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Thyroid Cancer

Thyroid Cancer

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Published by bryantmaroney811

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Published by: bryantmaroney811 on Oct 27, 2008
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What Is the Thyroid?The thyroid is a gland in the low, front part of the neck which produces special"thyroid hormones" necessarily for life. The thyroid gets it's "instructions" on howmuch hormone to produce by a chemical message sent from the mid-brain pituitarygland. The thyroid is located in the middle of the low neck, overlying the windpipe("trachea"). It is composed of 2 "lobes", with the lobes joined together at the lower third by by a connecting "Ithmus" and covered by cartilage, The thyroid connects tothis tough, thick cartilage, called the "thyroid cartilage". This cartilage provides somebarrier to the local spread of a thyroid cancer. The blood supply to the thyroid is fromthe "inferior" (lower) and "superior" (upper) thyroid arteries. These emanate from the"thyroid axis", which is a branch of the large "subciavian artery" coming off of theaorta from the heart. The thyroid veins that drain blood from the thyroid form anetwork ("plexus") on the surface of the organ and empty into the "jugular veins",which return it to the heart. Infections or cancer can thus be spead via thebloodstream ("hematogenously") to distant blody areas. The smallest blood vesselsare where the arteries and veins join, these are called "capillaries". The fluid portionof the blood ("serum") migrates through the walls of the capillaries to bathe-individual ceiis with oxygen and nutrients. This serum is filtered by a series of "fymph glands" ("nodes") in the neck; these tend to swell ("lymphadenopathy") wheninvaded by the spread of infections or cancer.The main hormones produced by the thyroid gland are thyroxine and calcitonin. Ahormone is a chemical produced at one location in the body (by a gland) that has it'seffects on another part of the body (like the heart or bone). Thus, a hormone is a"chemical messenger" that may,be produced either closeby or far distant to its"target tissue" area of action. Thyroxine controls the metabolic rate of the body, thatis "how fast our machine runs". It is crucial for the developing child, and without itthe child will be severely retarded ("cretin") and have stunted growth. An adultwithout any thyroxine will gradually go into a coma from too low of a metabolism.Signs that the thyroxine level is too low ("hypothyrold") include swelling in the neck(goiter), low heart rate, fatigue, getting obese, feeling of coldness, constipation andthickened hair. Conversely, signs that the thyroxine level is to high ("hyperthyrold")include a fast heart rate and palpitations, sweating, lots of energy, being thin, feelingof being hot, and diarrhea. Ideally people should be "euthyrold", meaning neither toomuch nor too little hormone is being produced. You can see that the thyroidhormone level must be tightly controlled for us to feel normal, and the pituitary glandin the brain does this bysensing the rate of metabolism and putting on "thyroidstimulating hormone" (TSH) which regulates the thyroid's production of thyroxine.Fortunately, even if the thyroid completely fails and no thyroxine is produced, it canbe artificially replaced by taking a daily pill (levothyroxine). Thus the patient can still
lead a normal life and not go into a coma ("myxedema") from lack of this crucialhormone. Too much thyroid hormone can be controlled by chemically or radioactively destroying ("ablating") part of the thyroid to limit it's production ohormone. Thus, medical science is good at adjusting the thyroxine level if the body'sregulation of it malfunctions.The other critical hormone produced by different glands within the thyroid (called the"medullary glands") is calcitonin. This hormone regulates the calcium level in theblood. It's release causes the blood calcium to go down as it is deposited into thebones. Older individuals with severe bone thinning may benefit from calcitonininjections ("Calcimar") to which builds up the cortex (hard portion) of the bones.Blood calcium must be maintained within a narrow balance or the patient will firsthave abnormal reflexes, be very fatigued, and eventually go into a coma. Its intricatefunctions in governing proper metabolism make the thyroid a gland basic for life. It isfortunate that medical science can fairly well replace thyroid function withmedications.What Is Thyroid Cancer?The thyroid, like other body organs, goes through a rapid development stage as wegrow from infancy to adulthood. The thyroid cells grow and produce their hormonesin a tightly controlled manner. In the adult, thyroid cells only divide to replace thoselost through old age or injury. Thyroid cancer starts In just one cell. Something goesawry in the internal workings of this cell; in it's "genes". The genes contain thegenetic information that controls the cell; they may be influenced by outsidehormones. With specific types of gene damage, the cell starts dividing out of control,forming a tumor. A tumor simply means a swelling, and is not necessarily cancer. Abenign tumor only grows in it's local area (although it can become very large); it isnot cancer. However, a malignant tumor can spread ("metastasize") to other bodyareas and Is cancerous. It is this ability for malignant tumors to spread to other vitalorgans, and disturb their functioning, that makes cancer dangerous.How Common Is Thyroid Cancer?Each year in the U.S.A. there are 15,600 new cases of thyroid cancer causing 1,200deaths. Thyroid cancer accounts for just 1.5% of new cancers in the U.S.A. Womenare affected more than men three cases to two. The risk increases with age, theaverage patient is 50 years old. Thyroid cancer is rare in people younger than 30.Thyroid cancer is more common in people of Asian extraction,and the number of cases has Increased worldwide over the past decade.What Causes or Increases the Risk for Thyroid Cancer?Like any cancer, why any one person develops the disease and another does notremains unknown. However, several factors have been noted to Increase risk for thyroid cancer by studying groups of patients; these are called "risk factors":
1) Goiter simply means an enlarged thyroid gland. It can be either generally big or  just have separate areas of enlargement (nodules). It the pituitary gland in the brainmakes too much TSH, then the thyroid will enlarge. Goiters can be present at birthor develop later in life. Iodine is necessary for the the thyroid to make it's hormonesand with iodine insuff iciencency, a goiter will develop as the brain tries to stimulatethe thyroid to make it's crucial hormones. In general, having a goiter increases therisk of thyroid cancer. In animals, thyroid cancer has been produced by severeiodine restriction, giving lots of TSH, and "goiterogen" foods (such as cabbage andrapeseed oil) that stimulate goiter.2) Nodules of the thyroid are simply "bumps" or uneven areas of enlargement. Itthere are many nodules, the thyroid may enlarge ("multinodular goiter"). About 4%of the American population has thyroid nodules. Clinically speaking, a lump is calleda "nodule" If it is more than 1 cm. (1/2") in size. While any growing nodule in thethyroid is suspicious for cancer, most are benign. Nodules may be either "hot"(function to produce thyroid hormone), "cold" (don't function to make hormones) or "warm" (make a little hormone, but not much). Over 90% of thyroid nodules are "OK.Even though a "cold" nodule Is more likely to be cancerous than a "hof'one, only 10% of cold nodules are cancerous. A single nodule is more likely to be cancer thanmultiple nodules, Larger nodules (over 5 cm. or -2 inches) are more likely to becancerous than small ones. A "cold" nodule in a male under 30 years old isparticularly worrisome for cancer. Nevertheless, all suspicious nodules should bechecked for cancer!3) Radiation Exposure is a risk factor for developing thyroid cancer. Radiationcauses changes in the genes of the thyroid cells, and increases the chance for nodules. Young people (under 30 years old) who get radiation to the neck area areat highest risk. Some young Japanese who survived the atomic bomb later developed it. Radiation is linked to slow growing thyroid cancer that often takes 10 -30 years after the exposure to become apparent. Radioactive lodine-1 31 used for to destroy (ablate) thyroid tissue for treatment of hyperthyroldism has not beenlinked to later development of cancer.4) Family History of thyroid cancer in first degree (close) relatives or rare familial5) Genetic diseases like "multiple endocrine neoplasia" ("MEN" syndrome) raisesthyroid cancer risk. Twenty percent of thyroid cancer patients have a family historyof goiter. Goiter was much more common in the "Goiter Belt" (Midwest) of the U.S.A.prior to salt being "iodized".Chronic Infections or Inflammation of the thyroid, as from Hashimoto's Thyrolditis(an "auto-immune" disease where the body's own Immune system turns agains thethyroid tissue) increase cell division in the thyroid. The more often cells divide, themore likely a change ("mutation") will arise in its genes, and certain mutationspresage cancer. Anything that irritates the thyroid gland over time will increasecancer risk.

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