May 25 is World Thyroid Day.

Excerpt from Dr Umanath Nayak’s book “Enduring Cancer – Stories of Hope”. Dr Nayak is a Head and Neck Cancer surgeon, Apollo Cancer Hospitals, Hyderabad

‘Doctor, what do you think is the problem?’

 The creases of worry on Deepa’s forehead made me hesitate. I told her about a couple of benign conditions to explain the swelling that had suddenly developed on her throat over the past few weeks. Though the thought of cancer did cross my mind, at that point of time I was not willing to consider cancerous lymph nodes as my first diagnosis. The swelling was diffuse and not well defined. My answer, however, did not seem to reassure Deepa. Especially since her brother, an orthopaedician known to me, had been quite insistent that she see me and the implications of that were not lost on her. As an oncologist, this is a problem I often face in my practice. Though I also see and operate on a good number of patients who do not have cancer—mostly those with benign thyroid nodules and tuberculous lymph glands—patients not already diagnosed with cancer are initially wary when they are referred to me. So in a way, my reputation precedes me!

 In Deepa’s case, I was wrong and she did turn out to have cancer—cancer of the thyroid gland. The swelling in her neck was due to secondaries (metastasis) in the lymph nodes. She took the diagnosis quite well and listened calmly to the details of the treatment and the prognosis.

 Cancer of the thyroid gland is an uncommon cancer and accounts for just about 1%–1.5% of all cancers. In the USA, the incidence of this cancer has shown a 2.4-fold increase in the last three decades (from 3.6 per 100,000 of the population in 1973 to 8.7 per 100,000 in 2004). This is believed to be due more to better diagnostic facilities such as ultrasound, which can pick up thyroid nodules much earlier, rather than any true increase in the incidence of the cancer. Exposure to ionizing radiation is one of the known risk factors for the development of thyroid cancer and the cancer often develops decades after the exposure has occurred. It is interesting to note that after the atomic bomb explosion in Hiroshima and Nagasaki, the incidence of thyroid cancer among the survivors increased by 200 times compared to the population which was not exposed to the effects of the bombing. Even today, after over six decades, the survivors of the bomb, known in Japan as ‘hibakusha’, continue to be regularly diagnosed with not only cancer of the thyroid, but also with leukaemias, lymphomas and other cancers. Following the Chernobyl nuclear disaster, too, a study of 1000 inhabitants exposed to the radiation found that 62 developed thyroid cancer in the first 10 years after the exposure.

 Fortunately, the regular type of thyroid cancer (commonly referred to as well-differentiated thyroid cancer) is one of the most curable cancers known and provided that adequate surgery is performed, most young patients with this cancer live their normal lifespan. Surprisingly, older patients with this cancer do not do so well. This is the only cancer in which the age of the patient is a very important factor determining the aggressiveness of the cancer and survival. One variant of thyroid cancer, the medullary carcinoma of thyroid or MCT, has a genetic basis and a sub-group of patients with this condition have been found to carry an abnormal gene, the RET proto-oncogene. The identification of this gene in subjects at risk (first-degree relatives of those with familial MCT) can predict with 100% accuracy the future development of thyroid cancer. Those who express this gene are advised a preventive thyroidectomy, sometimes even in childhood, before the clinical development of cancer. In certain cases in which the mutation indicates a very high risk, it is even recommended that the person undergo thyroidectomy as early as six months of age, though in practice, the majority of those identified with this gene undergo thyroidectomy at the age of around five years.

Deepa Tiwari is an example of the many young patients that I see with cancer of the thyroid. Young, smart, recently married to her steady boyfriend, Deepa works as a HR coordinator in Microsoft and loves to party. Not surprisingly, as her husband happens to be a DJ and likes to take her along for his professional engagements. In fact, the night before she was admitted to the hospital for her surgery, Deepa was seen at her favorite pub, dancing away her fears and apprehensions.

Deepa underwent a marathon five-hour operation to remove her thyroid gland and all the affected lymph nodes in her neck. During surgery, I was amazed to see that almost every possible site in her neck had enlarged nodes, and it was quite a challenge to remove all malignant disease and preserve the important nerves and other structures at the same time. Cancerous nodes had to be meticulously dissected from the large vein in the neck—the internal jugular vein, which drains blood from the head and neck region—at the same time taking care not to injure it. Damage to this vein could result in major haemorrhage. Any injury to the delicate nerves running along the sides of her thyroid gland could result in permanent hoarseness. These nerves were intimately surrounded by enlarged nodes and removing them while still leaving the nerves intact required all my skill and experience. She withstood this assault on her boldly and recovered well. The long scar running across the length of her neck was the only stigma of the extensive surgery she had undergone. High-dose radioactive iodine treatment was administered to her a month later. This treatment is routinely given post-operatively to all high-risk thyroid cancer patients to destroy any microscopic cancer that may be lurking unseen in any part of the body. Thyroid tissue (cancerous or otherwise) concentrates iodine and the radioactivity in the administered iodine destroys it. Following this treatment, Deepa was kept isolated for 72 hours, since the radioactivity she was emitting could be harmful to others around her. According to her, this was the most difficult part of her entire treatment—being in isolation and unable to see and talk to anyone for three entire days.

When I saw Deepa again three months after her surgery, she appeared quite cheerful, though philosophical. She continued with her parties and had her fun, but now took life somewhat more seriously. She valued certain things she had earlier taken for granted, such as spending time with her aged parents. She and her husband also took time out to be with each other more often. Thanks to supportive colleagues at work, she was able to cope with work pressures quite well. When asked if the scars on her neck bothered or embarrassed her, she dryly replied that there were far more important issues than that in life. She preferred not to dwell much on the uncertainties of the future and apprehensions about recurrence of the disease and survival. 

Dr Umanath Nayak’s book may be purchased online through Flipkart and Simply Books and can also be downloaded on Amazon Kindle. 

 

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  • preisvergleich

    Heya i’m for the primary time here. I came across this board and I find It truly helpful & it helped me out much. I am hoping to provide something again and help others like you aided me.

    • Editha

      I really am glad I found Mary Shoman’s Thyroid Diet book. I have been hyiphtyrood for a few years, and I never had a weight problem in the past. But the weight creeped up and by the time they diagnosed me, I had gained something like 40 pounds. (I never found out the final #, cause I wouldn’t even look at the scale at my highest. UGH!) I felt awful, and I tried every single diet program out there, I did no-carb, I did low-fat, I did low-cal, and I just kept gaining weight, or I didn’t lose anything. It was ridiculous. My doctor said that my thyroid had nothing to do with anything, but I knew, I just KNEW that my thyroid had something to do with it, because, for goodness sake, I never had an extra pound on me until the thyroid problems started up and I started with hyiphtyroodism. A friend of mine who is also hyiphtyrood told me that she had some success following some things she’d read from Mary Shoman at her website, and so I decided to get this book. It’s been a real godsend, because for the first time in about 5 years, I’ve actually been consistently losing weight. First it was just a few pounds, really slow, but I LOST!!! I’ve started taking a couple of vitamins that she recommends, and I think that’s helping too, but the overall diet is what’s making the difference. I’m eating, but I finally feel like I’m eating the RIGHT things, and believe me, you can go spend 7 a week, or 20 a month, or 2000 a year at a local weight loss program, but if you don’t lose weight and you tell them you have a thyroid problem, they’re going to tell you you’re not doing the program right. And Shoman doesn’t tell you that she knows how the thyroid affects weight, and she explains it, she interviewed doctors who also talk about leptin, and metabolism, and the impact of thyroid on blood sugar, timing of food, and the best thyroid medicines and such all things I think are what helped me sort of break the losing streak I had at weight loss! I even had a blood sugar test I read about in the book, and the doctor says I could be headed for pre-diabetes, so I definitely am doing the right thing by losing weight! There is definitely no magic diet cure wish there WAS!! with a thyroid problem or otherwise, but I feel like with Thyroid Diet, I at least have a fighting chance to figure out what foods, calorie levels, supplements, and other sorts of approaches might actually make a difference for me. I really recommend this book. I got it January of 2005, and as of April, I’m already down 20 pounds!!! Can’t argue with success, right?

      • Pretty

        Same here. I was diagnosed 10+ years ago at the age of 29. i bagan ruinnng 3+ years ago and take Levothyroxine every morning. I hit 30 + miles a week and just started training for my first marathon. I found it was better to take the pill ln the morning and to do it; say before you brush your teeth so it becomes routine and you won’t forget. Good luck!

    • Nut

      I have had hypo thyroids for 13 yrs..I have been on synoirthd for yrs and not to lie to you I have never felt they way I used to..I wake up tired and sometimes so depressed that I can’t handle life ..I have gained a lot of weight but still not as much as a lot of others.I have no self confidence no more and I have alot of fears and anxiety.Going to walk the dog is hard now..Making supper for family is hard..I stay sick and get sick easy..It’s like I no longer have a immune system..I have mood swings like I have bi polar and severe menstrual problems.Sometime I don’t even have a period at all for months and then I have one that last a week and then off for a week and starts over again..I really don’t eat alot and still gain weight and it is very difficult for me to loose weight even when I follow a doctors plan..My blood pressure is low and really that is only the one good thing about this disorder..I am cold all the time and in the summer I can’t take the heat at all.I don’t sun burn but sweat like a hog I hope you find something to help you and if you do let me know Please..Thanks and Good Luck .

  • Shyam

    my sister-in-law had tyhiord cancer a few years ago as well. she has a pretty cool scar on her neck from it, though if I were her I’d tell everyone it was a mugging gone wrong just to see their reactions. I’m so glad that kind of cancer is so treatable, though, & that they were able to find it quickly & take care of it completely for you! can’t wait to read more