PRESS RELEASE

UNDERSTANDING THYROID CANCER

Thyroid cancer may have a low incidence rate worldwide but here in the Philippines it is
the 7th leading form of cancer among Filipinos with an estimated 3,024 new cases in
2012.
According to the World Health Organizations International Agency for Research, in 2012
the country has recorded at least 865 deaths due to thyroid cancer, which accounts for the
1.5 percent of cancer related deaths, and in five years new thyroid cancer cases will reach
to 11,280 each year.
Though it can occur in any age group, thyroid cancer is most common among women
between 20 to 44 years old. It is three times more common in females than in males and
its aggressiveness significantly increases at age 30 and in older patients1.
Importance of early diagnosis and treatment
Thyroid cancer is a malignant growth of tumor in the thyroid gland. The thyroid is a
small, butterfly-shaped gland located at the front of the neck right below the throat. The
thyroid gland secretes thyroxine, a hormone responsible for the regulation of metabolic
rate, blood sugar, heartbeat and renal functions.
According to the Thyroid Cancer Association, Inc., (TCAI), Many patients, especially in
the early stages of thyroid cancer, do not experience symptoms. However, as the cancer
develops, symptoms can include a lump or nodule in the front of the neck, hoarseness or
difficulty speaking, swollen lymph nodes, difficulty swallowing or breathing, and pain in
the throat or neck.
Although thyroid cancer is generally slow-growing and curable,2,3 up to 30% of patients
can still experience recurrence4. Together with early diagnosis and appropriate treatment,
life-long compliance to follow-up is critical to detect persistent and recurrent disease.5
There are different types of thyroid cancer, the most common being the Papillary variant,
which accounts for around 80% of cases. The other types are Follicular (around 10% of
cases), Medullary (around 4%) and Anaplastic (2%).6
Disease management
The primary treatment for thyroid cancer is thyroidectomy, which is the surgical removal
of the thyroid gland.
After the removal of the thyroid, to effectively wipe out remnants of cancer tissues and
any other thyroid gland tissue, doctors usually advise radioactive iodine (RAI) treatment.

To effectively monitor for persistence and recurrence of disease, patients undergo followup using Thyroglogulin (Tg) blood tests, neck ultrasound tests and diagnostic RAI wholebody scans.6
It must be noted that since patients already have the thyroid gland removed, the body will
no longer produce thyroid hormones, hence patients will need thyroid hormone
replacement therapy with levothyroxine to prevent hypothyroidism for the rest of their
lives, in order to compensate for the loss of thyroxine in their bodies.7
However, in preparation for procedures involving RAI (treatment and diagnostic wholebody scan), doctors require patients to undergo thyroid hormone withdrawal (THW), or
the suspension of levothyroxine, in order to elevate levels of thyroid stimulating hormone
or TSH. Elevated levels of TSH enables effective absorption of RAI in the thyroid bed.
RAI destroys remnant tissues and is useful in monitoring for cancer tissue recurrence
THW for patients usually takes 4-6 weeks.5
With the absence of a national consensus across the different healthcare professionals
involved in thyroid cancer management, approaches in the care of patients vary per
institution and per clinic. Hence, standardized and optimized treatment8 might not be
offered to all thyroid cancer patients.
HYPOTHYROIDISM
Symptoms to watch out for during THW9
Aside from health consequence, hypothyroidism may affect a patients life in different
ways work performance, decision making, self-image, social activities, and the long
term effect on the patients body.
The most common symptoms to watch out for are:
Physical
- Less energy, fatigue
- Cold intolerance
- Drier skin and coarser hair
- Mild weight gain (5-20 lbs)
- Puffiness around the face (especially the eyes), hands, ankles, due to fluid build
up
Mental
- Slower mental function, irritability
- New or worsening depression
Cardiovascular
- Slowing of heart rate
- Slightly higher blood pressure
- Higher cholesterol levels
Hypothyroidism does not just cause symptoms; it can make other health conditions
worse.

Treatment options
To avoid the consequences of hypothyroidism, patients have the option to use synthetic
TSH* to keep them on levothyroxine thus preventing the symptoms and complications
caused by hypothyroidism4,5,10. The effect of synthetic TSH is the same as the natural
elevation of TSH following THW. It can stimulate remnant thyroid cells (whether normal
or malignant) and to absorb iodine that is found in the blood stream, including RAI.11
Patient support
*Synthetic TSH is a prescription medicine which can only be given by a doctor after
assessments are done to patients in order to determine disease condition, suitability and
other relevant factors.

Captions:
Photo A
Dr. Roberto Mirasol, a well-respected endocrinologist, and the Chief of the Section of
Endocrinology, Diabetes and Metabolism at St Luke's Medical Center poses with thyroid
cancer survivor Janis Franchesca Celicious. Mirasol shares his knowledge about thyroid
cancer, available treatment options, and hypothyroidism during a press conference held
recently in Manila. Mirasol is also the Chief of the Section of Endocrinolgy, Diabetes and
Metabolism at the Manila Doctors Hospital and the Head of the Diabetes and Thyroid
Clinic at the Rizal Medical Center. Meanwhile, Celicious also shares with the media the
ordeal she went through when she was diagnosed with thryroid cancer, and how she
survived and triumph over her illness.
Photo B
Members of the Philippine Thyroid Cancer Survivor Inc. pose for a photo op in one of
the gatherings they usually hold to show its support to its members who are undergoing
treatments for thyroid cancer or its symptoms.

References:
1. GLOBOCAN 2012 (IARC) Section of Cancer Information
2. American Cancer Society. What Is Thyroid Cancer? Atlanta: American Cancer
Society; 2008. Available at: http://www.cancer.org
3. American Cancer Society. What Are The Key Statistics About Thyroid Cancer?
Atlanta: American Cancer Society; 2008. Available at: http://www.cancer.org
4. NCCN Clinical Practice Guidelines in oncology Thyroid Carcinoma Version
2.2013. In: US NCCN, ed.; 2013
5. Cooper DS et al. Thyroid 2006;16(2):10942
6. http://www.cancer.org/cancer/thyroidcancer/
7. Roberts CG, Ladenson PW. Hypothyroidism; Lancet 2004;363:793-803
8. Cherie Mae Sison, et al. UP-PGH Clinical Practice Guidelines for the
Management of Well-Differentiated Thyroid Carcinoma; JAFES 2012;27(1): 4950
9. Hypothyroidism: A Booklet for Patients and Their Families; American Thyroid
Association, 2013
10. Chow SM, Au KH, Choy TS, et al. Health-related quality-of-life study of patients
with carcinoma of the thyroid after thyroxine withdrawal for whole body
scanning. Laryngoscope 2006; 116:2060-2066.
11. Thyroid. 2008 July ; 18(7): 687694. doi:10.1089/thy.2008.0162