Hypothyroid and thyroid cancer

Summaries for Patients from Clinical Thyroidology (from recent articles in Clinical Thyroidology)
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THYROID CANCER
Is there a relationship between thyroid cancer and Hashimoto’s thyroiditis?

ABBREVIATIONS & DEFINITIONS

Papillary thyroid cancer: the most common type of thyroid cancer.

Hashimotos thyroiditis: the most common cause of hypothyroidism in the United States. It is caused by antibodies that attack the thyroid and destroy it.

Hypothyroidism: a condition where the thyroid gland is underactive and doesn’t produce enough thyroid hormone. Treatment requires taking thyroid hormone pills.

Thyroiditis: inflammation of the thyroid, most commonly cause by antibodies that attack the thyroid as seen in Hashimoto’s thyroiditis and post-partum thyroiditis. It can also result from an infection in the thyroid.

BACKGROUND
Thyroid cancer is the fastest rising cancer in women and the most common type is papillary cancer. Hashimoto’s thyroiditis is the most common cause of hypothyroidism, which is mostly seen in women. When thyroid cancers are removed at the time of surgery, the cellular changes of Hashimoto’s thyroiditis is commonly seen surrounding the thyroid cancer. There has been a long standing debate regarding the relationship between thyroid cancer and Hashimoto’s thyroiditis. Specifically, it is unclear if the thyroid inflammation seen in Hashimoto’s thyroiditis causes the cancer or if the inflammation is the result of the cancer. Also, it is uncertain if thyroid cancers surrounded by inflammation behave better or worse than those without the surrounding thyroiditis. The goal of the study was to examine the relationship between papillary thyroid cancer and Hashimoto’s thyroiditis.

THE FULL ARTICLE TITLE:
Lee JH et al. The association between papillary thyroid carcinoma and histologically-proven Hashimoto’s thyroiditis: a meta-analysis. Eur J Endocrinol. December 4, 2012.

SUMMARY OF THE STUDY
The authors examined the data of 38 published studies that previously looked at the relationship between thyroid cancer and Hashimoto’s thyroiditis. Hashimoto’s thyroiditis was more likely to be detected around papillary cancer (40%) than around benign thyroid nodules (21%), in female patients (23%) compared to males (11%) and in papillary thyroid cancer (17%) compared to other types of thyroid cancer (8%). Patients with papillary cancer that also had Hashimoto’s thyroiditis were less likely to have cancer recurrence on follow up as compared with those with papillary cancer in the absence of Hashimoto’s thyroiditis.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
The current study showed that Hashimoto’s thyroiditis is commonly seen surrounding papillary thyroid cancer and, when present, it is associated with a better prognosis. Further studies are needed to confirm this association.

— Mona Sabra, MD

ATA THYROID BROCHURE LINKS

Thyroid cancer: http://www.thyroid.org/cancer-of-the-thyroid-gland

Hypothyroidism: http://www.thyroid.org/what-is-hypothyroidism

Thyroiditis: http://www.thyroid.org/what-is-thyroiditis

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Contents

Thyroid Cancer Symptoms, Possible Causes, and Risk Factors

A lump or nodule in the neck is the most common symptom of thyroid cancer. You may feel the lump, notice one side of your neck appears to be different, someone else might notice it, or your doctor may find it during a routine examination. Sometimes a thyroid tumor is found during diagnostic ultrasound or imaging tests performed for another reason. If the tumor is large, it may cause neck or facial pain, shortness of breath, difficulty swallowing, cough unrelated to a cold, hoarseness or voice change.1

If you feel a lump, see a change in the size or shape of your neck, or experience symptoms, make an appointment with your doctor. Early detection of thyroid cancer is essential to a good treatment outcome.

Potential Risk Factors

While many of the risks for developing a thyroid cancer are beyond your control, knowledge can help you share your concerns and communicate more effectively with your doctor.
Gender and Race-related risks

  • Females are affected 2 to 3 times more often than males.
  • People who are white or Asian are more likely to develop thyroid cancer.

Age and Family-related risks

  • Most cases of thyroid cancer affect people between the ages of 20 and 55.
  • Multiple Endocrine Neoplasia, or multiple endocrine tumors (MEN2A and MEN2B) are tumors that affect glands of the endocrine system (eg, thyroid, parathyroid, adrenal). MEN 2 tumors affecting the thyroid are medullary thyroid cancer. In rare cases, people have a family history of medullary thyroid cancer.
  • According to the American Society of Clinical Oncology, anaplastic thyroid cancer is usually diagnosed adults older than 60.2
  • Although rare, medullary thyroid cancer may develop in infants 10 months and older and during adolescence if the child carries the RET proto-oncogene* mutation.2

*DNA (deoxyribonucleic acid) makes up each person’s biological blueprint. Genes are parts of the DNA that are inherited. An oncogene is a gene that has mutated and has the potential to cause cancer. Proto-oncogenes are genes that have mutated and can cause a cancer at the cellular level. There are different types of proto-oncogenes, such as RET.
Radiation Exposure
Routine x-rays such as those performed during a dental examination or mammography do not cause thyroid cancer. The sources of radiation that may increase the risk for thyroid cancer include:

  • Before 1950, low to moderate doses of x-ray therapy were used to treat adolescents with tonsillitis or acne.
  • Radioactive fallout (eg, Chernobyl) from atomic and nuclear disasters.
  • Radiation therapy performed to treat Hodgkin lymphoma, such as the lymph nodes in the neck.

If you have a family member with thyroid disease, even if non-cancerous, you should share that information with your doctor. Your doctor may run certain tests to evaluate your thyroid function and risk for developing thyroid cancer.

Bridget Brady, MD, FACS is the first fellowship-trained endocrine surgeon in Austin, Texas. She has a passion for and expertise in disease of the thyroid, parathyroid, and adrenal glands. Dr. Brady has performed thousands of thyroidectomies and parathryoidectomies with a focus on minimally invasive techniques to optimize patients’ medical and cosmetic outcomes.

Updated on: 05/14/19 Continue Reading Thyroid Cancer Diagnosis View Sources

Thyroid Cancer: What Women Should Know

Thyroid Cancer: Common in Women

Thyroid disorders are more common in women , probably due to the roles of hormones, which are different in females than in males.

Thyroid nodules (growths), Russell says, affect up to 80 percent of women, but only 5 percent to 15 percent of those lumps and bumps are malignant. Better testing means thyroid tumors are on the rise, he notes, saying that it’s projected to become the third most common cancer.

“Malignant” and “cancer” are scary words, but Russell says that most thyroid cancer is highly treatable, even when the cancer cells spread to nearby lymph nodes, which occurs frequently.

“With thyroid cancer we talk about prognosis in terms of 20-year survival instead of five years, as we do with most other cancers. It’s usually a slow-moving disease. There’s a 98 to 99 percent survival rate at 20 years,” he says.

“We treat it almost like a chronic condition where the patient gets treatment and visits her doctor regularly for follow-up.”

Diagnosing Thyroid Cancer

If a woman notices a lump in the base of her neck, or if a doctor notices a lesion on the thyroid on an X-ray or CT , the next diagnostic test is usually lab work, followed by an ultrasound , which Russell says provides a lot of information on the nodule.

Doctors may recommend watchful observation of small nodules. Larger growths may be tested with fine-needle aspiration , in which the doctor collects a sample of cells from the nodule with a needle and looks at them under a microscope.

Russell says that about 70 percent of nodule biopsies will show that the nodule is benign. Another 25 percent of biopsies are inconclusive, and the remaining 5 percent show that cancer is present.

Treatment for Thyroid Cancer

Surgery to remove the thyroid and any affected lymph nodes is the preferred treatment. Afterward, the patient will take thyroid hormones to cover the loss of the gland and radioactive iodine to treat any remaining cancer cells.

Traditional surgical removal of the thyroid gland, or thyroidectomy, leaves a prominent scar on the front of the neck. Russell notes that some thyroid cancer survivors are fine with their thyroidectomy scar and regard it as a badge of honor.

But plenty of patients don’t want the constant reminder of cancer surgery each time they look in the mirror. Or they don’t necessarily want a scar to be the first thing a stranger notices. “They say ‘It’s my business that I had a problem with my thyroid,’” Russell says.

Russell offers patients the option of a scarless thyroidectomy , in which the surgeon reaches the thyroid gland and removes it through the mouth, so there’s no cutting or scarring of the neck.

Though initially skeptical about the novel approach, Russell studied the technique in Thailand and saw that scarless thyroidectomy could be a valuable alternative to a traditional approach. Now Russell’s clinic is a leader in performing scarless thyroidectomies and trains surgeons from all over the world.

  • Thyroid cancer diagnoses are on the rise
  • Mortality rates are slowly getting worse
  • Thyroid cancer is most common among women, and is often diagnosed at a young age
  • Most forms of thyroid cancer are easily treated

The speed of your metabolism, how fast your heart beats: These and many more of your body’s functions are controlled by hormones produced in your thyroid, a butterfly-shaped gland that sits between your neck and the top of your breastbone.

Sometimes, most often in women, the thyroid gets out of whack. In fact, the majority of thyroid cancers (about 75 percent, by some estimates) occur in women, says John Morris, M.D., past president of the American Thyroid Association (ATA) and an endocrinologist at the Mayo Clinic.

Morris explains that, while thyroid cancer and autoimmune diseases like hyperthyroidism (an overactive thyroid) and hypothyroidism (an underachieve thyroid) are indeed significantly more common in women than in men, no one quite understands why just yet. And, FYI, thyroid issues like hypothyroidism are linked to an increased risk of thyroid cancer.

Fortunately, thyroid cancer remains relatively rare, with about 64,000 new diagnoses in 2016 compared to the more than 240,000 breast cancer and 135,000 colon cancer diagnoses that year, according to the ATA. What’s more, most cases are diagnosed early on and have a very low mortality rate.

Still, experts say it’s important to keep thyroid cancer on your radar. “Your primary-care physician should palpate your thyroid gland at each routine visit,” says Jochen Lorch, M.D., director of the Thyroid Cancer Center at the Dana-Farber Cancer Institute. “Screening is also easy to do yourself, so thyroid cancer is generally easy to diagnose at early stages. And if you catch it early on, it’s usually not a problem at all.”

Here are nine things all women need to know about thyroid cancer.

Thyroid cancer diagnoses have tripled in the last decade

Thyroid cancer is the most rapidly-increasing cancer diagnosis in the U.S., according to the American Cancer Society (ACA). “Over the last 10 to 15 years, the frequency has increased three to five-fold. And in some parts of the world, more than that,” says Morris. Morris says at least some of that spike is due to increased screening along with improved imaging techniques.

Watch a hot doctor explain what to do about a thyroid condition:

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Mortality rates are low… but rising

Survival rates for papillary thyroid cancer, the most common type, reach 100 percent for stages I and II; 93 percent for stage III, and 51 percent for stage IV, according to the ACA. Unfortunately, those numbers are getting worse. “If you look at mortality rates, those have also slightly inched up, not at the same rate as new diagnoses, but there is a trend,” Lorch says, noting that advanced and aggressive thyroid cancers are becoming more prevalent.

So why are mortality rates rising? “There must be some kind of environmental factor,” Lorch says. While there are theories that increased exposure to chemicals and pesticides may be to blame, Lorch says there’s not enough research to pinpoint the problem just yet.

Thyroid cancer is a young woman’s problem

According to the ACA, thyroid cancer is more commonly diagnosed at a young age than most other types of cancers. While that’s in part due to increased incidental findings, the other part of the explanation is the cancer itself, says Lorch.

“Compared to other cancers, thyroid cancer is relatively simple. There’s not a lot of genetic mutations that drive it,” he says. Breast or colon cancer are typically the result of five to 10 genetic mutations; with thyroid cancer, there’s often just one genetic mutation at fault.

Because just one mutation can result in cancer, the age at which thyroid cancer is diagnosed is often younger, he explains.

Related: The Symptoms Of Colon Cancer That Every Young Woman Should Know

The most common symptom of thyroid cancer is a lump

While a goiter, or lump in your thyroid, is the most common symptom of thyroid cancer, according to the ATA, over 90 percent of all thyroid goiters are benign and could be linked to another condition like hypothyroidism or iodine deficiency.

Either way, it’s a good idea to check in with your primary-care doctor, who can examine the lump manually with their hands and, if they suspect a problem, recommend an ultrasound. Other symptoms of thyroid cancer are very rare and usually associated with a more advanced or aggressive form of the disease, says Morris. These can include hoarseness, pain in the thyroid, and trouble swallowing that doesn’t go away for weeks to months.

Some people live with thyroid cancer for their whole lives

As of 2013, more than 630,000 patients were living with thyroid cancer in the United States, according to the ATA, and less than 2,000 people die from thyroid cancer each year.

Because 70 to 80 percent of all thyroid cancers are papillary thyroid cancer, which tends to grow slowly or not at all, thyroid cancer may never even cause problems. “The majority of patients would live out the rest of their lives without even knowing they had cancer,” says Morris.

Related: 5 Signs Your Exhaustion Is A Symptom Of A Much Bigger Problem

Most thyroid cancers are not inherited

You’ve heard about the BRCA test for breast cancer. There’s no such test for most cases of thyroid cancer. “A great majority are not predictable by genetic testing,” says Morris. While one rare strain of thyroid cancer can be traced with a genetic test, for almost all cases, including papillary thyroid cancer, doctors don’t recommend routine genetic screening because most thyroid cancer tends not to be inherited.

Preventative screening is rarely recommended

Thyroid screening is usually only recommended for people who have a history of radiation exposure involving the head or neck (for, say, throat or brain cancer), says Morris. Otherwise ultrasound screening is only suggested if you have two or more people in your immediate family who have been diagnosed with thyroid cancer. “There’s a negative side to screening in that you find cancers that are not important,” says Morris—and you get treatments that aren’t necessary.

To check for a lump in your thyroid, tip your chin up in the mirror and swallow: if you see a lump that moves up and down at the notch between the base of your neck and the top of your breastbone, it could be worth checking in with your doctor.

Related: 9 Reasons Why You’ve Got Period Symptoms But No Period

Thyroid cancer doesn’t change how well your thyroid works

In most cases, thyroid cancer doesn’t affect how well your thyroid does its job. “Most of the time, it continues to function normally,” says Morris. “It’s still there and functioning normally even though cancer is present.”

Unlike hyper- and hypothyroidism, thyroid cancer does not cause symptoms such as weight changes, heart palpitation, and thinning hair.

If there’s a lump in your thyroid, doctors will often check your levels of thyroid stimulating hormone (TSH) as a screening method. If your levels are out of whack, that’s a sign that you’re dealing with a thyroid condition other than cancer, says Lorch.

You may not need treatment

In the past, doctors treated thyroid cancer by removing the entire gland, requiring patients to take hormone replacement pills every day for the rest of their lives. People were also usually put on radioactive iodine, which can potentially damage the salivary glands leading to loss of taste and dry mouth. That’s not the case today.

Related: ‘I Was Radioactive’: Here’s What It’s Really Like to Get Treated for Thyroid Cancer

Most often, doctors avoid radioactive iodine and sometimes don’t perform surgery at all, just surveillance—especially with common small papillary thyroid cancers. “Patients become concerned when they hear the word ‘cancer’ applied to a lump in body, but we spend a lot of time explaining why it’s not the same as being diagnosed with cancers in other parts of the body. Treatments can have consequences and side effects,” says Morris.

Even with more advanced cancers requiring surgery, most people don’t need radioactive iodine, Morris adds. “In the vast majority of cases for papillary thyroid cancer, surgery approaches a 100 percent cure rate, even if it’s spread to local lymph nodes. But it’s still critical to diagnose and find early on,” adds Lorch. In the rare event that advanced metastatic cancer requires further treatment, it’s usually with chemo treatments that can help shrink and slow the growth of tumors.

Colleen de Bellefonds Colleen de Bellefonds is an American freelance journalist living in Paris, France, with her husband and dog, Mochi.

Signs and Symptoms of Advanced Medullary Thyroid Cancer

Other, more rare or unusual signs of medullary thyroid cancer that you should be aware of include:

  • Severe diarrhea. This is a very rare symptom sometimes found in people with advanced medullary thyroid cancer. The tumor produces high levels of calcitonin, a hormone that may cause severe diarrhea.
  • Cushing syndrome. In rare cases, adrenal tumors can cause Cushing syndrome, a condition that arises when a tumor secretes hormones that the thyroid wouldn’t normal create. Cushing syndrome associated with medullary thyroid cancer is uncommon. The syndrome is more commonly caused by the pituitary gland overproducing adrenocorticotropic hormone (ACTH), or by taking oral corticosteroid medication.
  • Facial flushing. A red face, neck, or chest paired with warm or burning sensations can be a sign of many conditions. Tumors or other abnormal growths can overproduce hormones, triggering flushing. The symptom can also be a response to certain drugs, foods, alcohol, or menopause.
  • Bone pain. People with medullary thyroid cancer may have bone pain if the cancer has spread to form bone lesions.
  • Lethargy. Many people with advanced cancer may feel physically, emotionally, or mentally tired. The causes of fatigue during cancer are complex and not well understood.
  • Weight loss. Unusual weight loss is a symptom of advanced medullary thyroid cancer that has spread beyond the thyroid into other organs.

If you experience any of these symptoms, especially if there’s a family history of medullary thyroid cancer, go see your doctor. Being attentive to your health is often one of the best ways to detect cancer early.

Is thyroid cancer the ‘good’ cancer? It doesn’t feel that way when you get it.

My mother wouldn’t have known she had thyroid cancer had it not been for a routine checkup two years ago. She felt fine, but her doctor found a lump in her neck, and after several tests she got the diagnosis. I was worried, of course, but the research seemed encouraging: Thyroid cancer has one of the highest survival rates of all cancers — 97.9 percent five years after diagnosis, according to the National Cancer Institute.

This gives thyroid cancer a reputation as being a “good” cancer. But as I have learned, cancer survival statistics don’t tell the whole story.

These estimates are based on data from thousands of people, and as with all statistics they can’t gauge the actual risk for a particular individual. What the rosy survival outlook glosses over is the impact of thyroid cancer on a person’s quality of life, which studies have shown can be significant. For my mom, an outwardly healthy 51-year-old at the time of her diagnosis, thyroid cancer has been an emotional and physical challenge, though you wouldn’t know it by looking at her or talking to her.

Robert Smallridge, deputy director of the Mayo Clinic Cancer Center in Jacksonville, Fla., says patients often come to him very worried even though they’ve been told that thyroid cancer is the “good” cancer. This dichotomy often makes them feel that they’re not entitled to complain or even feel bad. “They’re told they’re supposed to feel lucky, but they don’t. They have cancer,” says Smallridge, who is president of the American Thyroid Association.

About 63,000 new cases of thyroid cancer are diagnosed in this country each year. Most of the tumors are slow-growing and small; they originate from cells that produce hormones in the thyroid, a tiny, butterfly-shape gland located in the front of the neck, near the Adam’s apple. Many people have no symptoms other than an enlarged gland, but some have pain in the front of the neck, trouble swallowing, persistent hoarseness or other voice changes, or constant coughing.

(ISTOCKPHOTO)

But other cases can be much more aggressive and are associated with worse outcomes, says endocrinologist Leonard Wartofsky,chairman of the Department of Medicine at the Washington Hospital Center. “Like all things in medicine, it depends on the individual case,” he says.

Surgery, then hormones

The first-line treatment is surgical removal of all or part of the thyroid, called a thyroidectomy. My mother had a total thyroidectomy, as well as removal of several cancerous lymph nodes, to prevent her cancer from spreading. The thyroid regulates a number of essential functions, including blood pressure, body temperature, heart rate and metabolism, so when the entire thyroid is removed, patients must take hormone replacement medication. This daily treatment replaces the organ’s vital role of producing and releasing necessary hormones.

The dosing of thyroid replacement hormones varies widely depending on the individual. Too much or too little can produce side effects including fatigue, chest pain, increased heart rate or pulse rate, sweating, nervousness and anxiety, headache, insomnia, diarrhea, vomiting, weight loss and fever.

“The biggest long-term adjustment that I went through — and most people with thyroid cancer go through — is modulating the medication,” says Cherry Wunderlich, 71, of Bethesda, director of outreach for ThyCa, a thyroid cancer survivors’ association.

Wunderlich was diagnosed in 1999 after noticing a hard protrusion on her neck, and she soon had her thyroid removed. But it took much longer to get her medication right, and for the first few years, Wunderlich experienced extreme fatigue.She needed to nap for two to three hours most afternoons during the first year. Eventually, after doctors fine-tuned her dosage, her health began to improve.

My mother also has experienced severe fatigue since going on thyroid replacement medication. She often has to rest after work, and she goes to bed early.

After a thyroidectomy, remnants of thyroid tissue or cancerous cells may be left behind. When this happens — as it did to my mother and Wunderlich — patients have to undergo radioactive iodine treatment to destroy these remaining cells.

After taking the isotope in liquid or pill form, patients are typically isolated at home for up to a week, while the body gives off low amounts of radiation. Patients must avoid close contact with people and pets, sleep alone, clean their dishes by hand, and wash their towels, sheets and clothes separately.

A further cancer risk

Although the radioiodine kills the thyroid cancer cells, it increases the risk of a secondary cancer because it exposes the kidney, bladder and pelvic organs to radiation, Smallridge says. The treatment also can cause short-term side effects including painful swelling of salivary glands, headache, nausea and appetite loss. The worst of my mom’s side effects was the metallic taste, which lingered long after her treatment. An avid cook, she didn’t enjoy food for months.

Even after thyroid cancer is gone, there’s a risk that it will come back: Ten to 30 percent of patients deemed disease-free after initial treatment will develop recurrence or metastases 10 to 20 years after treatment, according to the National Cancer Society.

When David Kalish, of Albany, N.Y., was diagnosed with a rare, aggressive type of thyroid cancer in 1994 at age 32, he had surgery to remove his thyroid, dozens of lymph nodes, part of his trachea, and one of his laryngeal nerves. That procedure has left Kalish permanently hoarse. A year later, he had another surgery to take out more cancerous lymph nodes. And in 1999 he had a third surgery to remove a tumor that had wrapped itself around his remaining laryngeal nerve, threatening his ability to speak.

After all that, Kalish’s battle with thyroid cancer wasn’t over.

“When I was diagnosed in 1994, all the literature said there was a 95 percent cure rate. What I was going through was definitely not in sync with that information,” says Kalish, whose type of thyroid cancer is more aggressive and more deadly than most.

By 2000, Kalish’s cancer had metastasized to his lungs. He underwent three years of traditional chemotherapy, but the cancer continued to spread.

In 2008 Kalish signed up for a clinical trial testing a novel treatment targeting the enzymes that tell cancer cells to grow. The cancer has stopped spreading, although some spots remain in his lungs.

Kalish wrote a comedic novel about his experience with cancer, “The Opposite of Everything,” and is hopeful that science will keep churning out drugs to keep him alive.

No ‘good’ cancer

What I’ve learned from my mother’s diagnosis is that while some other cancers are certainly more deadly, there is no such thing as a “good” cancer.

Or as my mother puts it: “Cancer diagnosis of any kind is still cancer.”

While she is relieved she doesn’t have a more serious type of cancer, it will be years before she’ll know whether she’s truly cancer-free. She needs regular tests to make sure the cancer hasn’t come back. When I ask her about the cancer, she almost always has a positive outlook, but she still regularly experiences fatigue and mood swings from her hormone medication.

Smallridge says patients’ quality of life tends to improve over time as they learn how to cope with what is essentially a chronic disease, the lack of thyroid hormones.

“It’s going to take a while for patients to get through the initial therapy,” Smallridge says. “It’s going to take several years before they can appreciate that they’re going to do well.”

Mullin is a freelance science writer living in the Washington area.

Is it Hypothyroidism or Thyroid Cancer?

Your thyroid is only about the size of your thumb, but it’s got an important job. This tiny butterfly-shaped gland situated in your neck just above your collarbone produces a hormone that controls the rate of many activities in your body, including how fast your heart beats and how quickly you burn calories. So when your thyroid isn’t working properly, you may notice changes in your energy level, your mood, and your waistline.

However, some thyroid disorders, including thyroid cancer, may be stealthy. In fact, more than half of the estimated 20 million Americans with some form of thyroid disease are unaware of their condition. A good way to protect your health is to learn more about thyroid conditions, like hypothyroidism and thyroid cancer, so you can assess your risk and address any concerns you have with your doctor.

Know the Signs of Thyroid Conditions

If your thyroid gland doesn’t produce the right amount of hormones your body needs, you develop thyroid disease. An overactive thyroid releases too much thyroid hormone.

Known as hyperthyroidism, this condition causes your metabolism to speed up. When this happens you may experience:

  • Unexplained weight loss
  • Nervousness
  • Irritability
  • Sensitivity to heat
  • Fatigue
  • Trouble sleeping
  • Rapid heartbeat
  • Muscle weakness

On the other hand, hypothyroidism occurs when your body doesn’t produce enough thyroid hormone, causing your metabolism to slow down. When this happens you may experience:

  • Depression
  • Unexplained weight gain
  • Fatigue
  • Muscle weakness
  • Constipation
  • Dry skin
  • Hair loss
  • Infertility
  • Trouble with concentration and memory

With hypothyroidism or hyperthyroidism, the thyroid can also become enlarged, so much so that you can feel or see it. When this happens, it’s called a goiter.

Some goiters are diffuse, which means the entire thyroid gland is enlarged. In other cases, goiters are nodular or the thyroid has bumps in it. In most cases, lumps or bumps in the thyroid gland, known as thyroid nodules, are benign. In fact, thyroid nodules are cancerous in fewer than 10 percent of cases.

There are other reasons why your thyroid gland might be larger than usual, such as an imbalance or changes in hormone levels from not getting enough iodine in your diet. Although the thyroid gland can also develop tumors, most of the time the cause isn’t cancer.

“Thyroid cancer is a growth in the thyroid gland and differs from other thyroid problems, which are typically conditions resulting from changes in thyroid hormone production,” explains Christopher Sullivan, MD, an associate professor of head and neck surgery at Wake Forest Baptist Medical Center in Winston-Salem, N.C., and a thyroid cancer surgeon.

Although thyroid disorders are very common, thyroid cancer is extremely rare. About 20 million Americans have some form of thyroid disease, but it’s estimated that just 60,220 people in the United States will be diagnosed with thyroid cancer this year.

What’s problematic about thyroid cancer is that it typically has few warning signs. “Unlike hypothyroidism or hyperthyroidism, there aren’t really any symptoms of thyroid cancer,” says Kristen Gill Hairston, MD, MPH, an assistant professor in the department of internal medicine in the section of endocrinology and metabolism at Wake Forest Baptist Medical Center. Very large thyroid tumors may cause voice, swallowing, or breathing problems.

Thyroid cancer and other thyroid conditions do have one thing in common: They’re not preventable. “Currently, there is no documented way to prevent thyroid disease or thyroid cancer,” says Dr. Hairston.

Know the Risk Factors for Hypothyroidism and Thyroid Cancer

They may not be considered preventable, but hypothyroidism and thyroid cancer share a few risk factors that could increase your likelihood of developing either condition and make you more vigilant about watching for them.

Most people diagnosed with thyroid cancer are 40 or older. Although those diagnosed with hypothyroidism are typically older than 60, both conditions are more common among women than men.

Exposure to radiation is another risk factor for both hypothyroidism and thyroid cancer. “Thyroid cancer is associated with a history of ionizing radiation exposure such as radiation used to treat acne or enlarged adenoids in the 1950s or mantle radiation used to treat lymphoma,” notes Dr. Sullivan.

Research has shown that radioactive fallout from nuclear weapons or power plant accidents have increased children’s risk for thyroid cancer. Anyone who has received radiation to the thyroid, neck, or chest is also at greater risk for hypothyroidism.

If you have a family history of thyroid disease, you’re also at greater risk for hypothyroidism. In addition, certain inherited conditions or a family history of the disease have been linked to thyroid cancer.

A thyroid condition known as Hashimoto’s thyroiditis is associated with an increased risk for thyroid cancer. This autoimmune disease is also the most common cause of hypothyroidism. With Hashimoto’s, the immune system makes antibodies that damage the thyroid and interfere with its ability to release thyroid hormone.

A 2013 study involving 2,478 patients revealed Hashimoto’s thyroiditis is associated with a significantly higher risk for papillary thyroid cancer, the most common cancer of the thyroid gland.

“Some patients with Hashimoto’s thyroid disease have increased association of thyroid cancer, but this is still very, very uncommon,” notes Hairston.

Is It Thyroid Disease or Thyroid Cancer?

For all thyroid conditions, Sullivan says that early detection and treatment are essential. “It is not possible to tell if a lump in the thyroid is cancerous without an ultrasound exam and a fine needle aspiration biopsy,” he points out. An ultrasound can help determine if a thyroid nodule is solid or filled with fluid and provide clues about whether or not it’s cancer.

For definitively diagnosing thyroid cancer, you’ll need to have a biopsy. For this procedure, your doctor will use a needle to draw out cells from the suspicious area of your thyroid. The cells will then be examined under a microscope. Sullivan notes that it’s sometimes necessary to remove a lump to determine if it is cancerous.

The good news is that thyroid conditions, such as hypothyroidism and thyroid cancer, are treatable. In most cases, hypothyroidism can be completely controlled with daily medication. And, the cure rate for thyroid cancer, which typically includes removing the gland, is more than 90 percent.

You and Your Hormones

Depending on the type and size of the cancer, it may not be necessary to remove the whole of the thyroid. However, most patients have the whole gland removed (total thyroidectomy) usually at a second operation through the same scar. The team of doctors will then discuss what was found at the operation in detail and make suggestions about what other treatment might be helpful. Sometimes further scans are required at this stage.

The most common recommendations are for radioactive iodine treatment and sufficient doses of thyroid medication to keep a hormone called thyroid stimulating hormone at very low levels in the blood. Treatment with radioactive iodine requires a few days’ stay in hospital and there are usually some restrictions on how much time the patient can spend near other people, particularly children, for a period of time after they leave hospital.

Are there any side-effects to the treatment?

All surgery carries some risks but, although serious complications from thyroid surgery are rare, it is important that the patient has them explained in detail by the surgeon. Changes in the quality of the voice are usually very small and only a problem for people who use their voice professionally. More significant voice change, which makes the voice very weak, usually recovers over time. If they have any concerns, they should ask their doctor.

The radioactive iodine therapy does not affect the ability to have children in men or women, but a delay is necessary after the treatment before starting to try for pregnancy. It does not make hair fall out or affect body weight.

What are the longer-term implications of thyroid cancer?

The majority of patients with thyroid cancer can be treated successfully, but it can be fatal. Following successful treatment, patients usually have a blood test every year, and in some cases, regular scans are recommended. Most patients will be taking thyroxine tablets for life. Unless there have been any complications from surgery, patients usually return to all their previous activities.

Are there patient support groups for people with thyroid cancer?

British Thyroid Foundation or Butterfly Thyroid Cancer Trust may be able to provide advice and support to patients and their families dealing with thyroid cancer.

Last reviewed: Mar 2018

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Discussion

This study used a comprehensive national database to investigate the incidence of cancer in a group of 1521 HT patients. A 1-to-4 comparison was conducted for 6084 controls, which were randomly frequency-matched for age, sex, and index year, with adjustments for baseline comorbidities that may cause a predisposition to cancer, including diabetes mellitus, hypertension, hyperlipidemia, and heart disease. Hashimoto’s thyroiditis patients were more likely to be diagnosed with thyroid and colorectal cancer, with an aHR of 11.8 and 4.76, respectively. Knowing the cancer risk is valuable in the prevention and care of HT patients. In addition, this study showed that older subjects in the HT cohort had a higher risk of developing cancer compared with the younger ones. It is important to note that the aHR of thyroid cancer is much higher in HT patents in the early 3 years of follow-up, while higher colorectal cancer risk appears later. The increased thyroid cancer risk appears in early years since HT have been diagnosed may be due to the coincident findings of thyroid cancer with HT. This reflects the result of early thyroid cancer diagnosis from hard investigation when diagnosis and treatment for HT are undergoing.

Patients with HT had a statistically significant higher incidence density ratio of colorectal, breast, uterus, prostate, kidney, thyroid, and haematologic cancer compared with the comparison cohort (IRR=4.02, 1.78, 2.01, 2.01, 2.68, 11.3, and 8.05, respectively). The incidence density ratio of thyroid lymphoma (1.01) was not statistically significant. Some report revealed the malignancy most strongly associated with HT (Holm et al, 1985; Hyjek and Isaacson, 1988; Motoi and Ozawa, 2005). Our data show thyroid lymphoma rates are not increased, probably because it is very rare. After adjusting for sex, age, and comorbidities, the aHRs for developing thyroid and colorectal cancer had statistical significance. In addition, the aHRs of HT patients with hypothyroid (234) for developing cancer did not have statistical significance (HRs=1.32, 95% CIs=0.67–2.59).

The coexistence of HT and thyroid carcinoma has a frequency from <1%–23% (Cheng, 2009). A link between thyroid cancer (in particular, the PTC histotype) and autoimmune thyroid diseases has long been recognized, although the precise relationship between the two diseases remains unclear. Hashimoto’s thyroiditis is an autoimmune disorder in which the immune system reacts against a variety of thyroid antigens. An epidemiological association has been identified between HT and thyroid cancer (Segal et al, 1985; Ott et al, 1987; Eisenberg and Hensley, 1989; Sclafani et al, 1993; Di Pasquale et al, 2001; Pisanu et al, 2003). The relationship between inflammation and thyroid cancer is complex and remains unclear. Epidemiological and histological data indicate that thyroid cancer frequently occurs in the context of HT, which is one of the most common autoimmune thyroid diseases, and that thyroid cancer is frequently infiltrated by inflammatory-immune cells (Guarino et al, 2010). The increased incidence of carcinomas in patients with HT suggests that thyroiditis may be a precancerous condition.

Inflammation is a physiological protective process used by organisms in response to tissue damage. Inflammation is an auto-limiting process; however, abnormal persistence of the stimuli that induce the inflammatory response or failure of the mechanisms that terminate it result in chronic inflammation (Coussens and Werb, 2002). A functional relationship between chronic inflammation and cancer has been supported by clinical and epidemiological evidence. Patients with HT were three times more likely to have thyroid cancer, suggesting a strong link between chronic inflammation and cancer development (Larson et al, 2007). The most compelling evidence is the association between intestinal chronic inflammatory diseases (Crohn’s disease and ulcerative rectocolitis) and adenocarcinoma of the colon (Balkwill and Mantovani, 2001; Guarino et al, 2010). A prior study showed that cyclooxygenase-2 (COX-2) expression is localized primarily in the mononuclear inflammatory cells, and was elevated in HT patients. Furthermore, follicular adenomas and papillary and follicular carcinomas exhibited strong COX-2 expression, indicating consistent upregulation in thyroid tumorigenesis, which was also observed for other organs, such as the colorectum (Eberhart et al, 1994; Sano et al, 1995). Because COX-2 expression was observed in follicular adenomas and papillary and follicular carcinomas, the enzyme may be involved in early processes of thyroid tumorigenesis, similar to cases with colorectal adenomas and carcinomas (Nose et al, 2002). The link between inflammation and cancer has been effectively established; however, the pathophysiology mechanism between HT and cancer requires further examination.

This study had a few limitations. First, we have evaluated a limited number of comorbidities for the cancer risk associations. These are most common comorbidities, but no significance associated with overall cancer appears in the data analysis. It is likely that comorbidities of less prevalence might not have significant association with the thyroid cancer and colorectal cancer as well. Second, the NHIRD does not provide detailed patient information, such as smoking habits, alcohol consumption, body mass index (BMI), physical activity, socioeconomic status, and family history of cancer. However, these covariates may have a less important role in this study because of strong relationship between HT and risk of thyroid cancer. Third, results derived from a cohort study are generally of lower methodological quality than those derived from randomized trials, because a cohort study design is subject to bias related to adjustments for confounders. Despite our meticulous study design, including adequate control of confounding factors, bias may remain because of possible unmeasured or unknown confounders. Fourth, the diagnoses recorded in NHI claims are used primarily for administrative billing; therefore, they are not subject to verification for scientific purposes. We were unable to contact the patients directly to obtain additional information because of the anonymity ensured by the identification numbers. In addition, our analyses excluded cancer patients prior to this study. This omission may have resulted in an underestimation of HT patients, and may have weakened the observed association. However, the obtained data on HT therapy and cancer diagnoses were highly reliable. Finally, we agree that the incidence of individual cancers is of low meaning because of small number of events. Hashimoto’s thyroiditis is a rare disease with an incidence of approximately 1.4 per 10 000 in the general population in this study. However, the important part of this study is that patients with HT are at very high risk of thyroid cancer and also at an elevated risk of colorectal cancer. The association between HT and colorectal cancer has not been established previously. Our cohort study proved previous studies of small sample sizes for thyroid cancer. In other words, this study suggests that clinicians should pay higher attention to the risk of these two cancers.

This study provides valuable information. This is the first large-scale nationwide cohort study of cancer and HT conducted in an Asian population. Patients with HT, particularly older patients, are at higher risk of developing thyroid and colorectal cancer compared with the general population. In addition, HT patients have an increased relative risk of developing thyroid and colorectal cancer within 3 years and after 3 years, respectively. Clinicians managing HT patients, especially older patients, must be aware of the possible increased risk of thyroid and colorectal cancer within 3 years and after 3 years, respectively. Therefore, strategies to facilitate the prevention of thyroid and colorectal cancer are recommended for these patients.

Hashimoto’s Thyroiditis Complications

Hashimoto’s thyroiditis is a disorder characterized by inflammation of the thyroid gland. This condition can cause certain complications, including putting you at a higher risk for developing other autoimmune disorders and, to a lesser extent, thyroid lymphoma, a specific type of thyroid cancer.

Hashimoto’s Thyroiditis and Other Autoimmune Disorders
Autoimmune disorders are caused by a malfunction in your immune system. Hashimoto’s thyroiditis is an autoimmune disorder, which is why the primary complication associated with Hashimoto’s thyroiditis is that it increases your risk of developing other autoimmune disorders.

Hashimoto’s thyroiditis increases your risk of developing a number of autoimmune disorders. Some examples include:

  • Addison’s disease
  • Graves’ disease
  • premature ovarian failure
  • type 1 diabetes
  • lupus erythematosus (a disorder that causes inflammation in a number of the body’s systems, including the lungs and heart)
  • pernicious anemia (a disorder that prevents the absorption of vitamin B12)
  • rheumatoid arthritis
  • thrombocytopenic purpura (a disorder that interferes with the blood’s ability to clot)
  • vitiligo (a disorder that produces white patches on the skin due to attacks on skin pigment cells)

Hashimoto’s Thyroiditis and Thyroid Lymphoma
It’s a very rare complication, but Hashimoto’s thyroiditis may increase your risk of developing a specific kind of thyroid cancer known as thyroid lymphoma. Thyroid lymphoma is highly treatable and curable when it’s detected early on. That’s why it’s so important to pay attention to any thyroid nodules (or thyroid lumps) and get them examined by your doctor as soon as possible.

Because Hashimoto’s thyroiditis can increase your risk for certain autoimmune disorders, you should talk to your doctor about what steps you should take to effectively manage these risks. Your doctor may recommend periodic tests to ensure that any associated complication is detected—and treated—as early as possible.

Updated on: 05/03/17 Continue Reading Preventing Hashimoto’s Thyroiditis View Sources

Sources

  • Most common cause of hypothyroidism in the United States
  • Also known as chronic lymphocytic thyroiditis or autoimmune thyroiditis
  • An autoimmune condition
  • Diagnosed by low TSH and detection of anti-thyroid antibodies
  • Effects women more common than men
  • Often appears between 40-60 years of age
  • Appears to have some hereditary component
  • Increased risk if you have other autoimmune disorders
  • Can produce pseudonodules

What Are The Symptoms of Hashimoto’s Thyroiditis?

Early in the course of the disease, symptoms may not appear because the condition progresses slowly. However, over time symptoms arise.

The following are a list of the more common symptoms of Hashimoto’s Thyroiditis:

  • Large thyroid or goiter
  • Neck/thyroid tenderness
  • Fatigue
  • Weight gain
  • Cold intolerance
  • Joint/muscle pain
  • Constipation
  • Irregular menstrual periods
  • Dry/thinning hair
  • Depression
  • Memory problems
  • Slowed heart rate

What Causes Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis is an autoimmune disease where the immune system malfunctions. We do not know exactly why it occurs, but we think it is multifactorial. Excessive iodine may trigger thyroid disease. There is likely a hormonal component because women are affected much more commonly than men. Lastly, there is likely a genetic component because Hashimoto’s thyroiditis runs in families who have thyroid disease or autoimmune diseases. Some anecdotal evidence suggests that dietary gluten may contribute to Hashimoto’s thyroiditis and dietary changes may improve some symptoms.

Regardless of the cause, we know that the immune system is finding our thyroid gland abnormal and mounts an antibody attack against the gland. Instead of the immune system protecting the body, the immune system makes antibodies that attack the thyroid gland. A large number of lymphocytes or white blood cells, that are part of the immune system, build up in the thyroid and produce antibodies. These antibodies are anti-thyroid antibodies that are more specifically called thyroid peroxidase antibodies and the anti-thyroglobulin antibodies.

This is a picture of a pathology slide of a patient that underwent thyroid cancer surgery and Hashimoto’s thyroiditis was also present. Thyroid cancer and Hashimoto’s thyroiditis are not exclusive of each other. The black arrow points to thyroid tissue. The large pink areas are called thyroid follicles. The yellow arrow points to dark purple cells in the thyroid gland. These are the bodies white blood cells. They are not normally present in the thyroid gland in large numbers except in thyroiditis or inflammation.

Hashimoto’s Thyroiditis Diagnosis: How is it made?

The following are a list of tests that are required in the evaluation of a patient with Hashimoto’s thyroiditis:

  • Complete Medical History and Physical Examination
  • Ultrasound
  • Blood tests
    • TSH
    • T3 and T4
    • Thyroglobulin (we obtain but not all doctors do)
    • Thyroglobulin Antibody
    • Thyroid Peroxidase Antibody
  • Laryngoscopy (looking at voice box)
  • Ultrasound with possible FNA (fine needle aspiration) biopsy

Medical History and Physical Examination is required for all patients with a potential diagnosis of Hashimoto’s thyroiditis.

If there is a suspicion that you may have a Hashimoto’s thyroiditis, your health care professional will want to know your complete medical history. You will be asked questions about your possible risk factors, symptoms, and any other health problems or concerns. If someone in your family has had a diagnosis of Hashimoto’s thyroiditis or other autoimmune disorders, these are important factors.

Your doctor will examine you to get more information about possible signs of thyroid goiter and other health problems. During the exam, the doctor will pay special attention to the size and firmness of your thyroid and any enlarged lymph nodes in your neck. Examination of your voice box is part of the physical examination obtained by the surgeon for any patient with Hashimoto’s thyroiditis. A small lighted microscope is used to look at the voice box to determine how the vocal cords of the voice box are functioning. Even though a patient does not report change in their voice does not insure that the vocal cords are working normally. Thyroid cancer must be ruled out if a vocal cord that is paralyzed. Patients do not always report changes in voice when a vocal cord has become paralyzed slowly over time.

Hashimoto’s Thyroiditis: How is diagnosis made?

  • The diagnosis of Hashimoto’s thyroiditis is made with a comprehensive analysis of the blood including thyroid stimulating hormone (TSH), Free T4 levels and Free T3 levels. In Hashimoto’s thyroiditis, the TSH level can be quite high consistent with a hypothyroid condition. When the thyroid gland is not producing enough thyroid hormone (Free T4), the pituitary gland which secretes TSH is stimulated to secrete more TSH to try to increase production of thyroid hormone. But this mechanism is failing to control the hypothyroidism.
  • The diagnosis of Hashimoto’s thyroiditis is made with the detection of a high TSH, low Free T4, and anti-thyroid antibodies. Hashimoto’s thyroiditis is supported by a blood test for Thyroid Peroxidase Antibodies (TPO) or Thyroglobulin Antibody. Ultrasound is used to see the thyroid gland and the lymph nodes of the neck. In Hashimoto’s thyroiditis, diffuse vascularity can be seen. Also, pseudo nodules can be seen, which are not real thyroid nodules. Pseudo nodules are an ultrasound artifact. The inflammation of Hashimotos’ thyroiditis makes the thyroid look lumpy bumpy on ultrasound. Pseudo nodules are diagnosed when the apparent nodules disappears on follow up ultrasounds. Ultrasound exposes you to no radiation whatsoever. It uses sound waves to look beneath the skin at the important structures of your neck. Needle biopsy is only indicated if there is a mass within the thyroid which is suspicious for thyroid cancer. Find out more about ultrasound evaluation and how important it is in the evaluation of thyroid cancer here: Ultrasound and evaluation of thyroid cancer.
  • FNA is generally done on all thyroid nodules that are big enough to be felt. This means that they are larger than about 1 centimeter (about 1/2 inch) across.
  • FNA biopsies of swollen or abnormal appearing lymph nodes in the neck may be more informative than the thyroid nodule itself in obtaining a diagnosis of thyroid cancer.
  • Cells from the suspicious area are removed without an incision or discomfort and looked at under a microscope.
  • The process of obtaining this small sampling of cells is called fine needle aspiration (FNA) cytology.
    • This type of biopsy can usually be done in your doctor’s office or clinic.
    • Before the biopsy, local anesthesia (numbing medicine) may be injected into the skin over the thyroid nodule.
    • Your doctor will place a thin, hollow needle directly into any suspicious dominant nodules within the thyroid goiter to aspirate (take out) some cells and possibly a few drops of fluid into a syringe.
    • The doctor usually repeats this 2 or 3 more times, taking samples from several areas of the nodule.
    • The content of the needle and syringe are then placed on a glass slide and then the FNA samples are then sent to a lab, where they are looked at under a microscope by the expert Cytologist to see if the cells look cancerous or benign.
  • Cytology means looking at just the cells under the microscope.
  • Thyroid cytology requires an expert physician (called a Cytologist) trained specifically in the diagnosis of thyroid nodules and thyroid cancers!
  • Unfortunately, the diagnosis of thyroid nodules are frequently misinterpreted by unskilled or inexperienced Cytologists.
  • Bleeding at the biopsy site is very rare except in people with bleeding disorders. Even when this occurs, the bleeding is almost always very self-limited. Be sure to tell your doctor if you have problems with bleeding or are taking medicines that could affect bleeding, such as aspirin or blood thinners.
  • FNA biopsy sometimes need to be repeated because the samples didn’t contain enough cells.
  • Most thyroid nodules in Hashimoto’s thyroiditis are benign. Rarely, the FNA biopsy may come back as benign even though a diagnosis of a thyroid cancer is actually present.

Ultrasound Appearance of Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis appears as a diffusely irregular gland with increased vascularity (new blood vessel flow) throughout the gland. Pseudo nodules of thyroiditis appear like well-defined nodules however they resolve over short periods of time and the diagnosis is made when the nodule can no longer be identified. Pseudonodules are not real nodules. They are an ultrasound “artifact” produced by edema (swelling) in an area of the thyroid gland. Thyroid cancer and Hashimoto’s thyroiditis are not exclusive of each other. They may co-exist together and therefore any suspicious thyroid nodule within Hashimoto’s thyroiditis should be biopsied based upon its size and overall concern. Hashimoto’s thyroiditis is commonly associated with increased size and prominence of the lymph nodes in the area of the thyroid gland. These lymph nodes cannot be differentiated from thyroid cancer lymph nodes based upon their general ultrasound appearance.

Find out more about Thyroid Cancer and spread to lymph nodes here: Thyroid Cancer Overview

Hashimoto’s Thyroiditis Ultrasound Images

The orange arrows point to the thyroid gland. Although the patient was referred to us with a diagnosis of concerning thyroid nodules, her ultrasound revealed diffuse thyroiditis without evidence of any nodules. Therefore the prior nodules found on ultrasound were in fact “pseudo nodules”.

What is the treatment for Hashimoto’s Thyroiditis?

Thyroid Hormone Replacement

Your doctor will likely prescribe you a medication to control your hypothyroidism. Thyroid hormone replacement therapy is highly effective, and likely the only treatment you will need. Thyroid hormone replacement treats this condition by compensating for the lack of hormones that the thyroid is actually producing. This medication should be prescribed by your endocrinologist who understands Hashimoto’s disease and how the medication will work. It will usually take several weeks to work.

Anti-inflammatory approaches

When the inflammatory condition is very severe, some doctors consider a short duration of steroid therapy. Alternative medical approaches such as gluten free and avoidance of food coloring in exacerbation of Hashimoto’s disease has been advocated as well.

Thyroid Surgery

Thyroid Surgery may play a role in the management of patients with Hashimoto’s thyroiditis:

  • A small component of patients with Hashimoto’s thyroiditis appear to signficantly benefit from thyroid surgery
  • Medical management of Hashimoto’s thyroiditis should be considered in patients prior to considering thyroid surgery
  • Thyroid Surgery may be recommended if there is:

    • symptomatic thyroiditis
    • thyroid enlargement and producing symptoms from its size
    • mood or hormonal dysfunction. A recent randonmized controlled study suggests that surgery tremendously benefits some patients with chronic hashimoto’s thyroiditis. In this study, those patients randomized to surgery did significantly better in quality of life measures than those patients managed conservatively with hormonal replacement only. They measured chronic fatigue improvement as well as General Health measures. Both were tremendously improved among surgery patients as compared to hormone replaced only patients. Published in the Annals of Internal Medicine April 2019
    • A thyroid nodule is present and an FNA is suspicious for thyroid cancer
    • The inflammatory condition has exhausted medical management and causing tenderness and pain in the neck or referred pain to the surrounding area. This is a rare event.
    • Hashimoto’s thyroiditis surgery should only be performed by highly expert thyroid surgeons. An occasional thyroid surgeon should not do this surgery.
    • Lifelong thyroid hormone replacement medication is almost certainly needed after thyroid surgery when Hashimoto’s disease is present.

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