The Basics of Follicular Thyroid Cancer

Cancer is an ailment that is so broad and complex that most types of it do not have a solid cure as of yet. One type of cancer that can happen, but is not commonly heard of is the follicular thyroid cancer.

What is Follicular Thyroid Cancer?

Follicular Thyroid Cancer (FTC) is described by ThyCa (Thyroid Cancer Survivors’ Association Inc.) as “differentiated thyroid cancer” meaning the cancer cells look and act like normal thyroid cells[1]. It accounts for ten (10) to fifteen (15) per cent of all thyroid cancer cases, but is only second most common thyroid-related cancer, next to Papillary Thyroid Cancer (PTC).[2]

As per the group Cancer Treatment Centers of America[3], it is found in about one in ten (10) cases and is usually found in countries with insufficient iodine in their diets. Although not as common, it is more aggressive than PTC as it can spread to other organs like bones and lungs rather that to nearby lymph nodes.

Dr James Norman wrote for EndocrineWeb that FTC affects a slightly older age group that in PTC and is also less prevalent in children.[4] It is also rare to develop this type of cancer after radiation therapy, as compared to its more common counterpart.

Causes of Follicular Thyroid Cancer

The causes of FTC and other thyroid cancers are unknown, but there are factors associated with a greater risk of developing this disease. Having a nodule that is rapidly growing is one obvious risk factor as this will almost always be malignant.

Having a low iodine diet may increase the risk of FTC, as well as poorly treated diabetes. Some doctors also think that there is a genetic predisposition to FTC, those with family members suffering from other thyroid diseases is a sign that they too could have it.

Symptoms of Follicular Thyroid Cancer

FTC usually develops slowly and in silence. The Columbia Thyroid Center has shared that most patients will not even know the cancer is present, hence foregoing treatments.[5] The closest thing to a symptom is a visible lump on the neck. Patients with very large nodules may feel and see the mass on their neck. These may compress the esophagus and trachea causing difficulty in swallowing and breathing especially when lying flat. Enlarged lymph nodes in the neck that may be of concern are those that are firm to the touch, growing and do not shrink over a period of time.

Possible treatment for Follicular Thyroid Cancer

Patients with FTC rarely need to undergo chemotherapy as there are specifically three (3) main parts of the treatment for this disease – surgery, thyroid hormone suppression, and radioactive iodine ablation.

Thyroid lobectomy (removal of the affected half of the thyroid) or thyroidectomy (removal of the entire thyroid) is strictly a personal choice for a patient suffering from FTC. Doctors can help explain the risks but statistically, patients with FTC ultimately have to have the entire thyroid removed.

After surgery, patients will be required to take thyroid hormone replacement pills, which must be maintained for their entire lives to be able to replace the hormones produced by the thyroid.

Radioactive Iodine (RAI) Ablation is the last phase of treatment wherein a RAI pill is taken by a patient to destroy all remaining thyroid cells after thyroidectomy.[6] It decreases the reoccurrence rate, but does not totally change the prognosis.

 

 

[1] Papillary and Follicular Thyroid Cancer and their variants, including Hurthle cell, tall cell, and others. ThyCa: Thyroid Cancer Survivors’ Association Inc. (Updated 2015 May 11). http://www.thyca.org/pap-fol/

[2] Thyroid Cancer. Benjamin Wedro, MD, FACEP, FAAEM. https://www.medicinenet.com/thyroid_cancer/article.htm#what_are_the_different_types_of_thyroid_cancer

[3] Types of thyroid cancer. Cancer Treatment Centers of America. (2017 January 31). https://www.cancercenter.com/thyroid-cancer/types/

[4] Thyroid Cancer: Follicular Cancer.  Norman J. (Updated 2016 July 7). https://www.endocrineweb.com/conditions/thyroid-cancer/thyroid-cancer-follicular-cancer

[5] Follicular and Hurthle Cell Thyroid Cancer. Columbia University Irving Medical Center. http://columbiasurgery.org/conditions-and-treatments/follicular-and-hurthle-cell-thyroid-cancer

[6] Treatment of Thyroid Cancer, by Type and Stage. American Cancer Society. https://www.cancer.org/cancer/thyroid-cancer/treating/by-stage.html

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