Your Story is Not Over

At this stage you should feel great that your cancer has been treated. Most thyroid cancer, once treated, does not recur. But, to make sure your success story remains a happy one, it is critical that active surveillance is not neglected. There are three main tasks to look after:

  1. monitor for recurrence
  2. appropriately replace or supplement thyroid hormones
  3. involve your family and friends

What can you do?

  • make sure you keep your follow up appointments! 
  • do periodic checks of your neck
  • let your doctor know how you're feeling - thyroid hormone needs change over time!
  • ask your PCP to do neck exam during routine physicals
  • know where you are in your follow up plan! 

Your follow up appointments should be boring! No interesting findings means no cancer! But don't mistake routine for unnecessary. Regardless of stage, there are recurrences - so don't miss your follow ups! 

1. How is a Thyroid Cancer Patient Followed?

Monitoring for cancer recurrence is done by several methods. First, physical exam of the neck is a basic part of every exam. Ultrasound is extremely useful and will likely be done on a scheduled, periodic basis. Ultrasound also is a great tool for the unexpected findings and one of the first ways to investigate a suspicious area. Thyroglobulin - a protein made by thyroid tissue - can be followed by use of a simple blood test. This will be drawn periodically and is useful as a marker for recurrence. Some patients have antibodies against thyroglobulin, which will make thyroglobulin levels more difficult to interpret. Sometimes these antibodies will lead to a falsely low level of thyroglobulin. 

2. Getting Thyroid Hormone Levels Right

If your thyroid was removed

You need the right level of thyroid hormone! Is it better to have too much or too little? The answer is neither! Both too much (hyperthyroidism) and too little (hypothyroidism) will make you feel bad. But in markedly different ways. To feel good and function normally you need the right amount. This has to be balanced with the goals of your thyroid cancer follow up plan. Some patients at higher risk of recurrence will be maintained on the higher side of normal or even slightly hyperthyroid. Know your individual plan and help your doctor by sticking to that plan! 

What if You still have part of Your thyroid?

If you did not have a total thyroidectomy then you likely have some functional thyroid. That's great and in most cases the remaining thyroid will do the job of supplying your needs. However, that's not true in all cases. Some patients will see a drop in thyroid hormone production even though one side was not operated on. Others may see their thyroid levels drop over time because of underlying disease. A good example of this is Hashimotos' thyroiditis. In this disease, it is common to see hormone levels drop over time as lymphocytic infiltration damages the remaining thyroid. As Hashimoto's is the most common thyroid disorder in the US and has higher rates of thyroid cancer, this situation is not uncommon. 

3. Involve your family and friends!

Many forms of thyroid cancer have genetic or familial connections. Your family may be at higher risk for thyroid cancer. Talk with your doctor about their risks and make a plan to have them screened. Like all cancers, thyroid cancer prognosis is better the earlier it is identified and treated! 

But what about those friends? Well, there's no risk of friend to friend transmission. But, friends can often help identify when your thyroid hormone levels are off. Acting anxious, nervous, or complaining of being hot all the time? You may be hyperthyroid! Your friends may notice your withdrawn or seem to be tired all the time. You may be hypothyroid or depressed (or both). Even with normal thyroid levels, it is not uncommon for cancer patients to become depressed - even after successful treatment. So, if your friends say you're not acting like yourself - take it seriously and check in with your doctor. I can't help what I don't know about!