CATEGORY: HTH Health

AUTHOR: MORRIS

HED:Thyroid cancer easily treated when caught early

By M. Scott Morris

Daily Journal

A profound sense of shock settled on Terry Maxwell when she was diagnosed with thyroid cancer in 1988.

"When you hear the word cancer, it's like, 'Oh my God, I'm going to die,'" said Maxwell, a Baldwyn resident.

Maxwell survived the diagnosis, the shock wore off and treatment plans were put into motion. She had surgery on a Thursday and left the hospital Sunday, leaving behind a substantial part of her thyroid gland.

The thyroid gland creates the hormone thyroxine which regulates the body's metabolism, affecting the body temperature, heart rate, growth of hair and nails as well as influencing the brain, liver, kidneys and skin.

Maxwell now takes levothyroxine, a synthetic hormone designed to perform the same functions as thyroxine.

"I take a pill every day," Maxwell said. "I'll be doing that for a good while - for life."

Finding cancer

While no one's glad to have cancer, Maxwell is certainly happy her doctor noticed the bumps or nodules on her thyroid. Her doctor performed a simple neck check that uncovered the problem during a routine physical.

"I had just switched doctors, and my old doctor didn't check my neck," Maxwell said. "Lots of physicians forget to look at the neck during exams. Everyone should ask their doctor to check it."

Maxwell had follow-up meetings with her physician to make sure the cancer didn't return after surgery. She was pronounced cured after five years.

While the regular trips to the doctor ended, Maxwell did not let her neck go unchecked.

"From my earlier encounter with cancer, I had learned to examine my neck to watch for nodules," said Maxwell.

She found new nodules in February 1995 when she was living in Jackson and set up an appointment with an endocrinologist.

"I really wasn't expecting to have it again," she said.

Diagnosis

According to Dr. Mark Shepherd, a Tupelo endocrinologist, thyroid nodules affect one out of every 20 people.

"The good news is the vast majority of nodules on the thyroid is not cancer," Shepherd said. "That's the good news."

For every 10 people who report having bumps on their thyroid, only one or two have cancer.

"Thyroid nodules are common; thyroid cancer is rare," Shepherd said.

In order to determine if Maxwell's nodules were caused by cancer, her doctor at the time performed a fine needle aspiration (FNA). Maxwell said her doctor inserted a needle (usually smaller than a needle used to collect blood) into her neck to sample tissue around the thyroid.

"Ten years ago, if we felt a nodule it meant surgery," Shepherd said. "You used to take 10 people to surgery for every one cancer found. The (FNA) test is relatively painless and very accurate."

Maxwell said the thought of having a needle stuck into her neck was disquieting to say the least.

"I was scared. Usually, if you're scared, it makes the pain seem worse," she said. "But there was nothing. It wasn't painful."

The test came back positive, which meant another trip to the operating room for Maxwell. This time, she had surgery on a Friday and left the hospital Sunday morning.

Long-term recovery

The aftermath of Maxwell's second surgery included the ingestion of radioactive iodine, a procedure that was not prescribed after her first surgery.

Maxwell learned an interesting and helpful fact about iodine it's attracted to thyroid tissue. If thyroid cancer spreads to other parts of the body, the iodine still seeks out that tissue and the radiation kills the cancer.

Dr. Sherry Martin, who currently serves as Maxwell's endocrinologist, said the American Association of Clinical Endocrinologists endorses the use of radioactive iodine in treating the remnants of thyroid cancer. However, not all doctors and patients are comfortable with the idea.

"When you start using the word radiation, it's like, 'Whoa É what does that mean?'" Martin said. "It's a very effective strategy for treating thyroid cancer."

Maxwell, who has moved to Northeast Mississippi since her second surgery, pays Martin a visit every six months to make sure the cancer doesn't re-establish itself. Simple blood tests are used to monitor the patient's condition and to make sure they're on the proper hormone replacement dosage.

"In the first couple of years, I like to check surgery patients every six months to make sure they're getting the right amount of thyroid hormone (replacement)," Martin said. "Once we know we've got that right, we generally see patients once a year."

Martin said thyroid cancer patients should continue the yearly follow-up visits for 15 to 20 years to detect any nodule that might appear over time.

"After I had the first surgery, I didn't think it would come back," Maxwell said. "Follow-ups are very important and it's important for people to examine their necks regularly."

Clear-cut

"To us, it's one of the most clear-cut things we take care of," she said, "but we have to diagnose it first."

Shepherd said the longer the diagnosis is delayed, the more difficult thyroid cancer is to treat.

"You certainly never want to delay a diagnosis," Shepherd said. "We just hate to see patients die from a disease that's curable."

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