CARE OF PATIENTS

WITH CANCER OF

THE THYROID
Thyroid cancer
• Thyroid cancer occurs in the cells of the thyroid — a butterfly-shaped gland
located at the base of your neck, just below your Adam's apple. Your thyroid
 produces hormones that regulate your heart rate, blood pressure, body
temperature and weight.

• Thyroidcancer might not cause any symptoms at first. But as it grows, it can
cause pain and swelling in your neck. Several types of thyroid cancer exist. Some
grow very slowly and others can be very aggressive. Most cases of thyroid cancer
can be cured with treatment.

• Thyroidcancer rates seem to be increasing. Some doctors think this is because

new technology is allowing them to find small thyroid cancers that may not have
been found in the past. Risk factors include: of the female gender, exposure to
high levels of radiation and certain inherited genetic syndromes.

Types of Thyroid Cancer

• Thyroid cancer is classified into types based on the kinds of cells found in the tumor. Your type
is determined when a sample of tissue from your cancer is examined under a microscope. The
type of thyroid cancer is considered in determining your treatment and prognosis.
Types of Thyroid Cancer
Papillary Thyroid Cancer
• Themost common form of thyroid cancer, papillary
thyroid cancer arises from follicular cells, which produce
and store thyroid hormones. Papillary thyroid cancer can
occur at any age, but most often it affects people ages 30
to 50. Doctors sometimes refer to papillary thyroid cancer
and follicular thyroid cancer together as differentiated
thyroid cancer.
Follicular Thyroid Cancer.
• Follicular thyroid cancer also arises from
the follicular cells of the thyroid. It usually
affects people older than age 50. Hurthle
cell cancer is a rare(3% to 5% of all thyroid
 cancer types) and potentially more
aggressive type of follicular thyroid cancer.
Anaplastic Thyroid Cancer
• Anaplastic thyroid cancer is a rare type of
thyroid cancer that begins in the follicular cells.
It grows rapidly and is very difficult to treat.
Anaplastic thyroid cancer typically occurs in
adults age 60 and older.
Medullary Thyroid Cancer
• Medullary thyroid cancer
begins in thyroid cells called C
cells, which produce the
hormone calcitonin. Elevated
levels of calcitonin in the blood
can indicate medullary
 thyroid cancer at a very early stage.
Certain genetic syndromes increase
the risk of medullary thyroid
cancer, although this genetic link is
uncommon.
Other Rare Types
• Othervery rare types of cancer that start in the
thyroid include thyroid lymphoma, which begins in
the immune system cells of the thyroid, and
thyroid sarcoma, which begins in the connective
 tissue cells of the thyroid.
PATHOPHYSIOLOGY
• It's
not clear what causes thyroid cancer. Thyroid cancer
occurs when cells in your thyroid undergo genetic
changes (mutations). The mutations allow the cells to
grow and multiply rapidly. The cells also lose the ability
to die, as normal cells would. The accumulating abnormal
thyroid cells form a tumor. The abnormal cells can invade
 nearby tissue and can spread (metastasize) to other parts
of the body.
ASSESSMENT
Subjective Cues Objective cues

• Fatigue • Weight loss due to the caloric needs of the tumor, taking away
• Loss of appetite from the needs of the body.
• Generalized • Anorexia.
weakness • A lump (nodule) that can be felt through the skin on your neck
• Pain in your neck • Changes to your voice, including increasing hoarseness •
and throat Swollen lymph nodes
• Difficulty
swallowing
MEDICAL MANAGEMENT
PHYSICIAN’S ORDER
SPECIAL NOTATION
•• Surgical removal of
affected area of the
thyroid, (thyroid
lobectomy)
•• Thyroidectomy
•• Lymph node dissection
•• Radiation therapy to decrease tumor size. • • Oxygen
therapy to supplement the needs of the body.
•• High-protein, high-calorie diet to meet the needs of the
body.
Laboratory /diagnostic examination
•• CT scan or MRI shows mass
•• Biopsy will show cell type:

•• Needle biopsy through thyroid tissue for peripheral tumors. • •

Ultrasound of the the thyroid

•• Thyroid panel T3,T4 and calcitonin

•• Thyroid Stimulating Hormone (TSH) Test

•• Radioiodine scan

•• Positron emission tomography (PET) scan

Medication
•• Chemotherapy often with a combination of drugs: • •
cyclophosphamide, doxorubicin, vincristine, etoposide, cisplatin • •
may see relapse after treatment

• • Administer antiemetics to combat side effects of chemotherapy: •

• ondansetron, prochlorperazine

• • Administer analgesics for pain control:

•• morphine, fentanyl
• •thyroid hormone replacement therapy: levothyroxine
•• radioactive iodine

• IV Fluid – as ordered

Nursing Care Plan

 Nursing Intervention Evaluation
Diagnosis

Risk for Assess for dyspnea, stridor, “crowing,” and cyanosis. Client will maintain
Ineffectiv Note quality of voice. a patent airway,
e Airway Monitor respiratory rate, depth, and work of with aspiration
Clearance breathing. Caution patient to avoid bending neck; prevented.
support head with pillows.
Assist with repositioning, deep breathing
exercises, and/or coughing as indicated.
Suction mouth and trachea as indicated, noting color
and characteristics of sputum.
Check dressing frequently, especially the
posterior portion.
Investigate reports of difficulty swallowing, drooling
of oral secretions.
Keep tracheostomy tray at the bedside.
Provide steam inhalation; humidify room air.
Assist with procedures: Tracheostomy, return to surgery.