Thyroid Cancer Care — Dr. Bidhan Koirala

🦋

What is Thyroid Cancer?

Cancer arising from the thyroid gland — the butterfly-shaped gland in the front of the neck
Papillary thyroid cancer (PTC) — most common (85%), excellent prognosis
Follicular thyroid cancer (FTC) — 10%, spreads via blood, still very treatable
Medullary thyroid cancer (MTC) — 3–4%, can run in families (RET mutation)
Anaplastic thyroid cancer (ATC) — rare but aggressive, requires urgent multimodal care

⭐ 90%+ of thyroid cancers are papillary or follicular — both carry an excellent long-term prognosis with proper treatment.

🔎

Symptoms — When to See a Doctor

A painless lump or swelling in the front of the neck
Voice change — hoarseness or persistent voice alteration
Difficulty swallowing (dysphagia)
Difficulty breathing or stridor (high-pitched sound on breathing)
Neck lymph node enlargement that persists beyond 2–3 weeks
Pain in the front of the neck occasionally radiating to ears

💡 Many thyroid cancers are painless in early stages and discovered incidentally on routine neck ultrasound. Don't wait for pain — a persistent lump always needs evaluation.

🗺️

Your Care Pathway — Step by Step

🔍

Step 1

Clinical Exam

Neck palpation, voice assessment

📡

Step 2

Ultrasound

TI-RADS scoring of nodule

🧫

Step 3

FNAC

Bethesda cytology report

🎙️

Step 4

NPL / Laryngoscopy

Vocal cord mobility check

🖥️

Step 5

CT / MRI

Advanced cases: check invasion

✂️

Step 6

Surgery

Hemithyroidectomy or Total

🔬 After surgery, histopathology confirms final diagnosis and staging (pTNM). RAI, TSH suppression, or radiation is decided based on this report.

🔬

Diagnosis in Detail

Ultrasound (TI-RADS) — First-line imaging; scores nodule risk from 1 (benign) to 5 (highly suspicious); guides biopsy decision
FNAC (Fine Needle Aspiration Cytology) — Bethesda I–VI classification determines next steps: observation, repeat, or surgery
NPL / Flexible Laryngoscopy — Checks vocal cord mobility before surgery; crucial baseline for recurrent laryngeal nerve monitoring
Thyroid function tests (TSH, T3, T4) — Most thyroid cancers do NOT affect hormone levels
Serum Calcitonin — Elevated in medullary thyroid cancer; important screening marker
CT / MRI neck & chest — Used in Bethesda V–VI or when invasion of trachea, oesophagus, or vessels is suspected
Molecular markers (BRAF, RAS) — Used in indeterminate FNAC to guide surgical extent

🏥

Treatment — Complete Guide

✂️

Hemithyroidectomy

Removal of one lobe. Used for low-risk papillary/follicular cancer ≤4 cm, no lymph node involvement, no extra-thyroidal extension.

Risks: Bleeding 1–2% · Voice change (RLN) 1–3% · No calcium issues

⚕️

Total Thyroidectomy

Complete removal of both lobes. Required for tumours >4 cm, bilateral disease, lymph node metastasis, extra-thyroidal extension, or when RAI is planned.

Risks: Low calcium (transient 20–30%, permanent <2%) · RLN injury 1–5% · Rare airway issues

🔄

Completion Thyroidectomy

Second surgery to remove remaining thyroid lobe when histopathology after hemi-thyroidectomy reveals high-risk features requiring total removal + RAI.

Same risks as total thyroidectomy, but slightly higher due to scar tissue

🔗

Neck Dissection

Central (level VI) or lateral neck dissection when lymph node metastasis confirmed by imaging or intraoperatively. Performed simultaneously with thyroidectomy.

Risks: Accessory nerve injury · Chylous fistula · Shoulder weakness

☢️

Radioactive Iodine (RAI / I-131)

Oral radioactive iodine given after total thyroidectomy. Destroys residual thyroid tissue and metastatic cells that absorb iodine. Requires low-iodine diet + thyroid hormone withdrawal or rhTSH injection beforehand.

Side effects: Dry mouth · Salivary gland swelling · Nausea (temporary)

💊

TSH Suppression Therapy

Lifelong levothyroxine (T4) after total thyroidectomy. Replaces hormones AND suppresses TSH to prevent cancer stimulation. Dose adjusted by risk category.

Monitoring: Thyroglobulin + Anti-Tg + Ultrasound every 6–12 months

⚡

External Beam Radiation

Used in anaplastic thyroid cancer, iodine-non-avid differentiated cancer with local invasion, or medullary cancer with residual disease after surgery.

Side effects: Skin reaction · Dysphagia · Dry mouth

💉

Targeted Therapy / Chemotherapy

Kinase inhibitors (sorafenib, lenvatinib) for RAI-refractory differentiated cancer. Vandetanib / cabozantinib for progressive medullary cancer. Dabrafenib + trametinib for BRAF-mutant anaplastic cancer.

Monitored by medical oncologist; used in advanced/metastatic disease

🚨 In advanced disease with airway compromise, tracheostomy may be required to secure the airway before or during surgery. This decision is made jointly by the oncosurgeon and anaesthesia team.

📈

Prognosis — Survival by Type

Papillary (PTC)

>98%

10-year Overall Survival

Follicular (FTC)

85–95%

10-year Overall Survival

Medullary (MTC)

75–85%

10-year Overall Survival

Anaplastic (ATC)

Stage-
dependent

Requires urgent multimodal care

🌟 Thyroid cancer is one of the most curable of all cancers. The vast majority of patients — even those with lymph node spread — are cured with surgery ± RAI and live completely normal, long lives.

💡

Common Questions & Myths

Will I need to take medicine for life after surgery?

After total thyroidectomy, yes — daily levothyroxine (T4) replaces what your thyroid produced and suppresses TSH. It is a simple, once-a-day tablet and most patients tolerate it well with no side effects.

Is RAI (radioactive iodine) dangerous or painful?

RAI is an oral capsule or liquid. It is not painful. It specifically targets thyroid cells — side effects (dry mouth, mild nausea) are temporary. Most patients are discharged within 24–48 hours. It is a safe, established treatment used for 70+ years.

Will my voice change permanently after surgery?

Permanent voice change (recurrent laryngeal nerve injury) occurs in only 1–3% of cases when performed by an experienced surgeon using nerve monitoring. Temporary voice change (weeks) is more common. Specialist surgeons have significantly lower rates.

Any surgeon can operate thyroid cancer — do I need a specialist?

High-volume thyroid surgeons have significantly lower complication rates (voice change, low calcium) and better oncological outcomes. The initial surgery is the most important determinant of cure — it must be performed correctly the first time.

👨‍⚕️

Why Choose a Specialist Thyroid Oncosurgeon?

🎯

Correct First SurgeryThe extent of the first surgery determines cure, RAI candidacy, and surveillance. Errors are irreversible.

🧠

Nerve MonitoringIntraoperative recurrent laryngeal nerve (RLN) monitoring protects your voice.

🩸

Parathyroid PreservationExpert technique preserves parathyroid glands, reducing calcium complications.

📊

Accurate StagingCorrect surgical staging determines whether RAI, TSH suppression level, and follow-up interval are needed.

🔁

Multidisciplinary CareEndocrinology, nuclear medicine, oncology and pathology all coordinated for you.

📅

Structured Follow-upThyroglobulin monitoring, ultrasound, and RAI surveillance personalised to your risk category.

✅ Choosing an experienced thyroid oncosurgeon is the single most important decision you can make for your outcome. The complication rate for voice change and low calcium drops significantly with volume and expertise.

🦋

थाइराइड क्यान्सर के हो?

घाँटीको अगाडि भएको थाइराइड ग्रन्थीबाट उत्पन्न हुने क्यान्सर
Papillary (PTC) — सबैभन्दा सामान्य (८५%), उत्कृष्ट नतिजा
Follicular (FTC) — १०%, रगतमार्फत फैलिन्छ, राम्रो उपचारयोग्य
Medullary (MTC) — ३–४%, पारिवारिक हुन सक्छ (RET mutation)
Anaplastic (ATC) — दुर्लभ तर गम्भीर, तुरुन्त बहुविध उपचार चाहिन्छ

⭐ ९०%+ थाइराइड क्यान्सर papillary वा follicular प्रकारका हुन्छन् — दुवैको उपचारबाट उत्कृष्ट दीर्घकालीन नतिजा पाइन्छ।

🔎

लक्षणहरू — कहिले डाक्टरकहाँ जाने?

घाँटीको अगाडि दुख्न नसक्ने गाँठो
आवाज बस्नु वा आवाजमा परिवर्तन
निल्न गाह्रो हुनु
सास फेर्न गाह्रो वा सास फेर्दा आवाज निस्कनु
२–३ हप्ता नगएको घाँटीको लिम्फ नोड सुन्निनु

💡 धेरै थाइराइड क्यान्सर सुरुमा दुख्दैनन् र routine ultrasound मा थाहा हुन्छ। दुखाइको पर्खाइ नगर्नुहोस् — गाँठो लागेमा जाँच गर्नुहोस्।

🗺️

उपचार यात्रा — चरण दर चरण

🔍

चरण १

Clinical जाँच

घाँटी स्पर्श र आवाज जाँच

📡

चरण २

Ultrasound

TI-RADS स्कोरिंग

🧫

चरण ३

FNAC

Bethesda रिपोर्ट

🎙️

चरण ४

NPL जाँच

भोकल कर्ड चेक

🖥️

चरण ५

CT / MRI

गम्भीर अवस्थामा

✂️

चरण ६

Surgery

Hemi वा Total

🔬 अपरेशनपछि Histopathology ले अन्तिम निदान र staging (pTNM) पुष्टि गर्छ। RAI, TSH suppression वा Radiation को निर्णय यसैको आधारमा हुन्छ।

🔬

निदान — विस्तृत जानकारी

Ultrasound (TI-RADS) — पहिलो जाँच; गाँठोको जोखिम स्कोर गर्छ; Biopsy कहिले चाहिन्छ भन्ने निर्देश गर्छ
FNAC (Fine Needle Aspiration Cytology) — सुइले कोष लिएर Bethesda I–VI वर्गीकरण; अवलोकन, दोहोर्‍याउने वा सर्जरी निर्धारण
NPL / Laryngoscopy — अपरेशनअघि भोकल कर्डको गति जाँच; RLN monitoring को आधार
Thyroid function (TSH, T3, T4) — अधिकांश थाइराइड क्यान्सरमा Hormone सामान्य नै रहन्छ
Serum Calcitonin — Medullary cancer मा बढी हुन्छ; स्क्रिनिङ मार्कर
CT / MRI — Trachea, Oesophagus वा वाहिनीमा आक्रमण शंका लागेमा
Molecular markers (BRAF, RAS) — Indeterminate FNAC मा सर्जरीको विस्तार निर्धारण

🏥

उपचार — सम्पूर्ण मार्गदर्शन

✂️

Hemithyroidectomy (आंशिक)

एक लोब हटाउने। कम जोखिमको ≤४ सेमी क्यान्सरमा। Lymph node नभए, Extension नभए।

जोखिम: रगत १–२% · आवाज परिवर्तन १–३%

⚕️

Total Thyroidectomy (पूर्ण)

दुवै लोब हटाउने। ≥४ सेमी, Bilateral, LN metastasis वा RAI योजना भएमा।

जोखिम: Calcium घट्ने (अस्थायी २०–३०%) · आवाज परिवर्तन १–५%

🔄

Completion Thyroidectomy

पहिलो Hemi-thyroidectomy पछि Histopathology मा High-risk features देखिएमा गरिने दोस्रो अपरेशन।

जोखिम Total thyroidectomy जस्तै + Scar tissue थपिने

☢️

Radioactive Iodine (RAI / I-131)

Total thyroidectomy पछि खाने radioactive iodine। बाँकी थाइराइड कोष र Metastatic cells नष्ट गर्छ। कम Iodine diet + TSH stimulation चाहिन्छ।

Side effects: मुख सुक्नु · Nausea (अस्थायी)

💊

TSH Suppression (Levothyroxine)

Total thyroidectomy पछि जीवनभर T4 चक्की। TSH दबाउँछ — क्यान्सर फर्कने खतरा घटाउँछ। जोखिम वर्ग अनुसार Dose मिलाइन्छ।

Monitoring: Thyroglobulin + Ultrasound प्रत्येक ६–१२ महिना

⚡

External Beam Radiation

Anaplastic cancer, Iodine-non-avid cancer, वा सर्जरीपछि बाँकी रोग भएमा प्रयोग।

Side effects: छाला · निल्न गाह्रो · मुख सुक्नु

💉

Targeted Therapy / Chemotherapy

RAI-refractory cancer मा Sorafenib/Lenvatinib। Medullary cancer मा Vandetanib। BRAF-mutant Anaplastic cancer मा Dabrafenib+Trametinib।

Medical Oncologist द्वारा Advanced disease मा

🚨 गम्भीर अवस्थामा सास फेर्न गाह्रो भएमा अपरेशनअघि वा बेला Tracheostomy (सासको बाटो खोल्ने) गर्नु पर्न सक्छ।

📈

बाँच्ने सम्भावना — प्रकार अनुसार

Papillary (PTC)

>९८%

१०-वर्षे जीवित रहने दर

Follicular (FTC)

८५–९५%

१०-वर्षे जीवित रहने दर

Medullary (MTC)

७५–८५%

१०-वर्षे जीवित रहने दर

Anaplastic (ATC)

स्टेज
अनुसार

तुरुन्त बहुविध उपचार चाहिन्छ

🌟 थाइराइड क्यान्सर सबैभन्दा निको हुने क्यान्सरमध्ये एक हो। अधिकांश बिरामी — LN metastasis भएपनि — सर्जरी ± RAI बाट पूर्ण निको भएर सामान्य जीवन जिउँछन्।

💡

सामान्य प्रश्न र भ्रम

अपरेशनपछि जीवनभर औषधि खानु पर्छ?

Total thyroidectomy पछि हो — दैनिक Levothyroxine (T4) चक्की। यसले Hormone replace गर्छ र TSH दबाउँछ। एक दिनमा एकपटक मात्र खाने, अधिकांशले कुनै असर नपाएर सहज महसुस गर्छन्।

RAI खतरनाक वा दुख्ने छ?

RAI एक खाने Capsule वा Liquid हो — दुख्दैन। थाइराइड कोषलाई मात्र लक्षित गर्छ। Side effects (मुख सुक्नु, हल्का Nausea) अस्थायी हुन्। २४–४८ घण्टामा Discharge हुन्छ। ७०+ वर्षदेखि प्रयोगमा रहेको सुरक्षित उपचार।

आवाज सधैंभरि बिग्रिन्छ?

अनुभवी Surgeon ले Nerve monitoring गर्दा स्थायी आवाज परिवर्तन १–३% मात्र हुन्छ। अस्थायी परिवर्तन (हप्ताहरू) बढी सामान्य। Specialist Surgeon ले यो दर उल्लेखनीय रूपमा घटाउँछ।

जुनसुकै Surgeon ले अपरेशन गर्न मिल्छ?

High-volume thyroid surgeon ले आवाज परिवर्तन र Calcium समस्याको दर उल्लेखनीय रूपमा कम गर्छ। पहिलो अपरेशन नै निर्णायक — यो एकपटक मात्र ठिक गरिनुपर्छ।

👨‍⚕️

किन Specialist Thyroid Oncosurgeon रोज्नु पर्छ?

🎯

पहिलो अपरेशन सही हुनुपर्छExtent र Technique नै Cure र RAI को आधार हो — गल्ती फर्कँदैन।

🧠

Nerve MonitoringRLN monitoring ले आवाज जोगाउँछ।

🩸

Parathyroid PreservationParathyroid ग्रन्थी जोगाउँदा Calcium सामान्य रहन्छ।

📊

सही StagingRAI, TSH suppression र Follow-up कार्यक्रम निर्धारण गर्छ।

🔁

Team CareEndocrinology, Nuclear Medicine, Oncology समन्वय।

📅

Structured Follow-upThyroglobulin monitoring र Ultrasound surveillance।

✅ अनुभवी thyroid oncosurgeon रोज्नु तपाईंको सबैभन्दा महत्त्वपूर्ण निर्णय हो। Complication rate र Recurrence दर Specialist हातमा उल्लेखनीय रूपमा घट्छ।

कर्मण्येवाधिकारस्ते मा फलेषु कदाचन तपाईंको अधिकार कर्ममा छ — परिणाममा होइन। उपचारमा विश्वास राख्नुहोस्।

Book a Consultation

Dr. Bidhan Koirala — Head & Neck Oncosurgeon | CMC Cancer Institute, Bharatpur

💬 WhatsApp Booking 📅 Book via HamroPatro

कर्मण्येवाधिकारस्ते मा फलेषु कदाचन Act on time without fear — early treatment saves life.

Thyroid Cancer Care
Diagnosis · Surgery · RAI · Recovery

थाइराइड क्यान्सर उपचार
निदान · सर्जरी · RAI · स्वस्थ जीवन

What is Thyroid Cancer?

Symptoms — When to See a Doctor

Your Care Pathway — Step by Step

Diagnosis in Detail

Treatment — Complete Guide

Prognosis — Survival by Type

Common Questions & Myths

Why Choose a Specialist Thyroid Oncosurgeon?

थाइराइड क्यान्सर के हो?

लक्षणहरू — कहिले डाक्टरकहाँ जाने?

उपचार यात्रा — चरण दर चरण

निदान — विस्तृत जानकारी

उपचार — सम्पूर्ण मार्गदर्शन

बाँच्ने सम्भावना — प्रकार अनुसार

सामान्य प्रश्न र भ्रम

किन Specialist Thyroid Oncosurgeon रोज्नु पर्छ?