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Usually slow-growing and with a very good outlook — many forms are fully curable.
Also known as: thyroid cancer · papillary carcinoma
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Usually noticed as a painless, firm lump in the neck, less often through hoarseness, difficulty swallowing or swollen lymph nodes. The commonest forms (papillary, follicular) grow slowly and have very good prospects of cure; rare forms behave differently. Important: thyroid nodules are extremely common and the large majority are benign — ultrasound and, if needed, a fine-needle biopsy clarify this. Blood thyroid values are usually normal and neither rule a nodule in nor out.
The treatment plan is not made by one person alone but in a round of surgery, oncology, radiology, pathology and radiotherapy. You may ask what was discussed there and which alternatives came up.
Before a big decision it is planned for in many clinics, and the records belong to you. It costs one to two weeks — acceptable in almost every course, and one asks about that if it is urgent.
It is today part of the treatment and not its opposite: it lessens the exhaustion, keeps muscle and bone and improves how the treatment is tolerated. Begin with guidance, less on bad days, but not nothing at all.
Unintended weight loss worsens how any treatment is tolerated. Restrictive diets do more harm than good here — with loss of appetite, dietary advice helps early, not only once kilos are already gone.
By the clock rather than as needed works better and needs less overall. Fear of dependence is the wrong adviser in this situation — untreated pain costs sleep, appetite and strength.
Psycho-oncological support, social advice for insurance and work, and the question of who takes on what at home. This is no emergency measure but belongs at the start — and the relatives belong in it.
After the operation the thyroid hormone is not only replaced but dosed so that the control hormone stays low. Too much and too little both have consequences — so the value is checked regularly and the dose is not changed on one’s own.
In the most common type the outlook is very good, and some small tumours are today only watched rather than operated on at once. After removal, levothyroxine does two jobs: it replaces the missing hormone and keeps TSH low, so that any remaining cells are not stimulated. Radioiodine reaches only cells that take up iodine — which is why it works in the differentiated forms and not in the anaplastic one. Thyroglobulin then serves as a marker of the course.
The most common type grows very slowly; more than ninety in a hundred are alive at twenty years. Small papillary tumours under a centimetre are today sometimes only watched, because they barely grow over years. Of needle samples from nodules, about one in twenty is malignant. After removal, thyroglobulin serves as a marker of the course — it should no longer be measurable after complete removal.
Nodules in the thyroid are very common and almost always benign. What draws attention: a single hard, immovable nodule, rapid growth and a size over one centimetre.
A change of voice for more than three weeks without a cold, together with a lump in the neck, belongs examined — the nerve to the vocal cords runs right past the gland.
A lump or tight feeling that stays on swallowing, a cough without a cold or breathlessness when lying down. Usually a benign enlargement is behind it.
A normal TSH says nothing here about the nature of the nodule. The ultrasound and, if needed, the fine-needle sample answer the question — not the blood.
The most important follow-up value after treatment: after complete removal the protein should practically vanish. It is only interpretable together with the antibodies against thyroglobulin.
The raw material of the thyroid hormones. In Switzerland it comes mainly from iodised salt, dairy and sea fish — too little and too much both cause problems, so the middle is the aim.
Needed to convert the storage hormone into the active form and protects the gland from oxidative stress. Brazil nuts, fish and eggs cover the need; not high doses over years without a reason.
The enzyme that builds iodine into the hormone needs iron. An empty iron store can therefore cause complaints that look like an underactive thyroid — and the two often occur together.
Involved in the conversion and in the action of the hormones inside the cell. A lack often shows first in hair and nails — exactly where the thyroid becomes visible too.
The point that governs everything here: before a radioiodine treatment iodine is deliberately avoided so that the radioactive iodine is taken up. Kelp, algae and iodine-containing preparations drop out during that time — they can make the treatment ineffective. The period is limited and is prescribed.
At the operation the four parathyroid glands lie immediately alongside. If they are injured too, the calcium falls — tingling around the mouth and in the fingertips is the first sign and often comes in the first days. Mostly this recovers; in a proportion the replacement stays permanently necessary.
Thyroid hormone in tablet form and iron, calcium or magnesium bind to each other in the stomach — taken together distinctly less of the hormone arrives. Four hours apart is the usual rule, and it explains many apparently fluctuating values.
With the common forms the TSH is deliberately kept low after treatment, so that thyroid cells are not driven. That is the reason for the exact dosing.
After the thyroid has been removed this hormone is replaced for life — not only to make up the shortfall, but at a dose that keeps the control hormone low.
The follow-up value of the rare medullary form. With it the question of the family and of other glands belongs too.
For about 1–2 weeks before treatment iodine is kept low so the radioactive iodine is taken up better. This concerns iodised salt, dairy, sea fish and seaweed — and only for that limited time.
The claim usually rests on the PET scan: weakly radioactive glucose is injected, and the tumour lights up. That shows tumour cells take up sugar faster than the tissue next to them — not that eaten sugar feeds them. You come to a PET scan fasting, and the tumour lights up anyway; the body keeps blood sugar within narrow limits by itself. It cannot be starved out this way. There is an established link nonetheless, but it runs through body fat: in 2016 the International Agency for Research on Cancer (IARC) reviewed the available studies and found sufficient evidence, for thirteen cancers, that absence of excess weight lowers the risk. That concerns prevention — it is not an answer to where an existing illness came from.
Before radioiodine therapy iodine is kept low for 1–2 weeks so the radioactive iodine is taken up. A time-limited measure with a clear purpose, not a standing recommendation.