Thyroid Cancer 101 & the Hidden Quality of Life Challenges -

September is just around the corner, & if you didn’t know, September is a huge month for cancer awareness, including thyroid cancer.

The good news is thyroid cancer is relatively uncommon, with a pretty decent survival rate.

The bad news, it’s still cancer & it can significantly impact our patients’ function & quality of life. So let’s dive into it!

Thyroid Cancer by the Numbers

Thyroid cancer accounts for somewhere between 2-4% of all cancer diagnoses in the US, so quite rare in the grand scheme of things.

Better yet, deaths from thyroid cancer only account for 0.3% of all cancer deaths.

Even with these encouraging stats, thyroid cancer appears to be on the rise & is actually the 5th most common cancer among American women.

Basics of Thyroid Cancer

There are 2 major cell types in the thyroid: thyroid follicular cells & parafollicular/C-cells. Thyroid follicular cells give rise to differentiated thyroid cancer (DTC), which accounts for about 90-95% of all thyroid cancers. Meanwhile, medullary thyroid carcinoma (MTC) arises from parafollicular or C-cells & accounts for about 1-2% of all thyroid cancers. Lastly, anaplastic thyroid carcinoma makes up the remaining 1% of thyroid cancers.

Risk factors for thyroid cancer include female sex, familial history of thyroid history, previous radiation therapy to the head & neck region, & genetic mutations/syndromes. However, most thyroid cancers don’t have an explicitly obvious cause & are likely due to a combination of factors & plain bad luck.

Most thyroid cancers are detected incidentally with neck imaging. Some patients may experience neck swelling, palpable lymph nodes, or other constitutional changes prior to diagnosis.

Once suspected, patients will undergo a thyroid function panel, & potentially a fine-needle aspiration of suspicious thyroid nodules or even molecular testing.

Treatment for Thyroid Cancer

Surgery

First line treatment for thyroid cancer is surgery. Surgery may include a lobectomy (removal of part of the thyroid) or a thyroidectomy.

Additionally, patients may also undergo a lymphadenectomy for more advanced thyroid cancer.

Radioiodine Ablation Therapy

Radioactive iodine is often used adjuvantly to treat any residual disease or to treat metastases.

Thyroid Hormone Suppression Therapy

Most patients will undergo thyroid hormone suppression therapy after thyroid cancer surgery. Thyroid hormone suppression therapy helps keep the hormone TSH low, which can help reduce risk of thyroid cancer returning.

Targeted Therapies

Targeted therapies are utilized increasingly in the management of thyroid cancers, including multikinase inhibitors, RET inhibitors, TKR inhibitors, BRAF inhibitors, & MEK inhibitors.

Chemotherapy

In some cases where thyroid cancer has spread distantly, chemotherapy may be used.

Common agents include:

Dacarbazine
Vincristine
Cyclophosphamide
Doxorubicin
& others

External Beam Radiation

External beam radiation may be used to treat thyroid cancers that don’t take up iodine &/or have spread beyond the thyroid. This is usually for medullary thyroid cancer or anaplastic thyroid cancer.

Potential Rehab Implications for Thyroid Cancer Survivors

Potential local pain & dysfunction secondary to surgery (spinal accessory nerve) palsy; neck/shoulder/head
Fatigue
Lymphedema
Bone loss, particularly in postmenopausal women
Decreased quality of life
- “TC survivors highlighted having their cancer referred to as the ‘good kind’ trivialized their diagnosis and decreased HRQOL as they felt unsupported by physicians and family” –

More Resources on Thyroid Cancer

ThyCa.org – Thyroid Cancer Survivors’ Association, Inc.

Until next time, this is Elise with TheOncoPT. And remember: you are exactly the physical therapist that your patients with cancer need. So let’s get to work.