that mothers with thyroid disorders (hypothyroidism, hyperthyroidism, goiter, and even benign thyroid nodules) were more likely to have children that would one day be diagnosed with thyroid cancer.

In 2021, there are projected to be about 44,280 new cases of 

 diagnosed in the United States, with about one quarter in men and three quarters in women. Fortunately, Lamartina and Handkiewicz-Junak (2020) tell us that the overall risk of death due to differentiated thyroid cancer is very low, at less than 2%. They also give us encouraging information in that the majority of DTCs (about two-thirds of diagnoses) are considered “low risk,” with an estimated rate of recurrence of only 5%. What is concerning though, is that while most recurrences happen within five years, there is data showing that some recurrences have occurred as much as 35 years out! With this in mind, treatment teams must look at a variety of information concerning the patient’s outlook and need for possible lifelong surveillance. Factors that determine a follow-up include: type, size, and spread of the initial disease, what treatment methods were used initially, how the patient responded to those treatments, and a variety of laboratory and imagine markers and tools. If you are interested in more on this topic, please take a look at 

Lamartina and Handkiewicz-Junak’s article

Doctors and researchers have been saying for many years that thyroid cancer is overdiagnosed and that it is a big problem. So, what is overdiagnosis? The answer to that is fairly simple, but the term leaves something to be desired. Overdiagnosis is a true diagnosis of cancer that has been confirmed by biopsy, but it is found in a person that is expected to outlive cancer (that the person would likely die of other natural causes before cancer does). Clear as mud, right?

So, if it’s a true diagnosis – then what’s the big deal?

Well, that’s where we get into things such as treating a disease that won’t affect a person in any appreciable way. This is huge in terms of not only monetary costs, but also stress and anxiety on the part of the patient and loved ones, and also utilization of an already stressed healthcare delivery system. Think of it this way – say you have a bunion that doesn’t really bother you at all. Do you treat it now, or wait till it's bothering you? I know that a bunion is in no way, shape, or form even close to cancer, but it’s the first analogy that popped into my head.

With that, doctors and scientists have been revising the criteria for performing a biopsy on thyroid nodules and suspected cancers, especially in low-risk populations (those folks without significant risk factors), such that fewer cases will be “overdiagnosed,” which could help ease the burden on both patients and healthcare systems.

As always, much love, many prayers, and abundant blessings to all of the warriors out there!!

Articles

New research sheds lights on the causes of thyroid cancer, overdiagnosis of PTC

Causes of Thyroid Cancer

Medullary Thyroid Cancer - For the most part, when people think of thyroid cancer, they think of an easily treatable disease. The reality of the matter is that this is seldomly the case. Thyroid cancer patients often deal with recurrences throughout their lives, after experiencing such lovely procedures as a radical neck dissection and systemic radiation treatments that can lead to other primary cancers. And this is for the “easy” papillary and follicular carcinomas (PTC and FTC).

Two other types of thyroid cancer exist, although they are very rare, accounting for only 1-2% of diagnoses for medullary thyroid cancer and X% for anaplastic thyroid cancer. Today, I’d like to take some time to visit with you about these rare thyroid cancers, their symptoms, treatments, and prognoses.

This incredibly rare form of cancer makes up only 1-2% of thyroid cancer diagnoses annually, yet can be one of the scariest. Medullary thyroid cancer (MTC) arises from the cells in the thyroid that produce calcitonin – a hormone that plays a role in the regulation of calcium in our bodies. In about ¼ of cases, MTC is inherited. In many of these cases, family members of an MTC patient can have a blood test that can identify the disease in its earliest, and most easily treatable stages.

Symptoms of MTC are similar to papillary and follicular carcinomas of the thyroid: a lump in the neck, soreness/pain in the neck, and hoarseness. In contrast to the more common types of thyroid cancer though, patients with MTC often have normal thyroid function tests.

Treatment usually starts with surgery to remove the thyroid gland and any adjacent lymph nodes that have become diseased. In contrast to treatment for PTC and FTC, medullary thyroid cancer does not respond to radioactive iodine, as the cancer is not in cells that absorb iodine. As such, external beam radiation and chemotherapy are treatment options for patients with disease that has spread beyond the thyroid. While a more aggressive cancer, MTC is thankfully slow growing.

Anaplastic thyroid cancer (ATC) is probably the scariest of all thyroid cancers. This rare form of thyroid cancer is aggressive and fast growing. It is known as an undifferentiated thyroid cancer, as the cancer cells do not look or behave in any manner like normal thyroid cells. The average time of survival after diagnosis is only 6 months, with only 1 in 5 patients surviving a year after diagnosis. In fact, this cancer is so aggressive that ALL patients are diagnosed as stage IV, with three substages:

: cancer is in the thyroid, and may be present in lymph nodes and other structures throughout the neck

: cancer has metastasized to distant locations such as the bones, lungs, and brain

Treatment for ATC is similar to MTC, in that radioiodine or thyroid suppression do not work on this disease. Given this, treatment usually consists of surgery, external beam radiation, and chemotherapy. The American Thyroid Association also tells us that many 

If you or a loved one have been affected by any of the four major types of thyroid cancer, please know that you aren’t alone. Numerous groups are out there that are ready and willing to help. From 

 (for privacy concerns) to national and global 

, help can be found at your fingertips. I also highly recommend the 

. From practical, day to day resources, to humor to recipes that are easy on a post-surgical throat – their offerings are compassionate, helpful, and from the heart.

As always, much love, many prayers, and abundant blessings to all of the warriors out there!

Kathryn E. Vinson, MS, CCRC

Causes of Thyroid Cancer

Medullary and Anaplastic Thyroid Cancer

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