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Lessons to learn from Brooke Burke's thyroid cancer diagnosis

December 07, 2012

In 2012, former “Dancing with the Stars” co-host Brooke Burke, then 41, underwent thyroid surgery to remove her thyroid gland. Burke shared that though her physician found a nodule on her thyroid in an unrelated exam, she had postponed further testing until she had heard a friend's story that spurred her on to further testing.

In an article she penned, she explained: “Being a woman devoted to living a healthy lifestyle with no health concerns other than chronic fatigue and Hashimoto's, I casually blew off my doctor's recommendation to get a thyroid ultrasound after he felt a lump in my neck during my routine physical.” Finally her friend's story motivated Burke to visit her doctor again, and a thyroidectomy revealed the presence of papillary cancer in a thyroid nodule. The discovery changed her life, and the lives of countless other cancer patients who receive the same news.

Unfortunately, postponement of testing and treatment is not unusual, though the consequences can be dire. Dr. Rema Gupta explains how thyroid nodules should be cared for and how thyroid cancer is diagnosed.

What are thyroid nodules?

A thyroid nodule is an abnormal lump or growth on or within your thyroid. There may be just one, or there may be several. They can be discovered during routine exams.

How is a thyroid nodule diagnosed?

Your doctor may feel your neck during a physical exam and detect a thyroid nodule. Many times thyroid nodules are incidental findings, such as an imaging test is done for a reason unrelated to the thyroid, but the test takes a picture of the thyroid and a nodule is discovered. Thyroid hormone tests do not diagnose a thyroid nodule. Although thyroid hormone tests can be abnormal, many people with thyroid nodules will have normal blood and laboratory results and will require additional evaluations. Most nodules are benign, but it is important to have a nodule evaluated to be sure it is not one of the 5-10 percent of nodules that are cancerous.

What additional work can be done to evaluate a thyroid nodule?To determine whether a nodule may be harmful, your doctor will decide if and when further evaluation is necessary, which may include:

Ultrasound (sonogram) – technicians use a machine to show sound waves that map out a picture of the thyroid gland and any nodules contained within it. An ultrasound can show whether the nodule is solid or filled with fluid, determine its exact size, and may be used to see whether nodules are growing or shrinking.

Fine-needle aspiration biopsy – in this test, a thin needle is inserted into the nodule to remove cells and/or fluid samples from the nodule for examination under a microscope.

Thyroid scan – this is a radiation detector that scans over the neck, after a tiny amount of radioactive substance is administered, to reveal whether the nodule is functioning (producing hormones).

How is thyroid cancer diagnosed?

The steps to a cancer diagnosis are the same as those for evaluating a thyroid nodule. A fine needle biopsy can determine if a nodule is cancerous. Some nodules may be determined as cancerous after surgical removal. Normal blood tests measuring thyroid hormones does not exclude thyroid cancer.

Nodules should be checked and monitored by your doctor. Symptoms of cancerous nodules include swollen lymph nodes under the jaw, rapid growth or they may feel hard or cause pain. Cancerous nodules may cause hoarseness or difficulty with swallowing or breathing. A doctor should still evaluate nodules that aren’t causing symptoms; you may have no symptoms, but ultrasound characteristics of thyroid nodules are very important in determining recommendations for next steps. If you have had radiation treatment around the head or neck areas, especially when you were a child you should tell your doctor because this can increase your chances of having nodules and cancer.

What is the treatment for thyroid cancer?

Usual treatments include surgery and if indicated, radioactive iodine therapy. Thyroid cancers need to be removed by surgery done by a specially trained head and neck surgeon, after which radioactive iodine therapy may be needed to destroy any remaining thyroid cells. In surgery the thyroid gland is removed and possible nearby lymph nodes. Prior to surgery a formal comprehensive neck ultrasound to evaluate the neck lymph nodes guides the head and neck surgeon in their operative approach.

Following surgery and subsequent radioactive iodine therapy, patients like Burke with thyroid cancer require lifelong monitoring. The monitoring varies among patients but may include tests for thyroid function and serum thyroglobulin levels (a tumor marker), as well as radiology tests to include ultrasounds, CT scans, and radioactive whole body scans or PET scans if indicated. The tests will vary based on the type and stage of tumor.

Despite the delay in treatment, Brooke Burke's surgery was successful. Doctors were able to remove the papillary cancer and surrounding tissue was unaffected. “It was the best case scenario,” Burke said. “We’re so happy and relieved.”

If you are in a situation similar to Burke's, or believe you may be displaying signs of thyroid cancer, you are encouraged to contact a doctor as soon as possible. Left untreated, thyroid cancer can spread to other places, cause more damage and be much more difficult to treat.

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