Thyroid cancer in women is a difficult subject to talk about because cancer is very emotional. It is a battle of your body and spirit that triggers mixed emotions of fear, denial and despair.
A diagnosis always comes unexpectedly, however it doesn’t mean that thyroid cancer has suddenly developed. It means that you were living with it for some time without even knowing you have it and now your whole world has changed.
All patients who get a diagnosis of thyroid cancer are shocked and there are no exceptions. Even if a patient has heard about thyroid cancer before, the majority have never thought they would get it.
“Cancer doesn’t have a face until it’s yours or someone you know”
Anthony Del Monte
The incidence of thyroid cancer is alarmingly increasing and the rate of thyroid cancer has more than doubled over the past three decades. There are over 60,000 people diagnosed with thyroid cancer each year in the US alone and three quarters of them are women.
There are 3 facts about thyroid cancer in women that I want to share with you today: one is about prevention and early diagnosis, another one is about a new treatment option and the third is about a common thyroid test that is absolutely useless for the thyroid cancer diagnosis.
Here we go:
1. Minimizing your risks whenever you can is your best thyroid cancer prevention strategy
There is one more thyroid cancer risk being recently confirmed. For many years, the relationship between breast and thyroid cancer has been controversial but not any more.
According to the study results presented at the Endocrine Society’s 97th annual meeting in San Diego in 2015, breast cancer survivors are at increased risk of developing thyroid cancer within 5 years of their breast cancer diagnosis.
Women who had breast cancer followed by thyroid cancer were on average younger than patients with breast cancer alone when they got a breast cancer diagnosis. They also were more likely to have the most common type of breast cancer called invasive ductal carcinoma and received radiation therapy as part of their breast cancer treatment.
The study recommends that breast cancer survivors especially those who received radiation therapy should undergo a thorough thyroid examination every year for the first five years after their breast cancer diagnosis.
One of the ways to prevent thyroid cancer in women and provide a more targeted therapy is to better understand its causes, risks and get an early diagnosis. In fact, thyroid cancer has a 98% survival rate if caught early.
Besides breast cancer there are
6 Major risk factors of thyroid cancer that were previously known:
– Radiation therapy to the neck, chest and head due to medical and dental procedures, occupational exposure and radioactive fall outs.
– Being a woman between 25 and 65 raises the risk of both thyroid and breast cancer (see more about estrogen-progesterone metabolism)
– Family history of thyroid disease and thyroid cancer. The link between autoimmune thyroid disease and thyroid cancer, in particular of well-differentiated papillary thyroid carcinomas has long been recognized. Patients with Hashimoto’s are 3 times more likely to have thyroid cancer.
In fact, thyroid cancer is frequently infiltrated by inflammatory-immune cells and the link between inflammation and cancer has been effectively established. Some researchers go so far as suggesting that thyroiditis may be a precancerous condition.
Knowing the cancer risk is valuable in the prevention and care of Hashimoto’s patients because inflammatory molecules and inflammation becoming promising targets for thyroid cancer therapy of the future.
– Genetic predisposition and some genetic conditions such as familial medullary thyroid cancer (FMTC), multiple endocrine neoplasia (MEN) both type 2A and type B syndrome. Medullary thyroid cancer is more likely to run in the family and may be diagnosed by genetic testing.
– Estrogen dominance increases the risk of both breast and thyroid cancer in women. Among other factors hypothyroidism is a well-known cause of estrogen dominance due to both estrogen excess and progesterone deficiency. This makes hypothyroid patients susceptible to any type of cancer in general because estrogen dominance raises the risk of any type of women cancer by 10 times.
– History of goiter can set the first stage for thyroid cancer. Both hyperthyroidism and hypothyroidism can cause a thyroid enlargement. For some patients thyroid medication can help partially or completely shrink the goiter. However, if this doesn’t happen and you still have a goiter after being on a proper dose of thyroid medication for some time, it may be a sign that you need to pay more attention to your progesterone and estrogen metabolism.
Estrogen dominance can also result in goiter. A progesterone deficiency, especially with unopposed estrogen that are so typical for women with hypothyroidism, causes the thyroid to enlarge. Adequate levels of progesterone have a supportive effect on the thyroid hormone secretion and co-interact the damaging effects of estrogen.
If you have hypothyroidism it is essential to regulate estrogen-progesterone metabolism by improving your diet and correcting your thyroid deficiency. A functional medicine practitioner Tom Brimeyer extensively researched this subject and made balancing of estrogen and progesterone as a part of his hypothyroidism treatment protocol.
2.New no-neck-scar alternative to a conventional thyroid surgery
Thyroid cancer is primary treated by thyroid surgery when a part or a whole thyroid gland is removed. About 85% of all surgeries are done on women.
Thyroid surgeries started to be performed about 150 years ago. Conventional thyroidectomy involves making a 6-8 cm incision in the center of your neck. It has two main disadvantages: high level of pain after the surgical procedure and a scar. The majority of patients who undergo thyroid surgery are women between 20 and 55 years old who consider a cosmetic appearance of the scar to be very important.
Image Credit: @the_cranky_thyroid
Endoscopic thyroidectomy was introduced 25 years ago and the first surgery was performed in 1997 by professor Huscher. Surgical instruments and a small video camera are inserted through the incisions and the camera guides the surgeon through the procedure. This type of thyroid surgery is also called low invasive because it uses smaller 1.5-2 cm incisions in the neck. While endoscopic surgery is more technically advanced and complicated it provides faster healing and a smaller scar.
Nowadays robotic thyroidectomy becomes a new low invasive alternative without a scar in the front of the neck. It is performed through incisions in the chest and armpit that allows to avoid an incision in the center of the neck. Due to complexity this procedure requires more time and there is an increased risk of hematoma under the skin (a solid swelling of clotted blood within the tissues).
There are 3 main criteria to determine if the scarless thyroid surgery is right for you:
– Size of the thyroid gland cannot be bigger than 25 ml
– Nodule size should not exceed maximum 30 mm in the diameter
– Absence of metastazes or cancer spreading into the surrounding lymphatic tissue
Robotic thyroid surgery allows to perform all procedures with more precision and provides the biggest cosmetic benefit – no scar on the neck. From the cosmetic point of view robotic thyroidectomy is a huge step forward in thyroid surgery and improving the well-being in thyroid cancer patients, the majority of those are young and middle age women.
3.Standard thyroid tests cannot be used as indicators of thyroid cancer.
Nodules and thyroid cancer in women often do not cause any symptoms and TSH remains in a normal reference range. It is important to note that
TSH doesn’t provide any information about the presence of thyroid cancer and its possible recurrence
After thyroid surgery a TSH test can only be used to make sure that the dose of thyroid hormone replacement is appropriate for the patient’s specific needs.
The target TSH goal depends on the type of thyroid cancer:
In medullary or anaplastic thyroid cancer patients will receive a dose to keep TSH within the normal reference range.
Women treated for papillary, follicular cancer or one of their variations receive a TSH suppressive thyroid hormone replacement therapy to treat hypothyroidism and to prevent growth or recurrence of thyroid cancer.
TSH suppression is achieved when the dose of thyroid medication is large enough to suppress the blood level below the normal TSH range. The American Thyroid Association (ATA) guidelines recommend TSH suppression when women have active or a very aggressive tumor that has been treated with surgery and radioactive iodine (I-131):
Initial TSH suppression below 0.1 mU/L for high-risk and intermediate-risk patients
TSH at or slightly below the lower limit of normal (0.1–0.5 mU/L) for low-risk patients
The good news is that according to the ATA guidelines, about 85% of patients who undergo thyroid surgery are at low-risk.
Two biggest challenges women face after the thyroid surgery and many even before thyroid cancer diagnosis are hypothyroidism and hypothyroid symptoms.
Despite TSH suppressive dose of thyroid medication many symptoms just don’t go away.
It is important to note that just because you are on a thyroid replacement therapy and your TSH is normal, it doesn’t mean that thyroid hormones are getting to your cells.
You could remain “functionally” hypothyroid until you realize and address how complex thyroid problems are.
Unfortunately, many doctors and a lot of treatments focus on a single aspect of thyroid disease, however this hypothyroidism program shows you how to start getting real long-lasting results.
1 THR-049: Increased Incidence of Thyroid Cancer Among Breast Cancer Survivors: An Analysis of the SEER 9-Database. Endocrine Society’s 97th Annual Meeting and Expo, March 5–8, 2015 – San Diego