Thyroid cancer: ask an expert

Written by: Mr Jonathan Bernstein
Published: | Updated: 15/02/2021
Edited by: Cal Murphy

In this article, top thyroid cancer surgeon Mr Bernstein explains the basics of thyroid cancer.

What is the thyroid?

The thyroid is a butterfly-shaped endocrine gland located in the middle of the neck. It is responsible for making thyroid hormone, which is essential for regulating the body’s metabolism.

Most thyroid nodules are benign and not of concern, but cancer of the thyroid gland has been getting more common, probably because of increased detection with imaging. The majority of this increase is accounted for by small, low-risk papillary thyroid carcinomas. Thyroid cancer can also occur in more advanced forms, with a firm mass in the neck or with spread to lymph nodes.


Thyroid cancer: 4 top facts

  1. Thyroid cancer is three times more common in women than men.
  2. There are four main types of thyroid cancer: papillary (most frequent), follicular, medullary and anaplastic (least frequent). Lymphoma can also occur in the thyroid but this is very rare.
  3. Thyroid cancer can be more aggressive over the age of 55.
  4. Thyroid cancer accounts for over 3% of all new cancer diagnoses each year.


Four types

  1. Papillary thyroid carcinoma – 8 out of 10 thyroid malignancies are papillary thyroid carcinoma. Most papillary thyroid carcinoma is low-risk. When solitary and under 4 cm, this form of thyroid cancer can sometimes be treated by only removing the affected half of the thyroid gland. It is important to tailor the treatment to the individual.
  2. Follicular thyroid carcinoma – 1 out of 10 thyroid cancers are follicular carcinoma. This and the Hurthle cell carcinoma variant can be higher risk.
  3. Medullary thyroid carcinoma – This type of thyroid cancer usually occurs sporadically, but medullary carcinoma can run in families and can be part of a condition called MEN type II.
  4. Anaplastic thyroid carcinoma – This is a fast-growing and very aggressive form of thyroid cancer, accounting for less than 1% of thyroid cancers.

Lymphoma can also be found in the thyroid. Lymphoma is a cancer that develops in the lymph system (part of the immune system).


What are the causes of thyroid cancer?

Usually there is no cause to be found for thyroid cancer; thyroid cancer is usually spontaneous. The incidence is much higher in women than in men. The risk factors associated with thyroid cancers include radiation exposure, a family history of thyroid cancer in a first-degree relative, and certain rare syndromes, such as Cowden syndrome.


What are the symptoms of thyroid cancer?

Most thyroid cancer, and low-risk papillary thyroid carcinoma in particular, cause no symptoms. Thyroid cancer symptoms can include:

  • A firm lump around the middle of the neck which moves upwards on swallowing
  • Firm lumps in the outer neck
  • Weakness of the voice lasting more than several weeks

The keys to diagnosis are ultrasound and fine needle aspiration cytology (biopsy). Sometimes a contrast-enhanced CT scan is needed because CT can show more extensive disease very clearly. Radioactive iodine therapy is frequently an essential part of treatment, and radiotherapy can be needed in certain more advanced cases.

Where can I go for thyroid cancer treatment?

The Cromwell Hospital Thyroid MDT in Kensington has particular expertise in all aspects of treatment of all forms of thyroid cancer. The team deals with all patients with early to advanced disease, diagnostics, and second opinions.

If you would like to see Mr Jonathan Bernstein at the Cromwell Hospital, the Wellington Hospital or Imperial Private Care as a private patient, you can arrange to be seen by calling the contact numbers given on his Top Doctors profile page

By Mr Jonathan Bernstein
Otolaryngology / ENT

Jonathan Bernstein is a Consultant ENT Surgeon specialising in head and neck surgery, thyroid surgery as well as all routine ear, nose and throat conditions. From London originally, he qualified at Bristol in 2002 and finished Calman specialist training in 2013. In Toronto, he elected to undertake a 3-year advanced fellowship programme in head and neck surgical oncology, reconstructive microsurgery and thyroid/parathyroid surgery at University Health Network and Mount Sinai Hospital, one of the three largest such programmes in North America.

Mr Bernstein is an honorary clinical senior lecturer at Imperial College London. He completed a 2-year period of translational research in head and neck cancer and was granted a medical doctorate (MD) by the University of Manchester. He has published and presented his research internationally on clinical outcomes in thyroid cancer, surgical technology, biomarkers, and functional MRI.  He has also published on other areas of ENT including BMJ Clinical Evidence guidelines and a Cochrane Review.

As well as ENT in general, his surgical interests include, salivary gland surgery (parotid/ submandibular), head and neck cancers (neck, mouth, throat), thyroid surgery and reconstructive techniques.

In your consultation with Mr Bernstein, he will discuss with you your opinion and preference, your health and medical history, and treatment options.

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