FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER NEEDS TESTS OF NODULE TO RULE OUT THYROID CANCER

Question: I had my annual physical last week and my doctor felt a nodule on my thyroid gland. She said not to worry, but she ordered other tests. She said it probably wasn’t cancer but that had to be ruled out. What if it is cancer? What else could it be?

Answer: Your thyroid is located in the front of the neck, just under the Adam’s apple. It is shaped like a butterfly with a lobe on each side of your windpipe, or trachea. A narrow band of thyroid tissue called the isthmus connects the two lobes together.

The primary function of the thyroid is to regulate metabolism. If the gland produces too much hormone, you have hyperthyroidism, resulting in nervousness, hyperactivity and weight loss. If the gland makes too little hormone, a condition called hypothyroidism, you feel tired, and tend to gain weight.

This very energetic gland is a common place for nodules. Most of the nodules or tumors are not cancerous. Nodules are commonly found just as yours was, on a routine physical. They occur in about one in every 1,000 people. Statistically, 90 to 95 percent of thyroid nodules are benign. Frequently they are fluid-filled cysts or just enlarged thyroid cells.

Only 5 to 10 percent of thyroid nodules are cancerous, and about 80 percent of these cancerous nodules are a highly treatable type called papillary carcinoma. This kind of cancer develops from the thyroid follicle cells and grows slowly. It usually affects just one lobe of the gland. The rate of successful treatment of this condition is very high and the condition is rarely fatal.

The next most common type of thyroid cancer is the follicular carcinoma. It makes up about 10 percent of all thyroid cancers and is slow to spread to other organs. It is more common in countries where people don’t get enough iodine in the diet.

One lethal but rare type of thyroid cancer -- accounting for less than 2 percent of all cancers in this gland -- has received a lot of publicity in the last few years. This is anaplastic thyroid carcinoma. It’s the type of aggressive thyroid cancer that killed the late Chief Justice William Rehnquist. There are some new treatments being tested for this disease that show some promise, but they are still in the experimental stages.

Your doctor did a very thorough physical, and you are lucky she found this nodule. She will order scans and ultrasounds on the thyroid gland and some blood tests as well. Be sure to complete all tests that are recommended. Chances are this lump will require no treatment once a proper diagnosis is made, or it will be an easily treated cancer. You will feel better when you know what it is and what it is not.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.