Scott Gargan, Correspondent

Earlier this year, Laura Longueira locked herself in her bedroom for a week.
No, it wasn't the stress of motherhood taking its toll -- the Fairfield mom had just undergone radioactive iodine treatment for thyroid cancer, and posed a radiation risk to her family. She couldn't be around her husband or three kids; she couldn't help out around the house; she couldn't even share a bathroom.
"The first few days were the worst," Longueira, 41, recalled. "You're not even supposed to leave your room. (My family) would have to leave me a cooler with stuff to eat," she added. "I felt bad because of my kids. It was tough not being able to help them with things. I missed three of my son's baseball games."
For Longueira, it all started with a nodule -- a tiny lump on her thyroid gland in her neck -- that turned out to be malignant. She underwent surgeries to remove the thyroid, followed by radioactive iodine treatment, or iodine-131, to eliminate remaining thyroid cells, and took medication to compensate for the functions of the excised gland.
"You gain weight, you have no energy, you're freezing," Longueira said of the effects of living without a thyroid. "I've been wearing a sweater up until now."
Longueira counts herself among the skyrocketing number of Americans diagnosed with thyroid cancer in recent years. Cases of the disease increased at a rate of 6.5 percent annually from 1997 to 2006, making it the fastest-growing cancer among women and men, according to the National Cancer Institute. More than 37,000 cases were recorded last year.
Generally, thyroid cancer has a positive prognosis -- the recovery rate for papillary thyroid cancer, the most common form, is more than 90 percent -- but the pace at which Americans, especially women, are contracting the disease has many doctors worried.
"(The trend) is disconcerting," said Dr. Sara Richer, an otolaryngologist and head and neck surgeon at St. Vincent's Medical Center in Bridgeport. "Many patients have excellent prognoses and do very well. But there's still the fact that we are diagnosing more people."
The trend has medical researchers baffled, although some propose that exposure to radiation could be the cause. A 2009 report by the International Journal of Health Services revealed an epidemic of thyroid cancer -- about 66 percent more than the national average -- in counties closest to the Indian Point Nuclear Power Plant in Buchanan, N.Y. The facility, which has attracted controversy in recent years, is about 30 miles northwest of Greenwich.
Better methods of detection have played a role in the increased diagnoses. This has boosted the prognosis for many individuals with thyroid cancer, even as the number of cases continues to rise.
Improved access to CAT scans and ultrasounds means "you end up finding stuff much earlier," said Robert Busch, managing partner at Endocrine Group, an endocrinology practice in Albany, N.Y. "It's very controllable and curable when found early."
Another positive development, Busch added, is that tests for unrelated issues also have led to an increase in "incidental findings" of the disease.
Such was the case for Longueira: a CAT scan for a problem with her salivary gland caught the nodule on her neck. Doctors kept an eye on the abnormality for several years, before a January biopsy determined the tumor, which was diagnosed as papillary, was expanding.
"It's kind of a scary thing, but it was found early and we've kept it under control," said Longueira, whose mother also had thyroid issues.
Situated in the neck, below the Adam's apple, the thyroid regulates the speed at which the body uses energy, makes proteins and interacts with hormones. To maintain these functions, Longueira and thousands of others recovering from thyroid cancer must take medication for the rest of their lives.
Still, while doctors remain alarmed over the spiraling rate of thyroid cancer, and keep a close watch over their patients, they are optimistic that a vast majority of people with the disease will recover.
"It's important for people to remember that . . . when cancer is diagnosed, most patients have an excellent prognosis," Richer said. "We have concern about increased incidences, but most people do very well."
Now in remission, Longueira is "feeling much better" and is hopeful about her recovery. After being forced to miss several family activities, she was looking forward last week to chaperoning her son's class trip to the Bronx Zoo in New York.
"I missed four months," she said. "I'm happy to be there for my family again."
Correspondent Scott Gargan can be reached at scott.gargan@scni.com or 203-964-2238.
Thyroid Cancer: Diagnosis Increasing, But Prognosis Positive
- Cases of the disease increased at a rate of 6.5 percent annually from 1997 to 2006, making it the fastest-growing cancer among women and men, according to the National Cancer Institute.
- Papillary thyroid cancer, the most common form of the disease, has a more than 90 percent recovery rate.
- Medullary thyroid cancer and anaplastic thyroid cancer, which make up a combined 10 percent to 13 percent of cases, are not nearly as responsive to treatment.
- Common treatment includes partial or full thyroidectomy, followed by radioactive iodine treatment, or iodine-131; medication to compensate for the functions of the excised gland; and continued monitoring from a physician. Lymph nodes may need to be removed if infected by abnormal thyroid cells.

Which Type of Thyroid Treatment Is Best?

In medicine it is sometimes both funny and sad to watch how drug company marketing and medical politics win out over common sense. An example of this is the argument over which form of thyroid hormone replacement is best.
The answer? Different people do better with different types of thyroid hormone, and you can tell which is best by what feels best to you.
Most doctors use the equivalent of a medication called "Synthroid." This contains only one of the hormones made by your thyroid (T4 or thyroxine, which is not active), and your physician presumes that your body will turn it into the active hormone. This works fine for about two thirds of folks — if the dose is adjusted to how you feel as opposed to being adjusted to only make the blood tests normal. Basically, it is best for your physician to continue to adjust the dose until you find the level that feels best, and then double check the thyroid blood tests to be sure they are in the normal range for safety. This is far preferable to simply adjusting the dose until the blood test is "normal," as normal only means that you are not among the highest or lowest 2% of the population (think of the analogy of a "normal" shoe size, which would only mean somewhere between the sizes 3 and 14).

What can I do if I still feel poorly on the Synthroid (thyroxine)?
When this occurs, many people find they do better by using a form of thyroid that combines both of the major hormones made by your thyroid gland. This is available by prescription (called "Armour Thyroid" — although I prefer the T4 plus T3 combinations made by compounding pharmacies). Although looking at studies overall suggests that either form has an equal chance of being effective, a recent study suggests that for those who feel lousy on Synthroid (approximately one third), three times as many will prefer the combination T4 plus T3. This combination can be especially effective in people who also have depression. If your physician is not open-minded enough to consider a trial of this treatment, consider making an appointment with a holistic physician who is trained in this issue.

Can I have low thyroid despite normal blood tests?
Absolutely! In fact, it is conservatively estimated that over 50% of people who need thyroid hormone have normal blood tests. So how can you tell?

• Symptoms of low thyroid include fatigue, weight gain, cold intolerance, constipation, infertility, low body temperature and hair thinning. A trial of thyroid hormone may be warranted if you have even one or two of these problems.
• Symptoms of an overactive thyroid feel like having had too much caffeine. These include anxiety, palpitations, shakiness and generally feeling hyper.

Although more and more physicians are learning to treat the patient instead of only treating the blood test, some physicians are more conservative and slower to move forward. If this occurs, consider seeing a holistic physician. The website of the American Board of Integrative Holistic Medicine can help you find a board-certified holistic physician near you.

Love and Blessings,

Jacob Teitelbaum MD, internist and author of From Fatigued to Fantastic!, researches treatments for Chronic Fatigue Syndrome and fibromyalgia. See full bio

AstraZeneca pill slows thyroid cancer progression

By Ben Hirschler

LONDON, June 7 (Reuters) - An AstraZeneca (AZN.L) pill that disappointed last year in lung cancer has produced good results in treating a type of thyroid cancer, a much smaller potential market.
Patients with advanced medullary thyroid cancer (MTC) given vandetanib experienced a 54 percent reduction in the rate at which their disease progressed compared to those taking a placebo, results of a late-stage study showed on Monday.
Peter Langmuir, executive director of medical science, told Reuters that AstraZeneca would use the data to file for regulatory approval in MTC during the third quarter of 2010.
Vandetanib had previously been known as Zactima. However, the company is no longer using this name because it didn't receive regulatory permissions for the brand in all countries.
The medicine had once been seen as a potential blockbuster but it suffered a big setback after failing to show an overall survival benefit in lung cancer, leading AstraZeneca to pull regulatory filings in that disease last October.
Consensus forecast point to sales of around $200 million in 2014, according to Thomson Reuters data.
The Anglo-Swedish company has placed a big bet on cancer pills like vandetanib, although so far the strategy has met with limited success. Iressa, a pill for lung cancer, has seen a revival in its fortunes thanks to tests to identify those patients who will gain from using it. But another cancer pill, Recentin, was recently dropped as a candidate for first-line colon cancer. [ID:nLDE64R059]
Results of the two-year Phase III trial of vandetanib, involving 331 patients, were presented at the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago.
Those on placebo went a median 19 months before their tumours started growing. In the vandetanib arm, the median point was not reached, since fewer than half of patients had disease progression, but using statistical modelling researchers estimated that the median for the treated group would have been about 30 months.
A total of 45 percent of patients on the drug saw their tumours shrink.
Langmuir said the advantage was "quite striking". No overall survival benefit was observed in the two-year study, however, since only 15 percent of patients died and there was also an option for patients to cross over from placebo to vandetanib.
Common side effects of the drug -- which targets three biological pathways known as VEGF, EGFR and RET -- were diarrhoea, hypertension and rash.
MTC can be cured by surgery but there are currently no specific drugs available for patients whose disease has spread around the body or returns after surgery.
There are around 2,000 new MTC patients each a year in the United States and a similar number in Europe, of whom around half could benefit from vandetanib, AstraZeneca calculates.
"The numbers are quite small," Langmuir acknowledged.
AstraZeneca is also investigating vandetanib in earlier stage clinical trials for other types of thyroid cancer, as well as brain tumours and head and neck cancer. (Editing by Sharon Lindores) 

Information about the thyroid

By Dr. LAURA ARCHULETA

Hey, Doc! Can you check my thyroid?
The thyroid gland sits at the front of the neck, just below the Adam's apple.  Its job is to regulate the body's metabolic processes: heart rate, digestion, burning calories and so on.  When the thyroid gland isn't working correctly, it can cause a whole host of symptoms, many of which are vague and easily overlooked.
The most common thyroid problem is hypothyroidism.  In this disorder, the gland does not produce enough thyroid hormone. Since the thyroid regulates metabolism, lack of the hormone can make a person feel like he or she is moving in slow motion.
Fatigue, cold intolerance, weight gain, body aches and constipation are the most common symptoms, but people also may notice changes in their hair, skin and nails.  Depression and other mood changes also can be part of hypothyroidism.
While these symptoms may not seem serious, hypothyroidism can have severe consequences.  Long-term lack of thyroid hormone can cause stress on many of the body's organs, especially the heart.  It also weakens bone and can lead to osteoporosis.
There are several causes of hypothyroidism.  Hashimoto's disease is the most common.  This is an autoimmune disorder in which antibodies that are supposed to fight off diseases start to attack the thyroid gland.  Other causes are previous treatments of overactive thyroid, surgery on the thyroid gland or certain medications.  Sometimes pregnancy can induce thyroid problems in women.  Rarely, infants can be born with an underactive thyroid gland.
Thyroid problems usually can be detected in blood work.  Simple blood tests can measure the levels of thyroid hormones in the body and give hints on how well the gland is functioning.
Sometimes, ultrasound is used to take pictures of the gland.  This can rule out goiter, a noncancerous mass on the thyroid.  It also can tell us if the gland is abnormally enlarged.  Occasionally, advanced tests like biopsies or nuclear scans may be necessary. In many cases though, blood work is all that is necessary to confirm a diagnosis of hypothyroidism.
An underactive thyroid can be treated with medication to boost the hormone levels.  Changes don't happen overnight, though.  It can take weeks to months for the body to return to normal functioning. After the medications have had time to work, blood work may be repeated to be sure that the dose is correct and the hormone levels are where they should be.
The thyroid gland plays an important role in keeping the body functioning properly.  When the gland is underactive, it can cause vague symptoms that are often difficult to diagnose.  Still, thyroid dysfunction usually responds well to simple treatments like medication. If you'd like to learn more, talk to your doctor at your next appointment.
(Dr. Laura Archuleta is certified by the American Board of Family Medicine and is a member of the American Academy of Family Physicians and the American Academy of Hospice & Palliative Medicine. Archuleta has special interests in pediatrics, natural family planning and end-of-life care. She lives in Bismarck with her husband and three children.)

Posted in Health-med-fit on Sunday, June 13, 2010 2:00 am

ATA Members Concerned About Reducing Dietary Iodine Intake

Following publication of an article in the February 18 issue of the New England Journal of Medicine (Vol. 362 No. 7 pp 590-599) by Bibbins-Domingo, et al. that projected the effect of moderate dietary salt reductions on future cardiac disease rates, several members of the American Thyroid Association, concerned about the subsequent potential reduction in availability of iodine, have responded with a letter in the current issue of the NEJM (Vol. 362 No. 23 pp 2224-2226).

SEE MORE on :                http://www.medicalnewstoday.com/articles/191717.php

Local study into link between thyroid disorders and depression

SINGAPORE - Researchers at the Singapore General Hospital (SGH) are hoping to beat the blues by treating thyroid disorders.

Studies overseas have shown some association between the two, but results have not been conclusive.

There will be a clinical trial here to find out how exactly thyroid disorders can lead to depression.

In Singapore, close to 9 per cent of adults suffer from depression, with more women falling prey.

And while thyroid disorders can lead to depression, doctors are not sure how.

To find out more, the researchers will look at hypothyroidism, where the body is short of the thyroid hormone.

The clinical trial which is expected to end in November next year will compare two groups of women - those who suffer from depression and those who don't. For a start, the trial will focus on non-pregnant Chinese women between the ages of 21 and 60.

Dr Chan Herng Nieng, associate consultant, Department of Psychiatry at SGH, said: "Our aim is to find out whether there's any difference in these two groups of people in terms of the levels of thyroid hormone, levels of thyroid antibody, as well as levels of cytokine, which are proteins that serve a signalling function in the immune system."

With an eventual pool of 160 participants, researchers hope to draw conclusions from a 90-minute survey, and blood and urine tests. Claire Huang

ASCO: Biologic Slows Rare Thyroid Cancer

By Charles Bankhead, Staff Writer, MedPage Today
Published: June 10, 2010
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

CHICAGO -- Progression of medullary thyroid carcinoma slowed by more than 50% in patients treated with an investigational multitargeted kinase inhibitor, according to data from a study sponsored by the National Cancer Institute (NCI). Patients treated with vandetanib (Zactima) had a progression rate of 32% compared with 51% with placebo (P=0.0001). Analyses using investigator assessment and adjusted for open-label therapy resulted in even larger reductions in the progression rate.
After a median follow-up of 24 months, the placebo group had a median progression-free survival of 19.3 months, whereas the median had yet to be reached in the vandetanib arm, Samuel A. Wells, MD, reported at the American Society of Clinical Oncology meeting here.
"Statistically significant advantages for vandetanib were also evident in the secondary endpoints of objective response rate, disease control rate, biochemical response, and time to worsening of pain," said Wells, of NCI's Medical Oncology Branch.
"Adverse events were generally manageable, permitting treatment with vandetanib for prolonged periods of time."
Medullary thyroid carcinoma is a rare cancer, accounting for just 3% to 5% of all thyroid cancers. The tumors are sporadic in 75% of cases and hereditary in the remaining cases. Activating RET (rearranged during transfection) mutations occur in more than half of sporadic cases and in almost all of the hereditary cancers, said Wells.
Vandetanib inhibits tumor angiogenesis and tumor-cell proliferation by targeting RET, vascular endothelial growth factor (VEGF) receptor, and epidermal growth factor receptor (EGFR). The agent is in clinical evaluation for several types of tumors, including thyroid and non-small cell lung cancer.
Wells reported findings from the largest-ever clinical trial for medullary thyroid cancer -- 331 patients with unresectable locally advanced or metastatic disease were randomized 2:1 to vandetanib or placebo.
Treatment and follow-up continued until progression, at which point patients in both arms could receive open-label vandetanib.
The primary endpoint was progression-free survival as determined by central independent review.
Study participants had a mean age of 52 and 57% were men. More than 90% had metastatic disease, and about 60% had received no prior therapy for metastatic disease. Sporadic or unknown disease type accounted for about 90% of the cases, and 56% of the patients tested positive for RET mutations.
The primary analysis of progression-free survival yielded a hazard ratio of 0.46 in favor of vandetanib. Exclusion of open-label therapy resulted in a hazard ratio of 0.27 (P<0.0001), and analysis by investigator-assessed progression-free survival produced a hazard ratio of 0.40 (P<0.0001).
The data also showed significant advantages for vandetanib with respect to:

• Overall response, 45% versus 13%, P<0.0001
• Biochemical response-calcitonin, 69% versus 3%, P<0.0001
• Biochemical response-carcinoembryonic antigen, 52% versus 2%, P<0.0001
• Time to worsening of pain, 7.85 versus 3.25 months, P=0.006

Wells noted that 12 of 13 responses in the placebo group occurred during open-label treatment with vandetanib.
Median duration of randomized treatment was 90.1 weeks in the vandetanib arm and 39.9 weeks in the placebo arm.
The most common adverse events occurred more often with vandetanib: diarrhea (in 56% of patients compared with 26% in the placebo arm), rash (45% versus 11%), nausea (33% versus 16%), and hypertension (32% versus 5%).
Additionally, 35% of patients in the vandetanib arm required dose reductions compared with 3% in the placebo arm.
Wells said 12% of vandetanib patients discontinued randomized therapy because of adverse events, as did 3% of the placebo group.
"Vandetanib demonstrated efficacy in this study of patients with advanced metastatic medullary thyroid carcinoma, a stage of disease for which there is currently no effective treatment," Wells said in conclusion.
Invited discussant Dimitrios Colevas, MD, of Stanford University, noted several limitations of the study, including the fact that progression-free survival curves appeared similar after six months, raising questions about the need for chronic treatment.
Additionally, he said, the trial did not examine overall survival.
The multitargeted agent was active in patients with and without RET mutations, suggesting the tumor is not "all about RET," Colevas continued.
"We can shrink tumors and extend progression-free survival in medullary thyroid cancer, but it's unclear if this is clinically meaningful," he said in conclusion.

Wells reported no disclosures.
Colevas disclosed relationships with Boehringer Ingelheim and GlaxoSmithKline.

 

 

Primary source: American Society of Clinical Oncology
Source reference:
Wells SA, et al "Vandetanib in locally advanced or metastatic medullary thyroid cancer: a randomized, double-blind, phase III trial (ZETA)" ASCO 2010; Abstract 5503.

The Voices of Thyroid Disease

Although many people haven’t heard of thyroid conditions like Graves’ disease or Hashimoto’s syndrome, thyroid problems are finally getting more attention.

SEE MORE on:
http://well.blogs.nytimes.com/2010/05/13/the-voices-of-thyroid-disease/
 

Report: Thyroid cancer radiation a public threat

• 

By Steve Sternberg, USA TODAY

A Nuclear Regulatory Commission rule allowing hospitals to discharge radioactive thyroid cancer patients to their homes and hotels poses a public health threat, a congressional report says today.

The report (pdf), released by Rep. Edward Markey, D-Mass., chairman of the House Subcommittee on Energy and the Environment, which oversees the commission, also found that insurers routinely use the rule to deny hospital care even to patients whom doctors say may pose a radiation risk to others. Patients are often discharged to recover in self-imposed isolation.

FORUM: Living with Cancer

ARCHIVES: It kills thyroid cancer, but is radiation safe?

"The United States simply cannot play radioactive roulette and gamble with public health and safety," Markey says.

Radioactive iodine is a proven cancer fighter, with a five-year survival rate of 97%. The thyroid is the only body organ that uses iodine. Radioactive iodine kills any thyroid cancer cells that surgery might have missed. But radiation also poses a cancer risk, especially to children. Thyroid cancer patients give off radioactive iodine in urine, sweat and saliva for several days; traces may remain in the body for as long as two weeks.

In 1997, the NRC "weakened" its patient-release regulations from the global standard requiring hospitalization for patients whose bodies contain 30 millicuries or more of radioactive iodine to one that allows outpatient treatment, the report says. The report says the NRC repeatedly rebuffed efforts to get the agency to adopt stricter standards.

In August, the Ninth Circuit Court of Appeals rejected a petition by thyroid cancer survivor Peter Crane, a former NRC lawyer, to force a change. The court ruled that he "lacked standing to bring the case" because he is not undergoing treatment, the report says.

"I'm gratified that the committee is paying attention to this," Crane said. "Patients are going home in this country with 200 millicuries of radiation in their system. In Germany, they would be hospitalized with 8 millicuries. This isn't an academic matter, it's about exposing children to cancer-causing radiation."

Owen Hoffman, a radiation-risk expert at Senes Oak Ridge, says even though the risk is fairly low, about 1 in 1,000 for an infant boy and double that for an infant girl, "the right thing to do is to reduce unnecessary exposures."

The report cites a 2007 USA TODAY survey, carried out with the Thyroid Cancer Survivors Association, showing that 4% of the patients treated with radioactive iodine checked into hotels or other accommodations, 2% took public transportation, and 14% failed to go directly home, which gave patients "plenty of opportunity" to "unwittingly" expose others to radiation.

NRC spokesman Eliot Brenner says the agency will examine the report, but he added in an e-mail, "I don't want to set up false expectations about what we might do with the recommendations.

Study Shows AstraZeneca Drug Works In Thyroid Cancer

By JENNIFER CORBETT DOOREN

CHICAGO—Results of a study involving an experimental AstraZeneca PLC drug, vandetanib, showed it extends the time before a type of rare thyroid cancer gets worse.
Vandetanib works to block a protein involved with cancer growth as well as block blood vessels that feed tumors. One of the proteins the drug targets is known as RET, which appears to be involved in a certain type of thyroid cancer known as medullary thyroid cancer. The thyroid gland is located at the base of the neck and makes hormones that control heart rate, body temperature and metabolism.
Vandetanib was previously studied as a treatment for advanced non-small cell lung cancer in combination with chemotherapy. Last year, AstraZeneca withdrew an application from the U.S. Food and Drug Administration for approval of vandetanib in the lung cancer setting after clinical data failed to show it increased patients' survival time. The company had proposed selling vandetanib under the brand name Zactima.
Peter Langmuir, executive director of medical science at AstraZeneca, said the company plans to file for FDA approval of vandetanib to treat medullary thyroid cancer based on the study results. The results are scheduled to be presented later Monday at the American Society of Clinical Oncology's annual meeting.
AstraZeneca's study involved 331 patients with advanced medullary thyroid cancer. About 230 patients received vandetanib while 100 received a placebo, or sham, treatment.
After an average follow-up of 24 months, the study showed that 48% of patients receiving vandetanib continued on treatment while 37% of patients progressed, or had their disease get worse. Fifteen percent of patients in the study died.
Researchers said the study showed that treatment with vandetanib reduced the risk of thyroid cancer progressing by 54% compared with patients not receiving the drug. The study data isn't mature enough to show whether slowing disease progression will translate into an increase in overall survival. AstraZeneca is also conducting another trial in a more common form of papillary thyroid cancer.
The American Cancer Society estimates that about 45,000 cases of thyroid cancer will be diagnosed this year in the U.S.
Write to Jennifer Corbett Dooren at jennifer.corbett-dooren@dowjones.com

Not all thyroid cancers need treatment: study

NEW YORK (Reuters Health) – People with papillary thyroid cancer that hasn't spread beyond the thyroid gland appear to have good outcomes regardless of whether or not they are treated, new research shows.
Papillary thyroid cancer is the most common type of thyroid cancer. Among more than 35,000 people with "localized" papillary thyroid cancer who underwent immediate surgery to remove half or all of their thyroid gland, researchers found that 99 percent were still alive 20 years later. For the 440 patients who didn't undergo immediate treatment, 97 percent were still alive after 20 years.
As the numbers show, surgery is the mainstay of treatment for localized thyroid cancer, with just a handful of patients -- 1.2 percent in all in the current study -- not being treated.
But the findings suggest that in many cases surgery may not be necessary, Dr. Louise Davies of the Department of Veterans Affairs Medical Center in White River Junction, Vermont, one of the study's authors, told Reuters Health.
But in an editorial accompanying the study in the Archives of Otolaryngology -- Head and Neck Surgery, Drs. Erich M. Sturgis and Steven I. Sherman of the University of Texas M.D. Anderson Cancer Center in Houston argue that observation "should only be cautiously considered in the most carefully selected cases."
In 2006, Davies and her colleague Dr. H. Gilbert Welch reported a sharp rise in thyroid cancer diagnoses over the previous 15 years, without a corresponding increase in deaths. This is because new diagnostic technology has identified many cancers in people who don't have symptoms; 87 percent of the new tumors identified were less than 2 centimeters across, meaning they likely couldn't have been felt by a patient or doctor.
In the current study using National Cancer Institute registries, Davis and Welch identified 35,663 cases of localized papillary thyroid cancer diagnosed between 1973 and 2005, including 440 people who did not undergo immediate treatment.
Among people who were treated immediately, 161 -- or less than a half percent -- died of thyroid cancer over an average of about 7.6 years. For the non-treated individuals, there were 6 thyroid cancer deaths (about 1.4 percent) over an average of 6 years.
The 20-year survival rate from cancer was estimated to be 97 percent for those who went without treatment and 99 percent for those who did receive treatment.
There are four types of thyroid cancer in all, Davies noted; the two most deadly types make up just 2 percent of all cancers. And people who develop this type of disease usually are aware that something is wrong, she added. The more serious types of thyroid cancer "don't just sort of sneak up on you. They cause symptoms. They make it difficult to breathe or talk, they change your voice, you feel something in your neck and it feels hard."
And certain groups of people are at risk of more serious forms of thyroid cancer, Davies added: men, people younger than 20, people over 70, people who have symptoms, and people who have had radiation to the head and neck area in the past.
If a doctor identifies a localized tumor in your thyroid gland, the researcher said, people can choose to have it biopsied, or they can opt for having another imaging test in six months to a year.
The new findings, Davies said, "make me feel much more comfortable advising patients that we don't need to do a biopsy right now."
In three to five percent of cases, Davies added, people have serious complications of thyroid surgery such as loss of function of the parathyroid gland (which necessitates taking multiple doses of calcium throughout the day) or loss of function in the vocal cords. People who have their entire thyroid gland removed, she added, will also need to take a thyroid hormone pill every day.
In their editorial, Sturgis and Sherman agree that observation without immediate treatment is appropriate for some patients, including those with other major health problems or small, recurrent tumors. But "inadequate initial evaluation and/or treatment" also carries risks, they add.
"We as individual clinicians must keep the individual patient's best interest at the center of our decision making, whether it be operating on, observing, or referring the patient," Sturgis and Sherman wrote.
SOURCE: http://archotol.ama-assn.org/
Archives of Otolaryngology--Head and Neck Surgery, May 2010.

New thyroid cancer therapy: Longer life

ROCHESTER, Minn., June 1 (UPI) -- U.S. cancer scientists say they've discovered aggressive treatment of anaplastic thyroid cancer can dramatically increase survival rates.
Mayo Clinic oncologists say the new approach reflects the need to aggressively treat metastasis even when the rare cancer seems to be confined to the neck. Historically, anaplastic thyroid cancer has been treated with surgery and radiation, but due to rapid spread of microscopic cancer, only up to 20 percent of patients survive more than a year. Because the prognosis for this cancer is so poor, Mayo physicians felt a more aggressive pilot approach that added earlier chemotherapy was merited.
Of 24 patients with newly diagnosed anaplastic thyroid cancer seen at Mayo Clinic between 2003 and 2007, 10 patients with local disease elected to pursue the aggressive approach. After surgery, the patients were treated with intensity modulated radiation therapy and with aggressive chemotherapy in efforts to simultaneously control disease in the neck and forestall metastasis.
One-year survival in the group was 70 percent, with six of the 10 patients alive at least two years post-treatment -- five of them without evidence of disease. Two of those patients were treated more than three years ago and are still in remission.
The study -- led by Drs. Keith Bible Robert Foote and Julian Molina -- is to be presented in Chicago during the annual meeting of the American Society of Clinical Oncology.

Is my thyroid causing fatigue, hair loss?

Asked by Christie, Arizona

I was diagnosed with a slightly slower thyroid about a year ago when I was on the Atkins diet. I went off the diet, gained back the weight and now I am having the hardest time losing it again. My hair is half its usual thickness and I am tired all the time. Can this be from my thyroid?

Expert answer

Conditions Expert Dr. Otis Brawley Chief Medical Officer,
American Cancer Society

    Given your symptoms, I am concerned that you might have hypothyroidism. This is a condition in which the thyroid does not secrete enough hormone. I would recommend that you consult an internal medicine specialist or an endocrinologist and discuss your concerns. It is sometimes appropriate to simply monitor a slightly hypoactive thyroid, but most hypoactive thyroids eventually need treatment.
The thyroid gland is located in the front of the neck. It secretes thyroid hormone, which controls our rate of metabolism. Someone who has a hyperactive thyroid has a gland that is secreting too much hormone. They are hyperactive. They will have weight loss. Thinning of hair is common, but hair loss is uncommon. These patients have a faster heart rate and sometimes even a slightly higher temperature and sweating. People with very bad hyperactive thyroids will have a prominent bulging of the eyes and difficulty sleeping. They will initially be treated with beta blockers to slow metabolism and then will be treated with drugs to block thyroid secretion. Radioactive iodine is sometimes given to destroy the hyperactive thyroid. Surgical removal is also sometimes a treatment option.
People who have no thyroid gland or hypoactive thyroids (thyroids that produce too little thyroid hormone) have a generalized slowing of the metabolic processes. They are fatigued, can have slow movement and slow speech. They have a slow heart rate, are cold intolerant, can have constipation and often have weight gain. These patients have skin that is cool and pale because of decreased blood flow. Hair may be coarse. Hair loss is common, and the nails become brittle. Anemia is also common. The voice can deepen.
Hypothyroidism is common in adults and is usually due to an autoimmune disorder in which the patient's immune system damages or destroys the thyroid. Iodine deficiency is a common cause of hypothyroidism in some countries in which foods are not fortified with iodine. A few people have hypothyroidism because of ingestion of radioactive iodine after nuclear accidents. Radioactive iodine in high dose can destroy the thyroid.
In the U.S. and Western Europe, hypothyroidism may occur in up to one in 25 adults with more than half being unaware that they are hypothyroid. It is often not diagnosed, although the diagnosis can usually be done through some widely available simple blood tests.
Treatment of hypothyroidism involves thyroid replacement through administration of oral medication. Synthetic thyroxine given once a day is the most common replacement drug. It is monitored through blood tests and the proper dose is created for each patient.

Health Tip: Things That Could Cause Graves' Disease

Factors that may play a role

(HealthDay News) -- Graves' disease occurs when the body's immune system causes the thyroid gland to produce more of a certain hormone than the body can use.
Symptoms may include an enlarged thyroid, insomnia, nervousness, a sensitivity to heat, and uncontrolled hand movement. Some people with the disease have swollen eyes.
The National Women's Health Information Center says the following factors may contribute to Graves' disease:

• Having a family history (genetic predisposition).
• Being a woman and producing female hormones.
• Experiencing extreme emotional stress or significant trauma may help trigger the disease in people who are prone to it.
• Being pregnant, which affects the thyroid.
• Having an infection.

-- Diana Kohnle

Copyright © 2010 HealthDay. All rights reserved.

Multiple Dental X-Rays Raise Risk Of Thyroid Cancer

Researchers from Brighton (England), Cambridge (England) and Kuwait have demonstrated that thyroid cancer risk increases as the number of dental x-rays taken grows. The researchers report that the incidence rates of thyroid cancer have doubled from 1.4 per 100,000 in 1975 to 2.9 per 100,000 in 2006 in the UK.

They stress that several factors are probably involved in the thyroid cancer increase, and that sensitive diagnostic techniques should not be considered to account for all of it. Further research is needed.

The research team was led by Dr Anjum Memon, senior lecturer and consultant in public health medicine at Brighton and Sussex Medical School (England), a partnership between Brighton and Sussex universities, and NHS (National Health Service) Brighton and Hove (England).

This study has been published in the medical journal Acta Oncologica.

The thyroid gland, which is located in the neck, is exposed to radiation from many dental x-rays. This gland is sensitive to ionizing radiation, especially in children. The researchers inform that dental radiography, a source of low-dose diagnostic radiation, is frequently ignored as a potential risk to the thyroid gland.

The scientists studied 313 patients in Kuwait, they all had thyroid cancer. In Kuwait dental treatment is free. Compared to other countries, such as the UK, the incidence of thyroid cancer in Kuwait is high.

They said the results of their study, although the largest case-control study on the subject, "should be treated with caution because the data were necessarily based on self-reporting by the participants. Comprehensive historical dental x-ray records were not available from the clinics."

The researchers believe their study provides good evidence to warrant further research in settings where historical dental x-ray records are available and where radiation doses can be estimated.

Dr Memon said the findings were compatible with earlier reports of raised risk of thyroid cancer in dentists, dental assistants, and x-ray workers, suggesting that multiple low-dose exposures in adults may also be significant. He said dental x-rays have also been linked to an increased risk of brain and salivary gland tumors.

Dr Memon wrote:

The public health and clinical implications of these findings are particularly relevant in the light of increases in the incidence of thyroid cancer in many countries over the past 30 years.

It is important that our study is repeated with information from dental records including frequency of x-rays, age and dose at exposure. If the results are confirmed then the use of x-rays as a necessary part of evaluation for new patients, and routine periodic dental radiography (at 6-12 months interval), particularly for children and adolescents, will need to be reconsidered, as will a greater use of lead collar protection.

Our study highlights the concern that like chest (or other upper-body) x-rays, dental x-rays should be prescribed when the patient has a specific clinical need, and not as part of routine check-up or when registering with a dentist.

(conclusion) The notion that low-dose radiation exposure through dental radiography is absolutely safe needs to be investigated further, as although the individual risk, particularly with modern equipment is likely to be very low, the proportion of the population exposed is high.

"Dental x-rays and the risk of thyroid cancer: A case-control study"
Anjum Memon , Sara Godward , Dillwyn Williams , Iqbal Siddique & Khalid Al-Saleh
Acta Oncologica May 2010, Vol. 49, No. 4, Pages 447-453

Written by Christian Nordqvist
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