Thyroid Cancers

Thyroid Cancers

Also called: Medullary Thyroid Carcinoma, Papillary Thyroid Cancers, Anaplastic Thyroid Cancers, Papillary Thyroid Carcinoma, Well Differentiated Thyroid Cancers, Follicular Thyroid Cancers

Reviewed By:
Mark Oren, M.D., FACP

Summary

Thyroid cancer is a cancerous tumor or growth within the thyroid gland. Located under the thyroid cartilage (Adam’s apple) in the front section of the neck, the thyroid gland is part of the endocrine system, a network of glands that produce and secrete hormones. It is responsible for absorbing iodine from food, water and the blood and using the iodine to produce thyroid hormones. Thyroid hormones play a major role in regulating the body’s metabolism, the body’s process of using food for energy and growth.

The thyroid gland is located just underneath the skin. As a result, tumors can often be felt as bumps in the neck (thyroid nodules). According to the American Cancer Society (ACS), one-third of all people develop thyroid nodules. These nodules can be either benign (noncancerous) or malignant (cancerous). In some situations, the nodules remain undiscovered and never cause a problem. It is estimated that 95 percent of thyroid nodules are benign.

Thyroid nodules can occur at any age, but are most common in adults. Approximately 5 to 10 percent of thyroid nodules are malignant. The four main types of malignant thyroid tumors include:

  • Papillary carcinoma
  • Follicular carcinoma
  • Anaplastic carcinoma
  • Medullary thyroid carcinoma (MTC)

Tumors can be found in normal-sized thyroid glands and enlarged thyroid glands. Currently physicians do not know what causes the development of benign thyroid nodules.

The exact cause of most thyroid cancers is also unknown. Some forms of cancer are caused by DNA mutations that “turn on” oncogenes (genes that speed up cell division) or “turn off” tumor suppressor genes (genes that slow down cell division or cause cells to die at the right time). In people with thyroid cancer, these mutations can be inherited or acquired during a lifetime.

Although there is no single cause of thyroid cancer, researchers have identified a number of factors that appear to place a person at higher risk for developing the disease. These risk factors include having had an enlarged thyroid and having a family history of thyroid disease.

Symptoms of thyroid cancer include a lump, neck pain and hoarseness. Individuals who experience these symptoms are encouraged to contact their physician to determine the cause. If a physician suspects thyroid cancer, a biopsy may be performed to remove a small sample of tissue and examine it under a microscope for the presence of abnormal cells.

If cancer is diagnosed from the biopsy, the disease will be staged to determine a course of treatment.

The lower the stage, the earlier the disease has been identified and the better the prognosis for recovery. The main method used to treat thyroid cancer is surgery. In some cases, a diagnosis is not made until after a thyroid nodule is removed during surgery.  The American Cancer Society (ACS) predicts that in 2007 there will be more than 33,000 new cases of thyroid cancer in the United States. However, thyroid cancer is one of the least deadly forms of cancer, with an overall five-year survival rate of 97 percent. Cases of thyroid cancer have been increasing in recent years. Women have a greater risk of developing the disease, as do Asian people.

About thyroid cancer

Thyroid cancer is a cancerous tumor or growth within the thyroid gland. The thyroid gland is located in the front of the neck, under the thyroid cartilage (Adam’s apple). It is part of the endocrine system, a network of glands that produce and secrete hormones. It is responsible for absorbing iodine from food, water and the blood and using the iodine to produce thyroid hormones. Thyroid hormones play a major role in regulating the body’s metabolism, the body’s process of using food for energy and growth.

The thyroid gland has two halves – the left lobe and the right lobe. Usually, the thyroid gland cannot be felt despite being just underneath the skin.

The thyroid gland contains several types of cells and different cancers can develop from each type of cell. Thyroid follicle cells  manufacture and store thyroid hormone. They also produce thyroglobulin, a type of thyroid protein. C cells produce a hormone called calcitonin. These different cells can produce different types of thyroid tumors. These tumors can be either benign (noncancerous) or malignant (cancerous).

Most growths found in the thyroid are benign nodules, growths that develop from follicle cells. They can be found in normal-sized thyroid glands and enlarged thyroid glands (goiters). The thyroid may contain one nodule or multiple nodules. An enlarged thyroid gland with multiple benign nodules is known as a multinodular goiter. Frequently, these nodules are fluid-filled cysts, or lumps of stored thyroid hormone known as colloid nodules. While some types of benign thyroid nodules may be related to other medical conditions, such as hyperthyroidism, they are not cancerous. The exact cause of most benign thyroid nodules is unknown.

Malignant thyroid tumors can develop from either type of thyroid cell. Because the thyroid gland is located just under the skin, tumors are often able to be felt as bumps in the neck. According to the American Cancer Society (ACS), one-third of all people develop thyroid nodules. They can occur at any age, but are most common in adults. Often, people discover these bumps on their own by seeing or feeling them. In some situations, the nodules remain undiscovered and never cause a problem. According to the ACS, more than 33,000 new cases of thyroid cancer will be diagnosed in the United States during 2007. The disease is more common in women, with approximately 25,000 cases being diagnosed in women each year, and about 8,000 new cases being diagnosed in men. In addition, nearly two-thirds of the cases are diagnosed in people between the ages of 20 and 55.

Types and differences of thyroid cancer

Thyroid nodules (abnormal lumps in the neck) can be either benign (noncancerous) or malignant (cancerous). Approximately 5 to 10 percent of thyroid nodules are malignant. The four main types of malignant thyroid tumors include:

  • Papillary carcinoma. Also known as papillary cancer or papillary adenocarcinoma, these tumors evolve from the thyroid follicle cells and typically grow very slowly. Papillary carcinomas account for approximately 70 to 80 percent of thyroid cancers. This cancer usually occurs in only one lobe of the thyroid gland. Both lobes are affected in about 10 percent of cases. Several subtypes of papillary carcinoma can be identified under a microscope. Treatment decisions and prognosis depend on the form of the disease. Although papillary carcinoma frequently spreads early to the lymph nodes in the neck, this form of cancer has a very high survival rate.
  • Follicular carcinoma. This cancer normally remains in the thyroid gland, but can spread to other areas of the body including the lungs and bone. It is the second most common form of thyroid cancer, accounting for approximately 20 percent of all cases. Also known as follicular cancer or follicular adenocarcinoma, the disease is more common in areas where people have iodine-deficient diets.
  • Medullary thyroid carcinoma (MTC). MTC accounts for approximately 3 percent of thyroid cancers. It is the only form of thyroid cancer that evolves from the C cells of the thyroid gland. One of the two types of MTC is familial medullary thyroid carcinoma (FMTC), an inherited cancer. FMTC may occur in people who have a condition called type 2 multiple endocrine neoplasia (MEN 2), which can produce tumors in other endocrine glands.
  • Anaplastic carcinoma. The rarest form of thyroid cancer, anaplastic carcinoma is believed to evolve from an existing papillary or follicular cancer. Also known as undifferentiated thyroid cancer, anaplastic carcinoma is an aggressive cancer that quickly invades the neck, and often spreads to other areas of the body. It is usually fatal. When examined under a microscope, its cells have very little resemblance to healthy thyroid cells.

Risk factors and causes for thyroid cancer

The exact cause of most thyroid cancers is unknown. Some forms of cancer are caused by DNA mutations that “turn on” oncogenes (genes that speed up cell division) or “turn off” tumor suppressor genes (genes that slow down cell division or cause cells to die at the right time). Some people with thyroid cancer inherit these mutations but more commonly they are acquired during the patient’s lifetime.

Patients with mutations in the RET proto-oncogene (RET gene) have an increased risk of developing many forms of thyroid cancer. The function of the RET gene is to produce proteins needed for the development of several kinds of nerve cells. Mutations in the RET gene can cause:

  • Papillary carcinoma. The DNA mutations that trigger some forms of papillary carcinoma are known to involve particular parts of the RET oncogene. Found only in the cancer cells, these mutations are acquired during a patient’s lifetime, and are not passed on to the patient’s children.

  • Medullary thyroid carcinoma (MTC). Nearly all people with familial medullary thyroid carcinoma (FMTC), and about one in every five patients with sporadic medullary thyroid carcinoma have a mutation in the RET gene. Most people with sporadic MTC have acquired mutations found only in their cancer cells. These mutations are not passed on to children. Patients with FMTC and MEN 2 inherit the mutation in the RET gene from a parent. The mutations are found in every cell and can be detected by genetic blood testing. According to the American Cancer Society (ACS), there is a 50 percent chance that a parent with FMTC will pass a mutated gene to a child. 

Acquired changes in other oncogenes and tumor suppressor genes (e.g., RAS, TRK, GSP, and p53) also have a role in causing papillary carcinoma and follicular carcinoma. Although these mutations have been identified and connected with thyroid cancer, researchers are still unaware of exactly how they occur and why they develop in only certain people.  

Although there is no single cause of thyroid cancer, researchers have identified a number of factors that appear to place a person at higher risk for developing the disease. These risk factors include:

  • Diet low in iodine. Papillary and follicular thyroid carcinomas are more common in populations where diets are low in iodine. In the United States, dietary iodine is plentiful because it is added to table salt and other foods.

  • Exposure to radiation. People who received radiation treatments to the head or neck during childhood have an increased risk of developing papillary carcinoma. Radiation was previously used to treat a number of conditions, such as scalp ringworm and enlarged thymus or tonsils. The cancer may develop as early as five years after the treatment, or after 20 or more years.  Exposure to radiation treatments as an adult poses little risk for thyroid cancer. In addition, studies have suggested that exposure to very high levels of radioactive material, such as from atomic weapons or nuclear power plant accidents, may increase a person’s risk of developing the disease.  

  • Genetic conditions. People with certain inherited conditions are at a greater risk of developing thyroid cancer. These conditions include:

    • Gardner’s syndrome. A hereditary disorder in which many polyps form in the digestive tract.

    • Familial polyposis. A hereditary disorder in which many polyps form in the colon.

    • Cowden’s disease. A rare hereditary disorder in which lesions form on the face, hands and feet or inside of the mouth.

    Approximately 20 percent of medullary thyroid carcinomas (MTC) result from the inheritance of an abnormal gene.

  • Goiter. People with enlargement of the thyroid gland (a goiter) have an increased risk of developing thyroid cancer.

  • Family history of thyroid disease. People who have close relatives with any form of thyroid disease have an increased risk of developing thyroid cancer. 

  • Gender. Thyroid cancer occurs more often in women.

  • Age. In general, thyroid cancer occurs more often in people between the ages of 25 and 65. Most cases of papillary carcinoma and follicular carcinoma occur in people between the ages of 20 and 55.

Although these risk factors have been linked to the disease, most patients with thyroid cancer have no apparent risk factors.

Signs and symptoms of thyroid cancers

Thyroid cancers can cause a variety of signs and symptoms.In many cases, the first symptom of early stage thyroid cancer may be a lump or nodule in the neck. These growths, which sometimes grow quickly, may be noticed by the patients themselves or by a physician during a routine examination. Other common signs and symptoms of thyroid cancer include:

  • Neck pain, sometimes extending up to the ears
  • Hoarseness
  • Difficulty swallowing
  • Breathing difficulty
  • A cough that continues and is not caused by a cold

Patients are encouraged to contact their physician when they experience these symptoms. In many cases, these symptoms may be related to other conditions, such as benign thyroid nodules. Awareness of potential thyroid symptoms can help early diagnosis. Although it is rare, some thyroid cancers may not cause symptoms until after the disease has progressed to an advanced stage.

Diagnosis methods for thyroid cancers

First, a physician will take the patient’s medical history and perform a complete physical examination. During the exam, the physician will inspect the size and firmness of the patient’s thyroid and examine any enlarged lymph nodes in the neck. The patient may also be asked to tip their head back, take a drink of water and swallow. The physician then watches the area of the thyroid gland carefully because swallowing may make a thyroid nodule or enlarged thyroid gland more apparent. The physician may also feel (palpate) the thyroid gland as the patient swallows to try to detect nodules. If the physician suspects thyroid cancer, a biopsy of the area may be ordered.

A fine needle aspiration (FNA) biopsy is a type of biopsy that may be ordered to determine if a thyroid nodule is cancerous. It can be used to determine whether other tests or surgery are needed. In this procedure, a thin needle and a syringe are used to remove cells and fluid from the nodule. The process is usually repeated two or three times to collect samples from different areas of the nodule. The test should be performed on all nodules that can be felt. In some cases, FNA is used in combination with ultrasound imaging to help guide the needle into nodules that are too small to be felt.

The cells are examined under a microscope to determine whether the nodule is malignant (cancerous) or benign (noncancerous). According to the American Cancer Society (ACS), approximately one in 20 FNA thyroid tests show cancer and between 60 percent and 80 percent clearly show the tumor is benign. When the findings are inconclusive, and test results cannot be classified as benign or malignant, the nodules are classified as “suspicious” or “atypical.” In such cases, additional tests such as a surgical biopsy may be ordered. This is particularly common when the physician suspects cancer.

After a diagnosis of cancer has been confirmed, the disease will be staged. Staging is the process of determining how far the cancer has spread and is necessary to determine the most effective course of treatment.  Additional tests that may be performed to classify, stage and monitor thyroid cancer include:

  • Thyroid scan. In this procedure, a small amount of radioactive iodine or technetium is taken by mouth or injected into a patient’s vein. The chemicals then concentrate in the thyroid gland. A special camera is then placed in front of the patient’s neck to measure the amount of radiation in the thyroid gland. Although this test is not useful in diagnosing thyroid cancer, it may be used to determine how far the cancer has spread.

  • Ultrasound. This procedure uses high-frequency sound waves to produce images of the body. As the waves bounce off the thyroid tissue, the echo patterns are translated by a computer, and an image of the thyroid gland is created. This test may be used to determine the number and size of thyroid nodules, although it is less useful for diagnosis because benign and malignant nodules cannot be distinguished in ultrasound images.  

  • Computed axial tomography (CAT) scan. Also known as a computed tomography (CT) scan, this test allows for multiple x-rays to be taken from different angles around the patient. The “slices” or cross–sectional images of the patient’s body are analyzed by a computer. Frequently after the first set of images is taken, the patient receives an intravenous (I.V.) injection of a contrast medium (dye) to better outline body parts. Then a second set of images is taken. CAT scans may be used to reveal tumors within the thyroid gland, and to determine if the cancer is growing or has spread.
  • Magnetic resonance imaging (MRI). A powerful magnetic field creates images of structures and organs within the body allowing a computer to produce very clear cross-sectional or three-dimensional images. As with CAT scans, a contrast medium may be injected in the patient to improve the quality of the images. MRI tests may be used to reveal tumors within the thyroid gland and to determine if the cancer is growing or has spread.

  • Octreotide scan. This procedure, which uses a radioactively tagged hormone, may be ordered to assess the spread of medullary thyroid carcinoma (MTC).

  • Blood tests. A thyroid-stimulating hormone (TSH) blood test may be ordered to asses the overall condition of the thyroid gland. When medullary thyroid carcinoma (MTC) is suspected, a blood calcitonin test may be ordered to help confirm its presence. Other blood tests may be used after surgical treatment to determine if the cancer is still present or is recurring.  may be measured to determine if the cancer is still present or is coming back.

Treatment options for thyroid cancers

As with all cancers, treatment for thyroid cancer is usually coordinated by a cancer care team, which may include:

  • Endocrinologist. A physician who specializes in diseases of the glands.

  • Otolaryngologist. A physician who specializes in ear, nose and throat disorders.

  • Radiation oncologist. A physician who specializes in the use of radiation to treat cancer.

  • Medical oncologist. A physician who specializes in diagnosing and treating cancer with chemotherapy and other drugs.

  • Surgical oncologist. A physician who specializes in using surgery to treat cancer.

After thyroid cancer is diagnosed and staged, a treatment plan will be recommended. Treatment methods are chosen based on the type, size, location, and stage of the cancer, as well as the patient’s age and general health.

The treatment approach for thyroid cancer usually combines two or more methods, and most patients are cured with this approach. In some cases, treatment may be used to relieve symptoms, even if it does not result in a cure.

Common treatment methods for thyroid cancer include:

  • Surgery. This is the primary treatment for all types of thyroid cancer. When a fine needle aspiration (FNA) biopsy suggests thyroid cancer, the patient will usually have the tumor and all or part of the remaining thyroid gland surgically removed. When nearly all of the thyroid gland is removed, the procedure is known as near–total or subtotal thyroidectomy. It may be recommended in cases where cancer is located in both lobes of the thyroid gland (multifocal) or when the cancer is aggressive. This procedure is common in cases of papillary carcinoma and follicular carcinoma.

    In other cases, the surgeon may only remove the affected lobe of the thyroid gland. Known as a lobectomy, this procedure may be used for papillary tumors smaller than one centimeter (about 1/2 inch), that show no evidence of spreading beyond the thyroid gland. When cancer has spread beyond the thyroid gland, surgery is typically used to remove as much of the cancer as possible from the tumor that has invaded the neck (debulk). This procedure is common in cases of medullary thyroid carcinoma and anaplastic carcinoma.

    When lymph nodes are thought to contain cancer, they are usually removed as well. In some cases, only one or two lymph nodes will be removed. More commonly, several lymph nodes located near the thyroid gland will be removed (central compartment neck dissection). The removal of additional lymph nodes, including the nodes on the side of the neck, is known as a modified neck dissection.

  • Radioactive iodine therapy. The thyroid gland absorbs iodine from the blood. Radioactive iodine may be used to destroy a cancer containing thyroid gland, without affecting other parts of the body. Currently, the procedure is not used to treat anaplastic carcinoma or medullary thyroid carcinoma (MTC).

  • External beam radiation therapy. This form of radiation therapy is used to destroy the cells and slow their growth. External beam radiation therapy may be used when radioactive iodine therapy has not been effective or cannot be used. In some cases, it may also be used after surgery to reduce the chances of the cancer reappearing in the neck.

  • Chemotherapy. This treatment method uses powerful drugs to destroy cancer cells. The drugs are either injected or taken by mouth. Although it is not very effective against thyroid cancers, chemotherapy is occasionally used when cancers no longer respond to other treatment methods.

  • Thyroid hormone therapy. All patients with thyroid cancer are treated with thyroid hormone therapy. The therapy may be used to prevent cancer cells from growing or to provide the body with hormones it is lacking. When a patient’s thyroid gland is surgically removed or destroyed, the patient’s body is no longer able to produce the thyroid hormone it needs. As a result, the patient must take thyroid hormone replacement pills for the rest of his or her life to replace the hormone.

    The majority of patients take this medication to keep their TSH levels low. TSH is a hormone produced in the pituitary gland. It promotes growth of the thyroid gland, and presumable thyroid cancer cells. Therefore it is important to keep TSH levels low because having high levels could stimulate the growth of any remaining cancer cells.

After treatment, patients are encouraged to make healthy lifestyle choices. This may include quitting smoking, limiting alcohol use, exercising and eating a nutritious and balanced diet. In addition, patients are required to have follow-up examinations and possible tests.

Thyroid cancers grow slowly and may recur decades after treatment, which makes follow-up care particularly important. Regular follow-up exams may involve blood tests, x-rays, and CAT scans to monitor for recurrence, metastasis, or the development of a new tumor. Patients are encouraged to immediately report any new or continuing symptoms to their physician. Such symptoms may be a sign of recurrence or side effects of treatment.

Prevention methods for thyroid cancers

The majority of people with thyroid cancer have no known risk factors. As a result, it is not possible to prevent most cases of the disease. Familial medullary thyroid carcinoma (FMTC) is one exception. With the development of genetic blood testing, most cases of FMTC can be prevented. After the disease is identified in a family, all family members should be tested for RET mutations. These tests may include blood chemistry tests and more complicated genetic tests. Those who test positive for RET mutations of FMTC can have surgery to prevent the disease, even if they do not have thyroid nodules or any other symptoms of thyroid cancer.

Some physicians believe the increase in cases of thyroid cancer may result from x-ray testing of young children. Although a solid connection has not been proven, parents may want to avoid unnecessary x-ray testing of their children.

Ongoing research regarding thyroid cancers

There is a great deal of research being conducted in the area of thyroid cancer including clinical trials and scientific studies. Researchers are currently studying the role of genetics in the development of thyroid cancer to develop new treatments. Scientists are working on genetic tests that can identify abnormal genes in individuals with a family history of medullary thyroid carcinoma.

Other clinical trials focus on treatment methods. These include trials for the use of chemotherapy drugs and combinations. Newer targeted therapies that have shown some success with other cancers are being tested on thyroid cancers. This includes the use of tyrosine kinase inhibitors. Researchers are studying the effectiveness of radiolabeled antibodies (antibodies with radioactive material attached). This method may make it more feasible to treat medullary thyroid cancer with radiation.

Staging thyroid cancers

A patient’s prognosis varies greatly based on the type of cancer and how far it has spread. Staging enables a physician to determine a patient’s prognosis and choose the most appropriate treatment methods.

The TNM system of the American Joint Committee on Cancer (AJCC) is the most common system used to stage cancer. When used to stage thyroid cancer, this system includes:

  • T describes the primary tumor (e.g., size, location)

  • N describes whether or not the cancer has spread to neighboring lymph nodes

  • M describes whether or not there are distant metastases (spread of cancer to distant parts of the body)

Information about all three of these factors are combined to assign a stage, in a process called stage grouping. Typically the stages are described by Roman numerals I to IV. Unlike many other cancers, thyroid cancers are classified into stages using a method that takes into account the type of cancer and the patient’s age.

Stage grouping for papillary carcinoma or follicular thyroid carcinoma:

Patients under age 45

  • Stage I. The tumor can be any size. It may or may not have spread within the neck or upper chest and/or to nearby lymph nodes, but has not spread to distant sites.

  • Stage II. The tumor can be any size. It may or may not have spread to lymph nodes, but has spread to distant sites such as the lung or bone.

Patients age 45 and older

  • Stage I. The tumor is 2 centimeters ([cm], about ¾ inch or smaller), and has not spread.

  • Stage II. The tumor is between 2 and 4 cm (¾ and 1½ inches) and has not spread.

  • Stage III. Either:

    • The tumor is larger than 4 cm (1½ inches) or has grown just outside the thyroid gland and has not spread

    • The tumor is any size and has spread to neighboring lymph nodes in the neck but not to distant sites.

  • Stage IV. Either:

    • The tumor is any size and has grown beyond the thyroid gland to invade neighboring tissues, and may or may not have spread to nearby lymph nodes in the neck or upper chest, but not to distant sites.

    • The tumor has either grown back toward the spine or into neighboring large blood vessels in the neck or upper chest. It may or may not have spread to the lymph nodes, but has not spread to distant sites.

    • The tumor is any size. It may or may not have spread to lymph nodes, but has spread to distant sites such as the lung or bone.

Stage grouping for medullary thyroid carcinoma (MTC):

  • Stage 0. No tumor is found in the thyroid gland, but screening tests detect the cancer. This stage is also known as carcinoma in situ (early cancer that has not spread to nearby tissues).

  • Stage I. The tumor is 2 cm (3/4 inch) or smaller and has not spread.

  • Stage II. The tumor is between 2 and 4 cm (3/4 and 1½ inches) and has not spread.

  • Stage III. Either:

    • The tumor is larger than 4 cm (1½ inch) or has grown just outside the thyroid gland and has not spread

    • The tumor is any size and has spread to neighboring lymph nodes in the neck but not to distant sites.

  • Stage IV. Either:

    • The tumor is any size and has grown beyond the thyroid gland to invade neighboring tissues, and may or may not have spread to nearby lymph nodes in the neck or upper chest, but not to distant sites.

    • The tumor is any size and has either grown back toward the spine or into neighboring large blood vessels in the neck or upper chest. It may or may not have spread to the lymph nodes, but has not spread to distant sites.

    • The tumor is any size. It may or may not have spread to lymph nodes, but has spread to distant sites such as the lung or bone.

Stage grouping for anaplastic carcinoma:

All anaplastic thyroid cancers are considered to be stage IV, either:

  • The tumor is any size and has grown beyond the thyroid gland to invade neighboring neck tissues. It may or may not have spread to nearby lymph nodes in the neck but not to distant sites.

  • The tumor is any size and has grown back toward the spine or into neighboring large blood vessels in the neck or upper chest. It may or may not have spread to lymph nodes, but has not spread to distant sites.

  • The tumor is any size. It may or may not have spread to lymph nodes but has spread to distant sites such as the lung or bone.

According to the American Cancer Society (ACS), the five-year survival rate for patients in the different stages of thyroid cancer includes:

Five-Year Relative Survival Rates

StagePapillaryFollicularMTCAnaplastic
I100%100%100%––
II100%100%97%––
III96%79%78%––
IV45%47%24%9%

Questions for your doctor on thyroid cancers

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about thyroid cancers:

  1. Do my symptoms indicate possible thyroid cancer?
  2. What tests will be used to diagnose this cancer?
  3. What type of thyroid cancer do I have and what stage is it?
  4. What are my treatment options?
  5. What are the benefits and risks of these treatments?
  6. If my thyroid gland is removed, what are the side effects?
  7. Will I need continuous medication if I do not have a thyroid gland?
  8. What are the risks of recurrence with my type of cancer?
  9. What is my prognosis with this type of cancer?
  10. Is my form of thyroid cancer genetic?
  11. Should my family members consider genetic testing?
  12. What is the likelihood of my children developing thyroid cancer?
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