Thyroid cancer often affects young patients, more frequently women then men. Although papillary and follicular thyroid cancer is highly treatable and has an excellent prognosis, the diagnosis of cancer is frequently frightening and may have psychological consequences that persist even once the cancer has been successfully treated. Once previously healthy individuals are told that they have thyroid cancer, it is quite common to experience some degree of panic and become frightened. This can last for days to weeks, and in some individuals, it can take years before regaining a former sense of confidence in ones health. Although most forms of thyroid cancer have an excellent prognosis, the word cancer and its connotations is frightening to most people, and fear of the unknown and what lies ahead is not uncommon.
A common scenario preceding the initial diagnosis is for the usual patient to be in reasonably good health, not feel sick, and simply have a small thyroid nodule that usually does not cause any symptoms. Indeed many patients have had their thyroid nodules for years prior to a diagnosis of thyroid cancer, and often have had several previously normal biopsies, and no symptoms. Hence, it often comes as a great shock when one is transformed from a very healthy person with a small imperceptible bump in the neck, to a patient with a diagnosis of cancer.
Despite an abundance of positive reassurance, and lots of statistics that suggest a very good to excellent prognosis, and despite being told 'not to worry' by friends, family and medical professionals, the majority of patients are understandably shocked, alarmed and often experience large amounts of anxiety, which at times can be disabling as outlined in The impact of thyroid cancer and post-surgical radioactive iodine treatment on the lives of thyroid cancer survivors: a qualitative study PLoS ONE. 2009;4(1):e4191. It is quite normal to feel physically ill, and experience a sense of dread or panic at the diagnosis of any cancer, no matter how good the prognosis. Cancer is a terrifying word. At the end of the day, all of us would rather not have any cancer, no matter how good the prognosis. The uncertainty that lies ahead, coupled with the multiple hospital and physicians visits, technical terms, strange drugs, surgery, hypothyroidism, radioactive iodine and isolation, and disruption of our normal daily activities can be a bit too much to handle while trying to always remain outwardly calm and confident.
Many patients may not have an excellent support network, or may not want to burden loved ones and friends with their real fears and anxieties. Hence, although apparently surrounded by friends and family, many patients will feel quite lonely and they often will feel like they need to be brave and tough, while having no one they can or wish to confide in or complain to.
An important component of dealing with the acute anxiety that accompanies a thyroid cancer diagnosis is the provision of gentle reassurance on an ongoing basis, without being patronizing.
It is not unusual for patients to start to notice various sore throats, twinges, aches, tingling, numbness and pains, that previously may have gone unrecognized. Most of us have these inexplicable minor twinges, spasms, aches or body sensations all the time,; they are fleeting and they don't usually bother us. However, once a diagnosis of cancer has been made, patients may become nervous and more easily frightened when sore throats, tightness in the neck, choking sensations, or occasional tingling is noticed. Furthermore, during a severe throat, viral, bacterial or dental infections, lymph nodes may appear (a normal reaction to the infection) in the neck that be frightening for the patient with a history of thyroid cancer. The neck, voice, or throat area is frequently the source of unusual sensations in patients with anxiety. It is generally useful to discuss these complaints, anxiety and associated concerns with a physician, as usually considerable reassurance can be obtained once an assessment of the problem is carried out.
Many patients, particularly young individuals, will have their confidence in their own health disrupted for the first time, by the diagnosis of thyroid cancer and may have significant ongoing anxiety that they do not wish to share with others, as they "don't wish to complain or be a nuisance etc to friends or family". It is helpful to acknowledge that these concerns are very common in the patient population with thyroid cancer and constitute a normal reaction to the diagnosis of cancer. Discussion of the treatment process, and the excellent prognosis, taken together with ongoing reassurance and support usually leads to a progressive diminution in anxiety, increase in confidence and a gradual return to a more normal life.
In a small minority of patients, anxiety may be persistent and chronically disabling, interfering with a normal return to the activities of daily living and enjoyment of life. Such patients may benefit from joining a support group of thyroid cancer survivors (see Thyroid Cancer Canada : or Thyca), or from professional counseling.
In the vast majority of patients, once a treatment plan is formulated, and treatment is completed, anxiety generally gradually diminishes, and fades into the background. Although anxiety can return at any time, particularly if one perceives abnormal sensations in the head and neck, or a small bump is detected, the majority of these instances resolve and do not represent recurrences of thyroid cancer. When there is any doubt, it is helpful to seek the counsel and assessment of your physician.