Head and Neck Oncology
Thyroid Cancer
Modern thyroid cancer care — risk-based surgical planning, nerve preservation, and long-term follow-up.
How common is thyroid cancer and what is the prognosis?
Thyroid cancer is among the fastest-growing cancers in women. Papillary type 85–90%; follicular 5–10%; medullary 3–5%; anaplastic 1–2%. In papillary and follicular thyroid cancer, 10-year overall survival exceeds 95%; with appropriate surgery and radioactive iodine when indicated, most patients achieve curative outcomes. Medullary cancer is familial in 25% (RET proto-oncogene). Anaplastic is rare but aggressive; multidisciplinary care is critical. Routine thyroid cancer screening is not recommended; it is not standard for asymptomatic individuals without risk factors.
Diagnostic pathway
Pathway: ultrasound → TIRADS classification → FNA on suspicious nodules → cytology (Bethesda category) → molecular testing (Afirma, ThyGeNEXT) when needed. Bethesda V (suspicious for malignancy) and VI (malignant) nodules go to surgery.
Lateral neck lymph nodes are evaluated by ultrasound + FNA when needed. Thyroglobulin washout from FNA aids in nodal involvement assessment. Distant metastasis assessment in high-risk cases uses PET-CT or whole-body scintigraphy.
Surgery and after
For low-risk papillary microcarcinoma (≤1 cm), lobectomy may be sufficient. For high-risk cases (>4 cm, extrathyroidal extension, lymph-node involvement), total thyroidectomy + central neck dissection is standard. Lateral neck dissection is added when lymph nodes are positive on clinical exam or imaging.
Post-operative radioactive iodine is given 4–6 weeks later in selected high-risk cases. TSH suppression (aggressive in young, mild in older) is achieved by levothyroxine titration. Follow-up: thyroglobulin, anti-thyroglobulin antibodies, neck ultrasound — every 6 months for the first 2 years, then yearly.
Frequently Asked Questions
- Bethesda V or VI cytology indicates surgery. In Bethesda III/IV grey-zone cases, molecular testing or repeat FNA is an option. "Active surveillance" can be an alternative in small (≤1 cm) low-risk microcarcinoma.
- No. Not in low-risk cases. In intermediate-to-high risk, surgery + RAI is standard. The decision uses tumour size, histology, genetic mutations, and post-operative thyroglobulin.
- Yes, usually. After RAI therapy, a 6-month wait is recommended. Levothyroxine dose is adjusted in pregnancy; a 20–30% increase is often needed early in the trimester.
- Familial risk is mild in papillary/follicular cancer. In medullary cancer, RET genetic testing is recommended; prophylactic thyroidectomy may be considered in family members.
- With modern intraoperative nerve monitoring: temporary hoarseness 1–3%, permanent 0.5–1%. Pre-op vocal-cord exam is standard for professional voice users.
- Imaging + cytology shared → tele-consultation → written treatment plan → Istanbul travel timeline → surgery → 1–2 hospital nights → 3–5 days in Istanbul → safe return. Hormone follow-up by email.
References
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