Thyroid Cancer

Last updated: January 2025 | Medical Reviewer: Oncol.net Editorial Board

Overview

Thyroid cancer begins in the thyroid gland, a butterfly-shaped gland at the base of the neck that produces hormones regulating metabolism, heart rate, body temperature, and calcium levels. The incidence of thyroid cancer has increased significantly in recent decades, largely due to increased detection of small, asymptomatic tumors through imaging studies.

Most thyroid cancers grow slowly and are highly curable, especially when detected early. However, behavior and prognosis vary significantly by type. The majority of patients are cured with surgery alone or surgery followed by radioactive iodine treatment. Long-term thyroid hormone replacement is required after treatment.

Types of Thyroid Cancer

Differentiated Thyroid Cancer (90-95% of cases)

Papillary Thyroid Cancer (PTC) - 80-85% of all thyroid cancers

• Most common type, usually occurs in people aged 30-50
• Grows slowly, often spreads to lymph nodes in the neck
• Excellent prognosis: >99% 10-year survival for small tumors
• Subtypes:
  • Classic papillary: Most common, best prognosis
  • Follicular variant: Behaves like classic papillary, very good prognosis
  • Tall cell variant: 5-10% of PTC, more aggressive, affects older patients
  • Columnar cell variant: Rare, more aggressive
• Common BRAF V600E mutation (40-60% of cases) - target for therapy in advanced disease

Follicular Thyroid Cancer (FTC) - 10-15% of all thyroid cancers

• More common in areas with iodine deficiency
• Typically occurs in older adults (40-60 years)
• Spreads through blood to distant organs (lungs, bones) more than lymph nodes
• Excellent prognosis: 90-95% 10-year survival
• Subtypes:
  • Minimally invasive: Best prognosis, confined to thyroid capsule
  • Widely invasive: Invades blood vessels, worse prognosis
• Cannot be diagnosed on fine needle biopsy alone - requires surgical pathology

Hürthle Cell Carcinoma - 3-5% of thyroid cancers

• Variant of follicular cancer with distinct cells
• More aggressive than typical follicular cancer
• Less likely to take up radioactive iodine (only 10-20% are RAI-avid)
• Prognosis: 80-85% 10-year survival

Medullary Thyroid Cancer (MTC) - 3-4% of cases

• Arises from C cells that produce calcitonin hormone
• Does NOT take up radioactive iodine (different cell origin)
• Two forms:
  • Sporadic (75%): Occurs randomly, usually one side of thyroid
  • Hereditary (25%): Associated with RET gene mutations
    • Multiple Endocrine Neoplasia type 2 (MEN 2A and 2B)
    • Familial medullary thyroid cancer (FMTC)
    • All patients with MTC should have genetic testing for RET mutations
• Calcitonin and CEA are tumor markers for monitoring
• Prognosis: 80-90% 10-year survival if localized, 40-50% if distant metastases

Anaplastic Thyroid Cancer (ATC) - 1-2% of cases

• Rare, aggressive, undifferentiated cancer
• Typically occurs in adults >60 years
• Very rapid growth - often large neck mass at diagnosis
• Often invades surrounding structures (trachea, esophagus, nerves)
• May develop from pre-existing differentiated thyroid cancer
• Poor prognosis: median survival 4-12 months
• BRAF V600E mutation in 20-40%, may respond to targeted therapy

Other Rare Types

• Thyroid lymphoma: Usually B-cell non-Hodgkin lymphoma, associated with Hashimoto's thyroiditis
• Thyroid sarcoma: Extremely rare
• Metastases to thyroid: From kidney, lung, breast, or melanoma

Risk Factors

Established Risk Factors

• Radiation exposure: Strongest known risk factor
  • Childhood radiation to head/neck (previous treatment for acne, tonsils, adenoids)
  • Radiation therapy for other cancers
  • Nuclear accidents or fallout exposure
  • Risk increases with younger age at exposure and higher doses
  • Diagnostic X-rays and dental X-rays do NOT increase risk
• Gender and age: Women 3 times more likely than men, most common ages 30-60
• Family history and genetic syndromes:
  • First-degree relative with thyroid cancer: 3-5 times higher risk
  • Familial adenomatous polyposis (FAP) - associated with papillary cancer
  • Cowden syndrome (PTEN mutation) - 10-35% lifetime risk
  • MEN 2 syndromes (RET mutation) - medullary thyroid cancer
  • Carney complex - increased risk
• Benign thyroid conditions:
  • Thyroid nodules (very common, >95% are benign)
  • Goiter (enlarged thyroid)
  • Hashimoto's thyroiditis (slight increased risk for lymphoma)
• Iodine intake: Low iodine increases follicular cancer risk; high iodine may increase papillary cancer risk
• Obesity: Modest increased risk

Protective Factors

• Cigarette smoking (paradoxically decreases risk by ~30-40%)

Signs and Symptoms

Common Symptoms

• Thyroid nodule or lump: Painless mass in the front of the neck
  • Only 5-10% of thyroid nodules are cancerous
  • Concerning features: hard, fixed, irregular, rapidly growing
• Neck swelling: Visible or palpable enlargement
• Lymph node enlargement: Swollen lymph nodes in the neck (especially papillary cancer)
• Voice changes or hoarseness: Persistent for >2 weeks
  • Suggests involvement of recurrent laryngeal nerve
  • More common with advanced disease
• Difficulty swallowing (dysphagia): Large tumors compressing esophagus
• Difficulty breathing (dyspnea): Large tumors compressing trachea
• Neck or throat pain: Uncommon, suggests invasive tumor
• Persistent cough: Not related to cold or allergies

Anaplastic Cancer Symptoms (Aggressive Presentation)

• Rapidly enlarging neck mass (over days to weeks)
• Severe difficulty swallowing or breathing
• Hoarseness
• Neck pain
• Visible neck deformity

Medullary Cancer Additional Symptoms

• Diarrhea (from excessive calcitonin secretion)
• Flushing
• Features of MEN 2 syndrome (pheochromocytoma, hyperparathyroidism)

Diagnosis

Physical Examination

• Thyroid palpation - assess nodule size, consistency, fixation
• Neck lymph node examination
• Vocal cord examination if hoarseness present

Laboratory Tests

• Thyroid function tests (TSH, free T4): Usually normal in thyroid cancer
  • Low TSH may suggest benign autonomously functioning nodule
  • Elevated TSH may slightly increase cancer risk
• Calcitonin: Elevated in medullary thyroid cancer
  • Some experts recommend checking in all patients with thyroid nodules
  • Very high levels (>1000 pg/mL) indicate advanced MTC
• CEA: Often elevated in medullary thyroid cancer
• Thyroglobulin: Not useful for diagnosis (used for monitoring after treatment)

Imaging Studies

• Thyroid ultrasound: First-line imaging
  • Evaluates nodule characteristics (size, composition, echogenicity, margins, calcifications)
  • Assesses cervical lymph nodes
  • Guides fine needle aspiration biopsy
  • Features suggesting malignancy: hypoechoic, solid, microcalcifications, irregular margins, taller than wide, increased vascularity
• Ultrasound risk stratification systems:
  • ACR TI-RADS (Thyroid Imaging Reporting and Data System)
  • Guides which nodules need biopsy based on size and features
• CT or MRI neck: For large tumors or to assess invasion of surrounding structures
• Chest CT: If evidence of advanced disease or medullary/anaplastic cancer
• Radioiodine scan: Not for initial diagnosis; used after surgery in some cases
• PET/CT scan: Not routine; may be used for aggressive cancers or recurrence

Fine Needle Aspiration (FNA) Biopsy

• Primary method for evaluating thyroid nodules
• Ultrasound-guided procedure - thin needle inserted into nodule
• Quick, minimally invasive, can be done in clinic
• Results reported using Bethesda System:
  • Bethesda I: Non-diagnostic/insufficient (5-10% of biopsies) - repeat FNA
  • Bethesda II: Benign (60-70%) - risk of malignancy <3% - observation
  • Bethesda III: Atypia of undetermined significance (5-15%) - risk 10-30% - repeat FNA or molecular testing
  • Bethesda IV: Follicular neoplasm (5-10%) - risk 25-40% - surgery usually recommended
  • Bethesda V: Suspicious for malignancy (5-10%) - risk 50-75% - surgery recommended
  • Bethesda VI: Malignant (5-10%) - risk >95% - surgery recommended

Molecular Testing

For indeterminate nodules (Bethesda III-IV) to help guide management:

• Gene mutation panels: Test for BRAF, RAS, RET/PTC, PAX8/PPAR-gamma
  • BRAF V600E strongly suggests papillary cancer
  • RAS mutations found in follicular cancers and adenomas
• Gene expression classifiers: Afirma, ThyroSeq, ThyGeNEXT
  • Help identify benign nodules to avoid unnecessary surgery
  • High negative predictive value (95-99%)

Genetic Testing for Medullary Thyroid Cancer

• All patients with MTC should have germline RET testing
• If positive, test family members and screen for MEN 2-associated conditions
• Prophylactic thyroidectomy recommended for RET mutation carriers (timing depends on specific mutation)

Staging (TNM System)

Staging differs by age and histology because prognosis is age-dependent:

Differentiated Thyroid Cancer (Papillary and Follicular) in Patients <55 Years

• Stage I: Any T, Any N, M0 (any tumor size, any lymph nodes, no distant metastases)
• Stage II: Any T, Any N, M1 (distant metastases present)

Differentiated Thyroid Cancer in Patients ≥55 Years

• Stage I: T1-2, N0, M0 (tumor ≤4 cm, no lymph nodes, no metastases)
• Stage II: T3 or N1, M0 (tumor >4 cm or lymph node involvement, no metastases)
• Stage III: T4, any N, M0 (invasive tumor)
• Stage IV: Any T, Any N, M1 (distant metastases)

ATA Risk Stratification (Used for Treatment Decisions)

American Thyroid Association categorizes patients by recurrence risk:

• Low risk (60-70% of patients):
  • Papillary cancer, intrathyroidal, ≤4 cm, no invasion, no metastases, no aggressive features
  • Minimally invasive follicular cancer, capsular invasion only, no vascular invasion
  • Recurrence risk: 1-3%
• Intermediate risk (20-30%):
  • Microscopic invasion beyond thyroid
  • Lymph node metastases
  • Aggressive histology (tall cell, columnar cell)
  • Vascular invasion
  • Recurrence risk: 5-20%
• High risk (5-10%):
  • Gross extrathyroidal extension
  • Incomplete tumor resection
  • Distant metastases
  • Recurrence risk: >20%

Treatment

Surgery - Primary Treatment for Most Thyroid Cancers

Total Thyroidectomy (Most Common)

• Removal of entire thyroid gland
• Recommended for:
  • Tumors >4 cm
  • Bilateral disease
  • Extrathyroidal extension
  • Lymph node involvement
  • Distant metastases
  • History of radiation exposure
  • Medullary or anaplastic cancer
• Allows for radioactive iodine treatment and thyroglobulin monitoring
• Requires lifelong thyroid hormone replacement

Thyroid Lobectomy (Hemithyroidectomy)

• Removal of one lobe of thyroid
• Acceptable for:
  • Low-risk papillary cancer 1-4 cm confined to one lobe
  • Minimally invasive follicular cancer
  • Tumors <1 cm without high-risk features (may also observe)
• 50-60% of patients maintain normal thyroid function and don't need hormone replacement
• Cannot use radioactive iodine afterward

Active Surveillance (Non-Surgical Management)

• Observation without immediate surgery
• Acceptable for:
  • Very low-risk papillary microcarcinomas (<1 cm)
  • No extrathyroidal extension, lymph node involvement, or aggressive features
  • Patient preference and ability to comply with close monitoring
• Monitoring protocol:
  • Ultrasound every 6-12 months initially, then annually
  • Surgery if tumor grows >3 mm, develops lymph nodes, or patient preference
• Studies show <5% of small papillary cancers grow significantly during observation
• Increasingly accepted option, especially in Japan

Lymph Node Dissection

• Central neck dissection: Removal of lymph nodes around thyroid
  • Therapeutic: If central nodes are enlarged/positive - always performed
  • Prophylactic: Controversial, may be done for T3/T4 tumors or aggressive histology
• Lateral neck dissection: Removal of lymph nodes on side of neck
  • Performed if lateral neck nodes are positive
  • Comprehensive dissection of affected compartment

Surgical Complications

• Recurrent laryngeal nerve injury (1-2%): Causes hoarseness/voice changes
  • Usually temporary, permanent in <1% with experienced surgeon
  • Bilateral injury can affect breathing
• Hypoparathyroidism (transient 10-30%, permanent 1-3%): Low calcium
  • Parathyroid glands injured or removed during surgery
  • Symptoms: numbness/tingling, muscle cramps, tetany
  • Treated with calcium and vitamin D supplements
• Bleeding, infection, scarring: Standard surgical risks (<1%)

Radioactive Iodine (RAI) Treatment

I-131 therapy to destroy remaining thyroid tissue and microscopic cancer cells:

• Indications:
  • Intermediate or high-risk differentiated thyroid cancer
  • Persistent or recurrent disease
  • Distant metastases
  • NOT for medullary or anaplastic (these don't take up iodine)
• Not routinely used for:
  • Low-risk papillary microcarcinomas
  • Small, intrathyroidal, well-differentiated cancers without aggressive features
• Administration:
  • Oral capsule or liquid, single dose
  • Outpatient for low doses (<30 mCi), hospitalization for higher doses
  • Preparation requires elevated TSH (stop thyroid hormone 3-4 weeks OR use Thyrogen injections)
  • Low-iodine diet for 1-2 weeks before treatment
• Whole body scan after treatment to identify any remaining cancer
• Side effects:
  • Short-term: Neck swelling/pain, nausea, altered taste, dry mouth, sialadenitis (salivary gland inflammation)
  • Long-term: Dry eyes/mouth (10-20%), nasolacrimal duct obstruction (rare), reduced fertility (temporary in most), very small increased risk of secondary cancers with high cumulative doses

Thyroid Hormone Suppression Therapy

• All patients after total thyroidectomy require lifelong levothyroxine (T4)
• Goals:
  • Hormone replacement: Prevent hypothyroidism
  • TSH suppression: Reduce cancer recurrence risk
    • TSH stimulates thyroid cancer cell growth
    • Target TSH <0.1 mU/L for high-risk disease
    • Target TSH 0.1-0.5 mU/L for intermediate-risk
    • Target TSH 0.5-2.0 mU/L for low-risk or in remission
• Dose adjusted based on TSH levels (blood test every 6-12 months)
• Side effects of over-suppression: bone loss (osteoporosis), atrial fibrillation, anxiety

External Beam Radiation Therapy (EBRT)

• NOT routinely used for differentiated thyroid cancer
• Indications:
  • Anaplastic thyroid cancer (may be combined with chemotherapy)
  • Unresectable or incompletely resected tumor
  • Gross residual disease that doesn't take up radioactive iodine
  • Medullary thyroid cancer with high-risk features
  • Palliation for symptomatic metastases (bone pain, brain metastases)

Systemic Therapy for Advanced Disease

Differentiated Thyroid Cancer (Radioiodine-Refractory)

• Defined as: progressive disease that doesn't take up radioactive iodine OR progresses despite RAI
• Occurs in 5-10% of patients
• Targeted therapy (first-line):
  • Lenvatinib (Lenvima): Multi-kinase inhibitor, improves progression-free survival from 3.6 to 18.3 months
  • Sorafenib (Nexavar): Alternative option, slightly less effective
  • BRAF/MEK inhibitors: For BRAF V600E mutated tumors (dabrafenib + trametinib)
  • RET inhibitors: For RET fusion-positive tumors (selpercatinib, pralsetinib)
• Reserved for symptomatic or rapidly progressing disease (not all patients need immediate treatment)
• Side effects: hypertension, diarrhea, fatigue, hand-foot syndrome, proteinuria

Medullary Thyroid Cancer (Advanced)

• Targeted therapy:
  • Vandetanib (Caprelsa): RET, VEGFR, and EGFR inhibitor
  • Cabozantinib (Cometriq): RET, MET, and VEGFR inhibitor
  • Selpercatinib (Retevmo) or Pralsetinib (Gavreto): Selective RET inhibitors for RET-mutated MTC (better tolerated, more effective)

Anaplastic Thyroid Cancer

• Multimodal aggressive approach with limited success
• Surgery (debulking) + EBRT + chemotherapy
• BRAF/MEK inhibitors: For BRAF V600E mutated ATC (dabrafenib + trametinib) - can produce dramatic responses
• Clinical trials highly encouraged
• Palliative care integration from diagnosis

Follow-Up and Surveillance

Monitoring After Treatment

Goals: detect recurrence early and adjust thyroid hormone dose

Laboratory Tests

• TSH and thyroglobulin (Tg):
  • Every 6-12 months lifelong
  • Thyroglobulin is tumor marker for differentiated thyroid cancer (made only by thyroid cells)
  • After total thyroidectomy + RAI, Tg should be undetectable
  • Rising Tg suggests recurrence
  • Must check anti-Tg antibodies (interfere with Tg measurement in 10-25%)
• Calcitonin and CEA (for medullary cancer):
  • Every 6 months, then annually
  • Doubling time <6 months predicts worse prognosis

Imaging Surveillance

• Neck ultrasound:
  • 6-12 months after initial treatment
  • Then periodically based on risk (annually for high-risk, every 2 years for low-risk)
  • More sensitive than physical exam for detecting recurrence
• Radioiodine whole body scan:
  • Not routinely performed if Tg undetectable and neck ultrasound negative
  • May be done 6-12 months after RAI treatment in intermediate/high-risk patients
• CT, MRI, or PET: If recurrence suspected or high Tg with negative neck ultrasound

Dynamic Risk Stratification

Risk category changes based on response to treatment:

• Excellent response: No clinical, biochemical, or structural evidence of disease
  • Recurrence risk <1-2%
  • Less intensive monitoring, lower TSH suppression goal
• Indeterminate response: Non-specific findings, Tg detectable but low, small stable lymph nodes
  • Recurrence risk 15-20%
  • Continued monitoring
• Biochemical incomplete response: Rising Tg or positive anti-Tg antibodies without structural disease
  • Recurrence risk 20-30%
  • Close monitoring, may require additional imaging or treatment
• Structural incomplete response: Persistent/recurrent disease on imaging
  • Requires additional treatment

Managing Recurrent Disease

• Recurrence occurs in 10-30% of patients, usually within first 10 years
• Most recurrences are in cervical lymph nodes (60-75%)
• Recurrence is often still curable

Treatment Options for Recurrence

• Surgery: Preferred for localized recurrence in neck
  • Lymph node dissection
  • May be curative
• Radioactive iodine: If disease is RAI-avid
  • May cure small volume disease
  • Effectiveness decreases with repeated doses
• Active surveillance: For small, asymptomatic, slow-growing recurrences
  • Not all recurrences require immediate treatment
  • Many remain stable for years
• Ablative techniques:
  • Ethanol ablation for small lymph nodes
  • Radiofrequency ablation (RFA)
  • Less invasive than surgery for selected cases
• External beam radiation: For unresectable local recurrence
• Systemic therapy: For RAI-refractory metastatic disease

Prognosis and Survival Rates

Overall Survival by Type (5-Year Survival)

Prognostic Factors

• Age: Most important prognostic factor
  • Patients <55 years have excellent prognosis even with advanced disease
  • Mortality increases significantly in patients >60-65 years
• Extent of disease: Tumor size, extrathyroidal extension, distant metastases
• Histologic type and subtype: Papillary best, anaplastic worst
• Completeness of resection: Gross residual disease has worse prognosis
• Distant metastases: Especially bone and brain metastases
• Response to initial therapy: Excellent response has very low recurrence risk
• Molecular markers: BRAF V600E may indicate worse prognosis; TERT promoter mutations associated with aggressive disease

Living with Thyroid Cancer

Thyroid Hormone Replacement

• Take levothyroxine every morning on empty stomach (30-60 minutes before food)
• Consistent timing and adherence important
• Many medications and supplements interfere with absorption (calcium, iron, PPIs - take 4 hours apart)
• Dose adjustments needed for pregnancy, weight changes, aging
• Symptoms of incorrect dose:
  • Too low (hypothyroid): fatigue, weight gain, constipation, cold intolerance, depression
  • Too high (hyperthyroid): anxiety, palpitations, weight loss, insomnia, tremor, bone loss

Managing Hypoparathyroidism

• If permanent, requires lifelong calcium and vitamin D supplements
• Monitor calcium levels periodically
• Recognize symptoms of low calcium: tingling, muscle cramps, seizures (severe)
• Keep calcium supplements readily available

Fertility and Pregnancy

• Thyroid cancer and surgery do not affect fertility
• Avoid pregnancy for 6-12 months after radioactive iodine treatment
• Safe to become pregnant after that period
• During pregnancy:
  • Levothyroxine dose usually needs to increase by 30-50%
  • Monitor TSH every 4-6 weeks
  • Thyroid cancer rarely progresses during pregnancy
  • Surgery for cancer diagnosed during pregnancy usually delayed until after delivery
• Breastfeeding is safe on levothyroxine (NOT safe for ~1 year after radioactive iodine)

Lifestyle and Wellness

• No specific dietary restrictions (exception: low-iodine diet before RAI treatment)
• Regular exercise recommended
• Maintain healthy weight
• Adequate calcium and vitamin D for bone health (especially if on TSH-suppressive therapy)
• Manage stress and prioritize sleep
• Avoid excessive iodine supplementation (seaweed, kelp supplements)

Psychosocial Concerns

• Anxiety about recurrence common, especially around surveillance appointments
• Minimization by others ("good cancer to get") can be frustrating
• Lifelong monitoring and medication can be burden
• Support groups and counseling can help
• Most patients adapt well and report good quality of life

Frequently Asked Questions

Is thyroid cancer the "good cancer"?

While most thyroid cancers are highly curable, referring to it as a "good cancer" minimizes the real challenges patients face. Treatment requires major surgery, potential lifelong complications (voice changes, low calcium), lifelong medications, regular monitoring, anxiety about recurrence, and in some cases, radioactive iodine treatment with isolation requirements. While prognosis is generally excellent, it is still cancer and should be taken seriously.

Do I need to have my thyroid removed if I have a small cancer?

Not always. Very small papillary thyroid cancers (<1 cm) without aggressive features may be observed without immediate surgery (active surveillance). For cancers 1-4 cm that are low-risk, removing just the affected lobe (lobectomy) may be sufficient. Total thyroidectomy is recommended for larger tumors, aggressive features, bilateral disease, lymph node involvement, or patient preference. Discuss options with your endocrine surgeon.

Will I need radioactive iodine treatment?

Not all patients need radioactive iodine (RAI). It depends on your risk category. Low-risk patients (small tumors confined to thyroid without aggressive features) typically do NOT need RAI. Intermediate and high-risk patients usually benefit from RAI to destroy remaining thyroid tissue and treat microscopic disease. The decision is individualized based on multiple factors including tumor size, extent, histology, and lymph node involvement.

Can I have children after radioactive iodine treatment?

Yes. It is recommended to wait 6-12 months after RAI treatment before trying to conceive (both men and women). This allows radioactivity to clear completely and any temporary effects on fertility to resolve. After this waiting period, there is no increased risk of infertility, birth defects, or cancer in offspring. Thousands of thyroid cancer survivors have had healthy children after RAI treatment.

Will I gain weight after thyroid surgery?

Weight gain is not inevitable. If your thyroid hormone replacement dose is correctly adjusted to maintain normal TSH levels, your metabolism should function normally. Some patients gain weight in the months after surgery, often due to reduced activity during recovery or metabolic adjustment. Maintaining a healthy diet and regular exercise is important. If you experience significant weight gain, have your TSH checked to ensure proper dosing.

How often will I need follow-up appointments?

Initially every 6 months for the first 1-2 years, then annually if doing well. You'll need blood tests (TSH and thyroglobulin) and periodic neck ultrasounds. The intensity of surveillance depends on your risk category and how you respond to initial treatment. Even after many years in remission, annual or biennial follow-up is recommended lifelong.

What if my cancer comes back?

Recurrence occurs in 10-30% of patients, usually in neck lymph nodes within the first 10 years. Most recurrences are still curable with surgery, radioactive iodine, or other treatments. Even patients with distant metastases often live for many years with good quality of life. The key is early detection through regular surveillance.

Should my family members be screened?

For most thyroid cancers (papillary and follicular), routine screening of family members is not recommended unless there are multiple affected family members or a known genetic syndrome. For medullary thyroid cancer, ALL first-degree relatives should have genetic testing for RET mutations. If you have a genetic syndrome (MEN 2, FAP, Cowden), family members should be evaluated.

Can I still exercise and live a normal life?

Absolutely. Once recovered from surgery and with well-adjusted thyroid hormone levels, there are no restrictions on physical activity or lifestyle. Many thyroid cancer survivors participate in vigorous exercise, competitive sports, and all normal activities. The main requirement is taking thyroid hormone medication daily and attending regular follow-up appointments.

Is there anything I could have done to prevent this?

For most people, no. The majority of thyroid cancers occur sporadically without clear preventable causes. Avoiding radiation exposure to the neck in childhood (now rare) is the only known preventable risk factor. Having a family history, being female, or other risk factors are not modifiable. The increased detection of small thyroid cancers is largely due to improved imaging, not increasing true incidence.

Sources and References

• American Thyroid Association (ATA) Guidelines for Management of Thyroid Nodules and Differentiated Thyroid Cancer
• National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines: Thyroid Carcinoma
• American Cancer Society: Thyroid Cancer Statistics and Information
• National Cancer Institute SEER Database
• European Thyroid Association Guidelines
• American Society of Clinical Oncology (ASCO) Guidelines