Thyroid Ultrasound


It’s easy to crunch the numbers on thyroid cancer and assume it is a disease fast on the rise. Incidence has more than doubled since the early 1970s, and for women, it is the cancer with the fastest-growing number of new cases.

But not every statistic tells the obvious tale. Despite the increase, thyroid cancer — a very treatable disease that develops in a butterfly-shaped gland in the neck — is still relatively uncommon.

Many people develop benign lumps, known as nodules, in the neck, but only one in 20, or less than 45,000 cases a year, are malignant. Even fewer patients have an aggressive form of the disease, which has a survival rate of nearly 97 percent after five years and results in an estimated 1,690 deaths each year. Over the last few years, however, studies showing there has been a significant increase in incidence, and even mortality, in certain groups have caused much debate in the scientific community.

“I don’t think there is any question that there is an increasing incidence of thyroid cancer,” said Dr. Kenneth Burman, chief of the endocrine section in the department of medicine at Washington Hospital Center in Washington, D.C. “But it is not that simple. The question is whether or not it is related to detection and radiological studies, or if it is related to an authentic rise in thyroid cancer.”

It is a question that still remains largely unanswered. Evidence from the Surveillance, Epidemiology and End Results database, a registry of cancer cases that is kept by the National Cancer Institute, leaves little question that there are more cases of thyroid cancer today than three decades ago. But the more important question, as Dr. Burman points out, is whether these statistics indicate a true rise in the disease or are simply a result of better diagnostic tools.

Over the last three decades, ultrasound and fine-needle biopsies have helped diagnose thousands of cases that would never have been found before. In many cases, nodules are discovered by accident during another medical investigation.

A study published in The Journal of the American Medical Association first brought this issue to light in 2006. Researchers concluded that the reported 140 percent increase in thyroid cancer from 1973 to 2002 was simply a result of “increased diagnostic scrutiny.”

They argued that a true increase in incidence would be reflected in every stage of the cancer. But the study showed that 87 percent of the increase was from small papillary thyroid cancer tumors — the most common and treatable type of thyroid cancer — that were less than two centimeters in size. Many of these cases, the researchers say, would never have caused any problems. In fact, studies have shown that thyroid cancer is found in nearly 4 percent of all fine-needle aspiration biopsy specimens.

“These cases have been there all along,” said Dr. Louise Davies, assistant professor of surgery in the division of otolaryngology, head and neck surgery at Dartmouth Medical School. “We just didn’t see them until now. Understanding this requires that you think about the word ‘cancer’ in a different way than we usually do. You can have increased rates of incidence without changing the number of people who die.”

But the mortality rate is a little more complicated than that. Survival rates, after five years, increased 4.7 percent in women, who are three times as likely to develop the disease as men, from 1974 to 2001. In men, however, the annual percentage change in thyroid cancer mortality increased significantly, by 2.4 percent, from 1992 to 2000 — the highest jump of any cancer. That is one reason many other experts argue that diagnostic tools are not the only factor.

“I think it is an oversimplification to say the increase in diagnosis is from the overuse of technology and only relates to small tumors that are insignificant,” said Dr. Steven Sherman, medical director of the endocrine center at the University of Texas M.D. Anderson Cancer Center in Houston. “There is a component that relates to increased technology, but until we can do a better job at predicting the outcomes for individuals who develop cancer we still need to treat each case.”

Physicians are fairly clueless about what else could account for this mysterious rise in incidence. Exposure to radiation from the Chernobyl nuclear power plant accident in 1986 and radioactive fallout from nuclear weapons testing in the 1950s have long been linked to thyroid cancer, but they would not account for all the new cases.

Regardless of the reported increase in small tumors, the standard of care for thyroid cancer remains the same as it was two decades ago. Patients must undergo a thryoidectomy, a surgical procedure that removes all or half of the thyroid gland. Afterward, many patients also require a radioactive iodine treatment, which kills any remaining cancer cells.

Dr. Bryan McIver, a physician in the division of endocrinology, diabetes, metabolism and nutrition at the Mayo Clinic in Rochester, Minn., said of the surgical default, “Even though the evidence does not support that it is beneficial, there is an increasing trend in the U.S., and probably worldwide, to treat all thyroid cancers in the most aggressive way.”

As a result, surgeons like Dr. Davies think the increase in diagnosis does patients with small tumors a disservice. “I don’t think it is helpful when patients pick it up by accident,” she said. “It distracts them from the problem they came in with and leads to unnecessary treatment. The mortality rate of papillary thyroid cancer is lower than the surgical complication rates.”

Since thyroid cancer has long been thought of as a disease that requires surgery, experts are starting to rethink how they approach the rapidly increasing number of small tumors.

“Sometimes I think we are doing more harm than good with these small tumors,” Dr. McIver said. “But there is also going to be a subset of these small tumors that are caught early and would have caused a problem. It’s hard to ignore a diagnosis of cancer.”

This article is from the New York Times

I met with my doctor yesterday afternoon.  He went over the results of the blood work and neck ultrasound with me. My levels look good!!  There were a couple of lymph nodes that we are watching, but they look normal on the scan.  Once again, I am cancer free!!!

My levels of calcium and vitamin D were a little low.  I should be taking calcium and vitamin D pills daily.  My doctor smiled at me and said “Take the damn pills.”  So this is something that I will start doing on a regular basis.

My doctor also told me to get Thyrogen shots and blood work to make sure we are not missing anything. Hmmmm…what? This caught me off guard.  I got Thyrogen shots during the low iodine diet to help my body prepare for the radioactive iodine treatment, but I did not know that it could also be used to further test my levels My understanding of Thyrogen is that it tricks your body into thinking that you have gone off of your thyroid medication.  This sure beats actually going off of your thyroid medication for a couple of weeks.  (I have not had to do this, but know many people who have done it.  More power to you!)  Anyway, when I got my Thyrogen shots in May 2009, I was amazed to find out that my insurance company covered it.  Each shot is around $1,200!  Two are required to get the job done.  So I was extremely grateful to my insurance company for covering the shots.  Now, I am supposed to get the shots again?

What a great topic to blog about!  I am going to do some research to learn a little more about Thyrogen.  I plan to write another post about my findings soon.  This opened up the door in my mind about the Thyroid Cancer SURVIVOR blog.  There are still many topics that I would like to write about here.  I’m going to do a “brain dump” to name a few.  Here is my random list:

  • Life beyond cancer
  • Preparing for tests and doctor visits
  • Affirmations and Mantras for cancer survivors
  • Being an advocate for your health – Ask questions, Speak up, Second Opinions, Feel heard
  • Health insurance coverage
  • Thyrogen
  • Calcium and Vitamin D post thyroidectomy
  • Swallowing food post thyroidectomy
  • Voice post thyroidectomy
  • Hot and cold flashes
  • Fertility with RAI (Radioactive Iodine)

That is all that comes to mind for now.  I would really appreciate your feedback, experience and input on any of these items.  What has your experience been?  What other items would you like to see posted on this blog?

Thank you!!!

As a cancer survivor, I get to go back for follow-up doctor visits, blood work, scans and more every six months.  Here we go again!  I got the blood work done yesterday.  Tomorrow I go to have my ultrasound scan after work.  Then I have an appointment with my doctor to go over the results at the end of next week.  Deja Vu!!

I’m getting the hang of it now.  The fear seems to lessen each time.  I’ve learned that worrying and negative thinking does not do me any good mentally, spiritually or physically.  (It reminds me of this quote I found.  “Worry is a huge waste of time; it doesn’t change anything, except maybe your blood pressure!” ~Author Unknown)

Trust me, I can list many other things that I would rather do with my time then getting more tests, scans and sitting in doctors offices.  But the reality is that I need to continue to be responsible for my health be doing these things. In turn, I am able to live a healthy life and free from cancer.

Last week I went for my six month follow-up thyroid ultrasound.  I was pleasantly surprised to be greeted by a very nice person at the front desk who treated me like a person with feelings instead of a person ordering cheese at the deli. (Next in line!)  Even Marie, the Ultrasound Technician was compassionate and relaxed.  She really took her time with me during the ultrasound.

The last time I had the ultrasound, they found two lymph nodes that were swollen.  My Endo said that we would keep an eye on it during the next follow-up ultrasound.  So this time when I was laying on the table with the warm gel on my neck and the ultrasound wand sliding around, my nerves were shot. 

Marie told me that there were two lymph nodes sticking out on the left side.  They were in the same area as the ones that were swollen six months ago.  Oh No!  She moved around and hovered the wand over the other side of my neck and found two more that were sticking out.  I felt sick and a wave of fear rushed over me.  Marie said “off record” that the lymph nodes looked like regular ones to her.  Well that did not make me feel better.  What Marie didn’t know is that I found out after my thyroidectomy that the cancer had spread to five  of the seven lymph nodes they removed during the surgery.

When I left the appointment I decided not to let the potential upsetting news get me down.  I walked back out as a thyroid cancer survivor!  I have not heard any good news or bad news yet.  I’m waiting for the results.  My appointment to go over the ultrasound results and blood work is not until February 2.  I can’t remember if my doctor called me prior to our appointment last time or not. 

Waiting for the results is starting to take a toll on me.  I am so good at focusing on gratitude and holding on to the fact that everything is going to be alright.  I consider myself to be a positive person with a wonderful support network that are here for me through it all.  But this waiting for results thing is really difficult.

I’ve been really emotional the past couple of days.  I feel really sensitive to everything and on edge.  The fear of what might be lurking in those lymph nodes is in the back of my mind.  I’m scared.  I hope and pray that the cancer has not come back to more lymph nodes.  Regardless, I can’t do anything about it now except write this post and know that the other people reading this understand.  And in turn it helps me to not feel so alone.

I got a call back from my doctor’s assistant (FINALLY!) From what they could see, the scan looked good!  She didn’t have the details, but since I had called earlier, my doc wanted to at least let me know that much.  WELL THANK YOU!!!  (I’m dancing right now, but you can’t see that part!) I’m a cancer SURVIVOR!!! My status remains!!!

HOWEVER, the blood work is NOT back yet, which will give the official “in the clear.” But I am not going to focus on that details. Because right now, all is well!!!  I am so grateful for all the love and support.  Especially from the other thyroid cancer survivors that contribute to this blog.  It helps us all!!

So let’s all live it up to the fullest.  Life is made for living, not waiting!!  ♥

Here is my latest status update on Facebook:

 “Update…NOT! I called the doctor again to see if the results were in. He’s still waiting on the scan. I don’t think he is gonna spend any time this weekend wondering if my cancer returned. So until I hear otherwise, I am a cancer survivor and my scan is clean!!!”