Thyroid Cancer Curable, Except With Rare Form

Times Staff Writer

Thyroid cancer, a disease that afflicts about 23,000 people in the United States each year, is usually curable -- except for a rare variety that is among the deadliest of all tumors.

Chief Justice William H. Rehnquist has not specified which form of the disease he has.

There are four major types of thyroid cancer. Papillary and follicular cancer, which account for as many as 85% of all cases, are considered easily treatable.


The usual treatment is to surgically remove the thyroid gland and target surrounding tissue with radioactive iodine pills. The cure rate tops 90%, though that declines somewhat with age.

The thyroid gland, located in the throat, secretes hormones that regulate metabolism. Once the gland is gone, patients must take replacement thyroid hormone, a once-a-day pill.

The prognosis is slightly worse for another form known as medullary cancer, which affects thyroid cells responsible for regulating calcium. That cancer has a greater tendency to spread to the lymphatic system.

The most dangerous form is anaplastic. It accounts for fewer than 5% of cases and mainly affects people older than 70. Those diagnosed often have long histories of thyroid problems.

“It is one of the most malignant types of cancer known to humans,” said Dr. Yuri Nikiforov, a pathologist and thyroid expert at the University of Cincinnati College of Medicine.

“To label a guy with anaplastic basically gives him a death sentence in a matter of months,” he said. Fatality rates top 95% in the first year after diagnosis.

Such tumors invade surrounding tissue so aggressively that surgery usually is useless.

Details about Rehnquist’s diagnosis remain scant. The 80-year-old chief justice underwent surgery Saturday but apparently did not have his thyroid removed. Supreme Court officials issued a statement that doctors performed a tracheotomy.

That surgery involves an incision into the trachea, or windpipe, and the insertion of a tube to allow unobstructed breathing. It is extremely rare in the treatment of thyroid cancer.

A tracheotomy indicates that the tumor threatened to obstruct Rehnquist’s windpipe, and that the tumor is fast-growing, according to several outside thyroid specialists.

“At his age, having had a tracheotomy, the first thing that comes to mind is whether or not he has anaplastic thyroid cancer,” said Dr. Peter Singer, chief of clinical endocrinology at USC’s Keck School of Medicine.

The Supreme Court’s statement gave no indication that a tumor was removed.

“Any time you leave a tumor in a patient, it means the tumor is going to continue to grow,” said Dr. Michael Weiss, chief of head and neck surgery at Maimonides Medical Center in Brooklyn, N.Y.

Thyroid cancer is more common in women than in men. Tumors are usually discovered as lumps on the throat area. Unlike many other cancers, thyroid cancer has never been linked to smoking, a habit of Rehnquist’s.

The American Cancer Society estimates 1,460 people -- about 6% of those diagnosed with the disease -- will die of it this year.