Thyroid cancer is the 12th most common cancer in the United States, affecting more than 44,000 patients in 2024.
Most patients are diagnosed with differentiated thyroid cancer, in which the cancer cells retain some features of normal thyroid cells.
The American Thyroid Association first published guidelines for managing differentiated thyroid cancer in 1996 and has revised them over the years to reflect advances in the field.
The current updates consider every aspect of the patient’s journey, including diagnosis, monitoring and treatment.
Megan Haymart, M.D., Nancy Wigginton Endocrinology Research Professor of Thyroid Cancer and a member of Rogel Cancer Center, answers questions about understanding the risk for thyroid cancer, active surveillance and current treatment options.
Who’s at risk for thyroid cancer?
Haymart: Thyroid cancer largely affects young adults and women.
It’s the most common type of cancer in adolescents and adults ages of 15 to 33. It is also the fifth most common cancer in women.
The average age of diagnosis is 51.
The only modifiable risk factor is radiation exposure, usually on the scale of a catastrophic event such as Chernobyl.
For differentiated thyroid cancer, only 5% of cases have a family history, but we still don’t understand why most patients get thyroid cancer.
What are the symptoms of thyroid cancer?
Haymart: Most thyroid cancers are asymptomatic.
If you feel a lump in your neck, that you haven’t noticed before and it doesn’t go away in a few weeks, it is important to alert your doctor.
If your voice changes and becomes hoarse without improvement, in rare cases it can be related to thyroid cancer.
How is thyroid cancer diagnosed and treated?
Haymart: When patients come in with a prior diagnosis of a thyroid nodule or a lump in their thyroid, we often follow up with imaging.
Depending on the type of nodule, the next step is often a biopsy, where we look at tissue samples to assess whether it is cancer.
If cancer is diagnosed, most patients choose to have surgery to remove the tumor.
If the entire thyroid is removed, patients receive thyroid hormone replacement therapy after surgery.
Sometimes, for individuals with small, low-risk cancers, we consider active surveillance where we monitor the tumor and intervene only when needed.
Other options for small cancers include ethanol injections or radio-frequency ablation to shrink the tumors. Both are minimally invasive procedures and are used when surgery isn’t recommended.
Why were the guidelines updated?
Haymart: I was part of a team of endocrinologists, oncologists, nuclear medicine physicians, surgeons and patient representatives who wrote the new guidelines.
Our goal was to ensure that the advice for clinicians paralleled what recent research and data have shown.
One of the major changes includes more focus on de-escalating care. This means that after a patient is cancer free for a period of time, we can reduce the amount of monitoring they need.
There is also more emphasis on shared decision making.
Often, patients differ in terms of what treatment works for them, and having a conversation with the doctor is helpful.
The guidelines also emphasize survivorship and thinking about the long-term complications and side effects that cancer survivors might face, including psychological and financial impacts.
If you care about cancer risk, please read studies that exercise may stop cancer in its tracks, and vitamin D can cut cancer death risk.
For more health information, please see recent studies that yogurt and high-fiber diet may cut lung cancer risk, and results showing that new cancer treatment may reawaken the immune system.
The research findings can be found in Thyroid.
Written by Ananya Sen, Michigan Medicine.
