Raising Thyroid Awareness With the Pacific Neuroscience Institute

The thyroid gland, part of the endocrine system, is responsible mainly for regulating the body's metabolism, or how cells convert food into energy. But the hormones it secretes affect much more than how quickly you digest lunch. A malfunctioning thyroid can impact various facets of health and cause a variety of symptoms, from fatigue to erectile dysfunction (ED) and weight fluctuations to infertility.

That's why it's important to raise thyroid awareness, especially as it relates to thyroid disease.

About 20 million people in the United States have some form of thyroid disease, according to the American Thyroid Association. Women are five to eight times more likely than men to be affected. Most sufferers have thyroid nodules, an underactive thyroid (hypothyroidism) or an overactive thyroid (hyperthyroidism).

Autoimmune conditions such as Hashimoto's disease and Grave's disease cause most instances of hypo- and hyperthyroidism and typically occur in people with a family history of the disease. Nodules may result from nutritional deficiencies, normal tissue overgrowth, fluid-filled cysts, inflammation or tumors, according to Cedars-Sinai, a healthcare provider based in Los Angeles.

Many tumorous nodules are benign, but about 2 or 3 in 20 are cancerous, according to the American Cancer Society, and between 1 percent and 2 percent of people develop thyroid cancer at some point in their lives. Each year, about 12,500 males and 31,200 females are diagnosed, and 970 men and 1,150 women die of the disease, according to ACS estimates. It's one of the five most common carcinomas among people ages 15 to 39, states the Pacific Neuroscience Institute (PNI).

But it isn't all bad news. The five-year survival rate for papillary thyroid cancer, the most common type, is 99 percent. And for regional follicular cancer and regional medullary cancers, the five-year survival rates are 98 percent and 90 percent, respectively.

As with most cancers, early detection can greatly improve a patient's prognosis. Knowing the signs—including an unusual swelling in the neck, persistent cough or hoarseness—can help. So, too, can routine medical care. Many thyroid conditions are identified when a patient seeks help for a different condition.

"Thyroid cancer is, in most cases, very treatable. In fact, some small thyroid cancers are treated with close observation, or 'active surveillance' in the common parlance," said Evan Walgama, M.D., a board-certified otolaryngologist at the Pacific Eye, Ear & Skull Base Center at PNI in Santa Monica, California.

PNI specializes in neurological and cranial disorders, minimally invasive surgical and interventional techniques, and novel targeted therapies. Walgama's particular expertise is treating patients with tumors in the head and neck, including the thyroid.

In support of Thyroid Awareness Month in January, Giddy conducted an email interview with Walgama, who answered a few questions about thyroid cancer and how it's treated.

Walgama: Most cases of thyroid cancer arise sporadically. It affects women more commonly than men, but it does affect both, [and] sometimes the very young, sometimes the elderly. Young people under the age of 55 are staged differently than older people and generally have an excellent prognosis.

Other risk factors, which don't come up that often, are a personal history of radiation exposure or a family history of thyroid cancer.

There are some very aggressive thyroid cancers with high mortality rates, though these are quite rare.

Some diets low in iodine or high in certain vegetables, such as cabbage, are goitrogenic, which means they can result in a goiter. A goiter is an enlarged thyroid gland that can become visible or symptomatic and sometimes needs surgical removal.

The first sign is usually a nodule. A thyroid nodule may be palpable, though rarely visible. It most often shows up on an ultrasound or CT [computed tomography] scan of the neck. A nodule is first assessed with ultrasound and, if suspicious, a fine needle biopsy. This is an outpatient procedure that is safe and well-tolerated.

Thyroid nodules are quite common compared to thyroid cancers. Our current guidelines seek to reduce the amount of surgery done for low-risk, benign nodules, especially when [the patient is] asymptomatic.

Thyroid cancers are sometimes treated with radioactive iodine. Women who receive this treatment are generally advised against pregnancy for several months after treatment.

Most thyroid cancer is treated and curable with surgery. This may include the removal of half the thyroid in low-risk cases. Preservation of half the thyroid reduces the risk of needing to take thyroid hormone replacement, though it does not eliminate this risk. Many thyroid cancers require the removal of the whole thyroid. Sometimes a lymph node dissection is performed at the time of thyroidectomy. The risks include damage to the nerves that control voice production, as well as calcium dysregulation, which is performed by the parathyroid glands, small pea-sized organs that live behind the thyroid.

Advanced or high-risk thyroid cancers may be treated after surgery with radioactive iodine treatment. This is an oral treatment that targets any remaining thyroid tissue in the body with a dose of radiation.

New medications have been approved by the FDA [Food and Drug Administration] to treat very advanced or metastatic thyroid cancer. These include RET inhibitors, which target proteins overexpressed by certain types of thyroid cancer.