Ask the Doctors

Dear Doctor: I read that a doctor knew that a woman had thyroid cancer just by seeing her neck on TV. Why was a visual diagnosis so easy? What happens next?

Dear Reader: The incident you're referring to took place in the spring of 2018, when a head and neck surgeon from New York was watching "Beachfront Bargain Hunt," a popular real estate show on HGTV. He noticed an area of swelling on the front of the home buyer's throat; when she turned her head or stretched her neck to look upward, the swelling became prominent enough that he believed it could be a thyroid mass.

Unsure of how to find the woman, he posted his concerns to his Facebook page. With the power of the internet, the surgeon and the home buyer were quickly put in touch with each other. He explained his suspicion and urged her to undergo diagnostic tests, specifically a sonogram and a fine needle biopsy. She followed his advice, learned that she did indeed have a malignant tumor, and immediately sought appropriate treatment.

Interestingly, this was not the first time that thyroid cancer has been diagnosed on HGTV. Several years prior, a nurse watching the popular home renovation show "Flip or Flop" discerned what she believed to be a tumor on the neck of one of the hosts. Her concerns proved to be correct. The tumor was malignant, and the host underwent successful treatment for his thyroid cancer.

The reason these tumors were visible is due to the location of the thyroid gland, which sits below the Adams apple and is just beneath the skin. The thyroid measures about 2 inches across and consists of two main lobes, which make it appear somewhat like a bow tie, or a butterfly. The gland produces the hormones used by the body to regulate metabolic rate. It also contains specialized cells that produce calcitonin, a hormone that plays a role in managing blood levels of calcium and phosphate. Diseases of the thyroid such as Graves' disease, hyper- or hypothyroidism, and thyroiditis often cause the entire thyroid to swell, which is referred to as a goiter. Thyroid cancers are more often asymmetrical swellings, and thus can be distinctive.

In addition to a visible tumor, symptoms of thyroid cancer can include trouble swallowing, difficulty in breathing, a persistent cough in absence of a cold and pain in the front of the neck that may radiate up to the ears. When thyroid cancer is suspected, diagnostic tests may include imaging of the gland, blood tests, a radioiodine scan to test thyroid function, and a biopsy to search for cancer cells. Depending on the type of cancer that is present, as well as the stage at which it is identified, treatment consists of surgery, radioiodine or hormone therapy, chemotherapy or radiation. Targeted therapies that enlist the aid of the immune system to fight the cancer are also now being used.

The good news is that the most common types of thyroid cancer are very treatable, with five-year survival rates of 98 percent. Both of the individuals in the HGTV diagnoses have reported successful treatment.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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