The diagnosis of thyroid cancer is usually not difficult and is made by a needle biopsy or sometimes open surgery
biopsy. In a patient with a thyroid lump, suspicion of cancer arises when there is a change in the voice (as the
voice nerve runs intimately behind the thyroid gland and can be invaded by cancer), a feeling of the lump being
fixed to the neck structures, or an association with a neck swelling, such as a lymph node.
Having established the diagnosis of thyroid cancer, the main treatment of such cancers will be a complete surgical
removal of such a mass. A common question from patients who have done their own research about the cancer and the
risk of surgery would be: "Doc, will I be able to talk after surgery?" One of the risks of thyroid surgery is that
of voice impairment or even breathing difficulties. Good surgical technique is vital to preserving the integrity of
the laryngeal nerves. There is also the need to preserve the calcium balance hormone glands (known as parathyroid
glands) as a failure to preserve sufficient parathyroid tissue will lead to a long term need for oral calcium
Our young mother who had thyroid cancer underwent a successful total removal of the thyroid and also the removal of
some of lymph glands of the neck. Fortunately, there were no complications from the surgery. She was then informed
about the next phase of the treatment: radiation therapy in the form of an oral dose of radiation-tagged iodine six
weeks after the surgery.
The young mother’s main concern was if the radiation would affect her baby. Radio-iodine remains in the body for
about 2 weeks, so a period of physical separation is crucial in order not to place the baby at risk.
The treatment of thyroid cancer is well studied and the tri-modality treatment protocol of surgery, radio-iodine
and suppression of cancer regrowth by thyroxine is the cornerstone of thyroid cancer treatment. There are
situations where the use of external beam radiation is required but this is uncommon – it is usually reserved for
large invasive cancers or poorly differentiated grade of thyroid cancers.
A year from her first radio-iodine treatment, our young mother was told that the blood test suggested that there
were still some cancer cells that needed to be dealt with. Consequently, she underwent another round of radiation
isolation. Two years after the second radiation treatment, with the doctor’s encouragement, the young mother is
ready for baby number two.
A study I conducted of 150 Singaporean thyroid cancer patients revealed that thyroid cancer survivors have a good
(near normal) quality of life. In particular, having a vocation and family support were directly related to
avoiding this sense of “helplessness” after cancer diagnosis.
In summary, thyroid cancer is in general a very treatable disease. Although thyroid cancers usually do not have
early warning signs, the diagnosis is not difficult to establish. The treatment results are excellent if the
tri-modality of surgery, radio-iodine and thyroid hormone intake is done well. She remainswell today. Her second
child is preparing for PSLE and the elder is in the ninth Grade.
DR Luke Tan is an ENT - Head and Neck Surgeon in Private Practice at Mount Elizabeth Medical Centre, with a special
interest in thyroid, head and neck cancers. He obtainedspecialist training in head and neck cancer surgery at the
University of Texas Medical Branch. He holds adjunct Associate Professorship and was the former Head of the
University Department of ENT - Head & Neck Surgery at National University Hospital Singapore.