Introduction to Thyroid Cancer Prevention

Until recently, thyroid cancer was the fastest growing cancer in the United States, mainly due to our ability to detect these cancers so well (Ultrasound, CT scan, MRI, etc.). Thyroid cancer is the 5th most common cancer in women. Since the 1970’s, the incidence of thyroid cancer has doubled. Overall, the 5-year survival rate for people with thyroid cancer is 98%, with long-term survival being 95% or higher.

As with all cancers, screening, early detection, and prevention are crucial. Certainly, decreasing the risk of thyroid cancer and diagnosing the cancer sooner are very beneficial. Below I will discuss the 5 most important things a person can do in order to prevent thyroid cancer (or avoid delaying the diagnosis).

#1 Recommendation for Thyroid Cancer Prevention: Minimize Radiation Exposure

Significant radiation exposure is unquestionably one of the two primary risk factors for thyroid cancer. Large amounts of radiation exposure to the head/neck area or chest, typically from treatment of another cancer (lymphoma, breast cancer, etc.) increases the risk of thyroid cancer. Some folks also get exposure due to their line of work (x-ray technician, fluoroscopy technician, etc.). Finally, there have been some major exposures due to nuclear accidents (Chernobyl, 3 Mile Island) and atomic bombs (World War II).

Medical radiation is by far the most common cause of exposure. In certain instances, this medical radiation is targeted at the neck, head, face, or chest in high doses to treat other cancers. Before 1960, some people even had low dose radiation targeted at the head and neck to treat non-cancerous conditions affecting skin, scalp, tonsils and adenoids, and more. Indirect or direct exposure to this radiation is harmful to the thyroid gland and increases the risk of thyroid cancer. Wearing a thyroid shield and more targeted radiation are very helpful at limiting or decreasing thyroid exposure. Of note, diagnostic radiation from CT scans and X-Rays in adults has not been shown to increase the risk of thyroid cancer in the vast majority of patients. Diagnostic radiation is often minimized in children to be safe, but thankfully has not been associated with a high risk of developing thyroid cancer.

You may also be exposed to harmful radiation at your job. Many folks in the medical field work around radiation. Wearing a thyroid shield when exposed is paramount to prevent harmful radiation to the thyroid gland. Additionally, some people work around radiation and radioactive substances in other lines of work. If this sounds like your job, make sure to minimize exposure, wear a thyroid shield, and monitor exposure with a dosimeter (device that tracks harmful radiation exposure).

#2 Recommendation for Thyroid Cancer Prevention: Know Your Family History

Similar to all other cancers, genetics plays a roll. While some of the genetics of thyroid cancer involve changes in genes at the cellular level (mutations), inherited genetic risk does occur occasionally with thyroid cancer. A family history of thyroid cancer in a close family member (parent, grandparent, sibling, or child) increases the risk of thyroid cancer. This occurs even if there is no known genetic condition, syndrome, or change (mutation) that causes thyroid cancer. In most cases, we do not know what the inherited gene or gene mutation is that increases the thyroid cancer risk in families.

Papillary thyroid cancer is the most common type of thyroid cancer. We know that if an immediate family member has papillary thyroid cancer, their first- degree relatives are at increased risk for developing papillary thyroid cancer (2-10 fold increased risk). Additionally, this thyroid cancer is associated with FAP (Familial Adenomatous Polyposis). FAP is a condition that causes many precancerous polyps to grow in the large intestine, but can also lead to other types of growths including desmoid (fibrous) tumors, stomach tumors, and of course cause thyroid cancer.

On the other hand, there are a few inherited syndromes that we know are associated with genetic causes of a rare form of thyroid cancer. The most well-known genetic cause of medullary thyroid cancer is the MEN2 (Multiple Endocrine Neoplasia) syndromes associated with mutations in the RET gene. Depending on which MEN syndrome one has, there is significantly increased risk of medullary thyroid cancer, pheochromocytoma, parathyroid adenomas, pancreatic tumors, pituitary tumors, and mucosal neuromas.

Known genetic causes of follicular thyroid cancer include Cowden Syndrome and Carney Complex. Cowden Syndrome is associated with tumors of the breast, thyroid, uterus, colon, kidney and skin. Carney Complex is associated with brown skin spots, thyroid cancer as well as multiple other types of tumors in the heart, skin, and other endocrine organs.

Bottom line is to research and pay attention to the health of your close family members and first-degree relatives. If there is any concern or question, a thyroid ultrasound is the imaging test to start with. Inherited genetic syndromes that increase thyroid cancer risk require genetic testing and counseling along with the appropriate screening and evaluation for associated conditions and cancers. Learn more about the top causes of thyroid cancer. 

#3 Recommendation for Thyroid Cancer Prevention: Do Self-Checks or Get Examined by Your Physician

Self- checks are an important part of cancer screening and prevention. Similar to breast cancer and testicular cancer, self-checks of you neck can help diagnose thyroid cancer. The vast majority of thyroid cancers are very subtle and do not cause symptoms. Additionally, 95% or more of thyroid cancers cannot be diagnosed with a blood test.

The thyroid is a butterfly shaped organ that lays in the middle of your neck right above your collar bone. Performing this self-check may allow you to feel a lump or tumor in the thyroid that is cancerous. Thyroid cancers can also spread to lymph nodes in the sides of your neck.  In the same fashion, performing a self-check of the sides of your neck can detect an enlarged lymph node caused by a thyroid cancer that has traveled outside of the gland.

The way to perform a self-check for thyroid cancer would involve moving your fingers around the middle of your neck where your thyroid is.  You would also move your fingers throughout both sides of your neck up, down, and around the muscle you see on each side of your neck when you turn your head.  Lymph nodes that can harbor thyroid cancer are located anywhere from below your ear to you collar bone on both sides of your neck. Therefore, you would want to make sure that you are feeling the whole front and both sides of your neck during your self-check for thyroid cancer. 

Dr. Rashmi Roy of the Clayman Thyroid Center created a video demonstrating how to performing a self-check for thyroid cancer symptoms.

Another important method to diagnose thyroid cancer is regular checks with your doctor. Your physician will take a complete history and do a thorough physical exam as part of the thyroid cancer screening process.  When your physician is taking your history, you will be asked many questions about recent signs and symptoms. If certain symptoms like a change in voice, difficulty swallowing, or a sense of a lump in your throat are mentioned, then a formal thyroid ultrasound should be ordered to diagnose a potential thyroid cancer. During your physical exam portion of your visit, your neck would also be felt to detect any lumps or irregularities. Anything significant on the exam portion of the neck should also prompt a thyroid ultrasound.

Learn more about the top symptoms of thyroid cancer.

#4 Recommendation for Thyroid Cancer Prevention: Get an Ultrasound

A thyroid ultrasound done by a skilled and experienced team is the foundation in evaluation and diagnosis of thyroid cancer. Often, an excellent ultrasound is enough to make the diagnosis of cancer because many thyroid cancers have a very characteristic appearance on ultrasound. During ultrasound, the technician must thoroughly examine the thyroid and all the areas of lymph nodes in both sides of the neck that can be involved with thyroid cancer. If your ultrasound is not comprehensive and does not include these important components, cancer may be missed (and left behind after surgery).

Ultrasound should be the first imaging test to examine a person for a potential thyroid cancer. CT scan, PET/CT scan, and MRI (very rarely) are occasionally needed as well to evaluate and diagnose if the cancer has spread outside of the thyroid and/or neck area, but those tests are never first—ultrasound is always the first test on thyroid glands. If your doctor is ordering and MRI or PET scan as the first imaging test, you need to get a second opinion from an expert ASAP. As noted above, if you have any risk factors (family history) or concerns for a thyroid cancer (lump in neck, change in voice or swallowing, etc.), make sure to get an expert ultrasound of your thyroid and neck promptly.

Learn more about thyroid ultrasound.

#5 Recommendation for Thyroid Cancer Prevention: Live a Healthy Lifestyle

Controlling the aspects of your health and lifestyle that you can is crucial for thyroid cancer prevention. Diet, exercise, and avoidance or cessation of smoking are important, modifiable factors related to thyroid cancer. As we all know, smoking is associated with increased likelihood of developing many chronic illnesses and cancers, including thyroid cancer. Obesity is also linked to many chronic diseases and increased risk for numerous cancers. Not surprisingly, obesity increases your risk of thyroid cancer. The risk goes up as the body mass index (calculated formula relating one’s weight to their height²) goes up. It would follow then that diet and exercise are important in maintaining a healthy lifestyle and reducing the chance of thyroid cancer. A well- rounded, balanced diet that includes fruits, vegetables, whole grains and fiber, well-sourced protein, and antioxidants (substances that slow or prevent damage and death of cells by unstable molecules in the body) is key. Lastly, dietary iodine is a factor to pay attention to as well. Not enough iodine is associated with Follicular Thyroid Cancer, and too much iodine is associated with Papillary Thyroid Cancer.

Summary of Thyroid Cancer Prevention

Screening, prevention, and early detection of thyroid cancer are crucial. Multiple tools can be used to prevent and detect thyroid cancer. Limiting radiation exposure, knowing your family’s medical history, self-check’s and regular doctor’s visits, getting an expert thyroid and neck ultrasound, and maintaining a healthy lifestyle are paramount. When dealing with your thyroid health and screening, entrust only the best experts.

Our team of thyroid cancer experts is here to help and guide you every step along the way during your thyroid cancer screening and prevention process. To learn more and become a patient, please see our resources below.

Additional Resources

• Become our patient by filling out the form at this link. 
• Learn more about The Clayman Thyroid Center here. 
• Learn more about our sister surgeons at the Scarless Thyroid Surgery Center, Norman Parathyroid Center, and Carling Adrenal Center
• Learn more about the Hospital for Endocrine Surgery.