Thyroid Cancer

Thyroid gland – also called simply the thyroid. It is located in front of the neck it looks sort of butterfly
with one wing each side of the neck. The thyroid is important in many ways for keeping your body
healthy. It sends out certain chemicals or hormones that help control many activities in the body such as
breathing and pumping blood. The thyroid helps children bodies as they grow up including getting taller
and putting on muscle, it helps control weight and is also involved in other functions. The primary
function of thyroid gland is to secrete 2 hormones: triodothyronine or t3 horm or thyroxine horm or t4
hormone. Both t3 and t4 hormones play a very important role and affect almost every tissue in the
body.

2 main types of thyroid cell

- Follicular cell – used iodine from the blood to make thyroid hormone which helps a person to
regulate metabolism. HavinG too much hormone will lead to hyperthyrodism it can cause a fast
irregular heartbeat, trouble sleeping, nervousness, anger, weight loss and feeling of being too
warmed. Having too little hormone or hypothyrodism causes a person to slow down feel tired
and gained weight. The amount of thyroid hormone released by the thyroid is regulated by
pituitary gland at the base of the brain, which makes a substance called thyroid stimulating
hormones.
- C cells (also called parafollicular cells) – make calcitonin a hormone that helps conyrol how the
b ody uses calcium. Other less common cells in the thyroid gland include immune cell (system
cell) or the lymphocytes and supo=portive (stromal cells)

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.

It 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 other can be very aggressive. Most cases of
thyroid cancer can be cured with treatment. Thyroid cancer 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.

1. Papillary Thyroid Cancer – Papillary carcinoma/Papillary Adenocarcinoma

The most 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.
About 8 out of 10 thyroid cancers are papillary cancers this cancer tends to grow very slowly and usually
developed in one lobe of the thyroid gkand. Even though they grow slowly, papillary camcer often
spread to lymph nodes in the neck, even when this cancer have spread to the lymph nodes they can
often be treated successfully and rarely fatal.

2. 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 and potentially more aggressive type of follicular thyroid
cancer.

It is the Next most common type that makes up to 1 out of 10 thyroid cancer. It is more common in
countries where people don’t get enough iodine in their diet. This cancer usually do not spread to lymph
nodes but they can spread to other parts of the body such as the lkungs or bones. The prognosis for
follicular cancer is not quite as good as the papillary cancer although it is still very good in most cases.
 3. Anaplastic Thyroid Cancer - Anaplastic Carcinoma/ Undifferentiated Carcinoma

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.

It is called undifferentiated because the cancer cells do not look very much like normal thyroid cells

4. 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 this cancer although this genetic linked is
uncommon.

- Other very 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.

Factors that may increase the risk of thyroid cancer include :

• Female sex – occurs more often in women than men

Exposure to high levels of radiation.

Certain inherited genetic syndromes. – includes familial medullary thyroid cancer, multiple
endocrineoneoplasia, cauden’s syndrome and adenomatous folic foci

CLINICAL MANIFESTATION • A lump (nodule) that can be felt through the skin on your neck •
Changes to your voice, including increasing

hoarseness • Difficulty swallowing Pain in your neck and throat Swollen lymph nodes in your neck
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

Fatigue Loss of appetite Generalized weakness Pain in your neck and throat Difficulty swallowing

Objective Cues

Weight loss due to the caloric needs of the tumor, taking away

from the needs of the body. • Anorexia. • A lump (nodule) that can be felt through the skin on your
neck . Changes to your voice, including increasing hoarseness

Swollen lymph nodes

SPECIAL NOTATION

Surgical removal of affected area of the thyroid,

(thyroid lobectomy) . .

Thyroidectomy – surgical removal of all part of thyroid gland. Used in goiter and overactive thyroid
or hyperthyroidism. Complications: hypocalcemia, airway obstruction due to compressing
hematoma and tracheomalasia, recurrent laryngeal nerve injury and wound infection.

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.

Thyroid hormone therapy – this is a therapy that is followed by the removal of the thyroid gland.
Involves prescribing thyroid hormones medication for lifelong for providing the missing hormone
produced by the thyroid gland

Radioactive iodine – this procedure involves large doses of iodine that is radioactive in a form of a
pill. The radioactive iodine will pass out through urine however during this time patient are
recommended to avoid close contact to other family members.

Chemotherapy – this involves cancer treatment with the help of varied chemicals and drugs.
 Laboratory/Diagnostic Examination
CT scan or MRI shows mass – x-ray test that makes detailed cross-sectional images of your
body. It can help determine the location and size of thyroid cancer, and whether they have
spread nearby areas. Although ultrasound is the test of choice, a CT scan can also be used to
look for spread for distant organs such as lungs
Biopsy will show cell type:
Needle biopsy through the stomach tissue for peripheral tumors.
Ultrasound of the thyroid
Thyroid Panel t3 , t4 and calcitonin – main hormone of thyroid gland
TSH – used to detect how well the thyroid is
Radioiodine
Positron emission tomography (PET) scan

Medication:

Additional: levothyroxine (Synthroid)-Levothyroxine is a medicine used to treat people with

hypothyroidism.is also used to prevent or treat a goiter (an enlarged thyroid gland) or with other
therapies to treat thyroid cancer. This drug is a hormone, which works by replacing thyroid hormone
that your body normally produces.

NCP

Nursing Diagnosis: Risk for Ineffective Airway Clearance

Intervention:

Assess for dyspnea, stridor, crowing," and cyanosis.

Patent airway, with Monitor respiratory rate, depth, and work of breathing
aspiration prevented. Caution patient to avoid bending neck; 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.

Eval: Note Client will maintain a quality of voice.