Dr. Jones: "It brought a lump to my throat." This is a phrase that usually implies an emotional response to something. But what if there's really a lump in your throat? Or really a lump in your neck? This is Dr. Kirtley Jones from Obstetrics and Gynecology at the University of Utah Health, and we're talking about thyroid cancer and women today on The Scope.
Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.
Dr. Jones: Most of the time one of our most important hormone glands in our body just does its thing without us feeling it. For women, men are another story, the thyroid is the only gland that we can touch with our fingers. It's sort of a flat butterfly-shaped gland about two inches across in the front of our neck in front of our throat. It regulates the metabolism at every cell in the body.
Millions of women have thyroid problems, the most common being under or overactive thyroid. The majority of people in the United States with thyroid problems are women. We're not sure why that's the case except that most thyroid problems are due to autoimmune disease, antibodies that we make against part of the thyroid gland. All autoimmune diseases are more common in women.
Over and underactive thyroid symptoms are vague. The symptoms are feeling cold or slightly depressed. For underactive thyroid, feeling hot, your heart pounding and anxious, maybe weight loss are common for overactive thyroid. Sometimes the thyroid is slightly enlarged with over or underactive thyroid problems, but thyroid cancer presents as a lump. Sometimes the lump is noticed by the patient, but sometimes it presents with hoarseness of voice or difficulty swallowing, and sometimes the lump is detected by a clinician during a physical exam.
It's important to know that lumps in the thyroid are very common, and only 5% to 10 % of lumps in the thyroid in women are cancer. Now, thyroid cancer is the most cancer in women 15 to 30 years of age and is the second most common cancer after breast cancer in women under 50. Seventy-five percent of all thyroid cancers occur in women. And thyroid cancers generally happen younger in women than men.
There are a number of risk factors for thyroid cancer, the majority of which you can't change. I already mentioned that being a woman is one of them and you mostly can't change that. There are families that have genetic mutations that make cancers more common, and thyroid cancers are part of that family risk.
Another risk for thyroid cancer is exposure to radiation, especially as a child. The most common reason for a young person to have radiation exposure these days is because of radiation treatment for another cancer when the person was a child. Also, for those of us who grew up in the Intermountain West, the increased exposure to radiation from nuclear testing in the 50s is associated with a slightly increased risk of thyroid cancer. And of course exposure to an accident at a nuclear power plant that releases radiation can increase the risk, but this is uncommon.
Finally, children with a low diet in iodine are at an increased risk, but that's uncommon in the U.S. because table salt and sea salt have iodine and iodine is found in fish and is added when salt is added to some foods. Now, if you have a lump in your thyroid or an enlargement in the front of your neck where your thyroid is, you should see your doctor. The doctor will feel your thyroid, do a blood test to check out the thyroid hormones, and sometimes check a blood test to see if you have antibodies to your thyroid.
If there's any question of a lump in the thyroid, an ultrasound of your thyroid is the next step. If the ultrasound shows a lump, the next step could be to collect cells from the lump with a small needle. Now there's some controversy about when to do this test. So many thyroid lumps or nodules are totally benign. If the lump is less than a half inch or about one centimeter, most experts would just recommend watching it over time, unless of course you have a family history of thyroid cancer. In that case, you really need to watch things more carefully and the biopsy would be right.
If it's over an inch, most experts will recommend a biopsy. Now, if the biopsy shows cancerous cells, the next step is surgery usually to remove the thyroid and make sure the cancer hasn't spread to the lymph nodes. If it's spread, the next step can be radiation. It's most important to know that thyroid hormone can be easily and inexpensively replaced with a pill if you've had your thyroid removed. The other important fact, and listen up, is that thyroid cancer in young women is very curable with over 90%, survival for 20 years. So thyroid cancer is one of the most curable kinds of cancers.
So if you have a lump in your throat, first check out and make sure it isn't really your adorable child or the movie you're watching, but if it really is a lump in your neck, and bring it to your attention to your doctor. The chances are highly likely that it isn't cancer, but it should be evaluated. And if it's found to be thyroid cancer, it's often easily cured in women, and that's the best news. And thanks for joining us on The Scope.
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