Dr. Natasha Das,
Consultant, Medical Communications
A papillary thyroid carcinoma patient
On the 16th of July, I mark one year since a diagnosis that shook my near and dear ones. Until then, I was a doctor and a medical communications professional leading a normal ‘healthy’ life and conducting outreach programs and training people how to do a self-examination of the breast and the oral cavity for early detection of cancer.
I have always believed in the power of early
detection. Now, I have lived it.
The clue I
missed – and my friends did not
A year ago, a friend, who is also a doctor, noticed something I
hadn’t – a slight swelling on my neck. I had no symptoms. No pain. No voice
changes. No trouble swallowing. And like many patients, I could have dismissed
the swelling as harmless, especially in the absence of symptoms. But as a
doctor, I knew better.
It turned out later, my thyroid hormone levels also were within
normal limits. All that I had was just a visible lump that I had not known of
till then.
A few weeks later, another friend nudged me to get a scan to check
if it was only a cyst (a fluid filled sac) or a solid tumor.
The clinical
examination
Next, I got myself clinically examined by a physician friend. She
examined the swelling and said it felt like a cyst and there may not be much to
worry. She insisted that in spite of the normal hormone levels, a swelling is
an abnormality. She advised me to get an ultrasound scan followed by a
fine-needle aspiration cytology (FNAC) to be sure it was a benign cyst.
The ultrasound
that revealed a silent story in the other lobe
I went in expecting the scan to confirm a benign nodule in the area
of the swelling. Instead, the ultrasonologist noticed something entirely
different.
He didn’t just scan the obvious lump. He thoroughly examined the
entire neck. His attention to detail changed the course of my care.
Yes, there was a cyst in the right lobe of the thyroid that did seem
to be benign. But the ultrasonologist found foci of microcalcification in the
left lobe of the thyroid. Microcalcifications are detected by the ultrasound as
small, bright spots – a red flag for thyroid cancer. The ultrasonologist insisted
that I get an FNAC from the left side rather than the right.
I cannot emphasize this enough. It was his skill and thorough
examination that brought the true picture to light.
A quick and
conclusive FNAC report
While the tiny bright spots (less than a mm in diameter) detected by
ultrasound were a strong indication of thyroid cancer, they could also have
been due to benign conditions such as Hashimoto’s thyroiditis. Because of its
association with cancer, since microcalcifications were identified, a thorough
evaluation was crucial.
Although I was advised to get an FNAC done with a sample from the
left lobe, there was no lump on the left that could be seen or felt. The
pathologist therefore, went in for an ultrasound-guided FNAC. The ultrasound
was used to locate the position of the microcalcifications. A fine needle was used
to withdraw cells from there. These cells were then examined under the
microscope to determine if there were any cancerous cells.
It was the FNAC that confirmed the diagnosis of papillary thyroid
cancer.
Ultrasound to
detect the spread of the cancer
Once the diagnosis was confirmed, a surgery was planned. But before
that, the cancer surgeon needed to know about the spread of the cancer.
He advised another ultrasound of the neck. This time, with the
cancer already diagnosed, the ultrasound was used to assess the lymph nodes in
the neck for any signs of metastasis or spread of cancer.
When the cells in the lymph nodes die, the lymph nodes become what
doctors call ‘necrotic’. Necrotic lymph nodes often appear darker on the
ultrasound monitor.
This second ultrasound of my neck revealed several necrotic lymph
nodes indicating spread of the cancer.
CE CT scan to rule out the rare possibility of abdominal or pelvic mass
In rare cases, follicular or papillary thyroid cancers have
presented as pelvic masses or as asymptomatic pelvic bone metastases.
I also underwent a contrast-enhanced computed tomography (CE CT)
scan of the abdomen and pelvis to rule out any abnormality in these areas.
Surgery and biopsy
that helped determine the staging of the cancer
Since one lobe of my thyroid had a large visible cystic swelling and
the other lobe had cancer, the surgeon decided to remove the thyroid gland
completely.
As ultrasound had revealed necrotic lymph nodes in the neck, the
surgeon decided to clean the neck and remove the nearby lymph nodes.
The surgeon also decided to remove one of the four parathyroid
glands as it was too close to the affected area and might harbor cancer cells.
While necrosis of lymph nodes on an ultrasound often points to spread
of cancer, it is important to consider other possibilities such as
tuberculosis, fungal infections and other chronic inflammatory disease.
The removed thyroid gland, parathyroid and neck lymph nodes were
sent for biopsy. There were multiple cancerous nodules in the thyroid and the
largest one had a diameter of over 2 cm. The cancer was confined to the thyroid.
It had spread to four of the neck lymph nodes but there was no distant spread.
The cancer was therefore, staged at T2N1M0. Since I was less than 55 y old at
diagnosis, this was considered as stage I papillary thyroid cancer.
Adjuvant
therapy after the surgery
After the surgery, I underwent adjuvant nuclear therapy in the form
of radioactive iodine (RAI) therapy.
The RAI therapy ensured that any remnant thyroid tissue or
microscopic disease was treated. It also completed the active phase of my
treatment.
A follow-up scan after the RAI therapy ensured that all thyroid cells
in my body had been killed.
A pill each morning – that’s all it takes to keep me going
Once the RAI therapy was done, it meant all
my thyroid cells were killed – even that microscopic amount that have been left
behind after the surgery.
I need thyroid hormones for overall functioning
of my body. As my body no longer produces these hormones, I have been put on thyroid
hormone replacement therapy.
This means every morning, I get up and take a
pill that gives me enough thyroid hormones to allow my body to work to its
optimum ability.
A final word –
the power of looking closer and paying attention
When I reflect today, 1 year after the diagnosis, on what saved me –
I believe it wasn’t just a machine and a test. It was the people behind them
who looked closer and paid attention.
A friend who saw what I didn’t.
The ultrasonologist who paid attention to the left side too when the
swelling was only on the right side. The pathologist who confirmed the
diagnosis. The ultrasonologist who found the necrosed lymph nodes. The surgeon
who carefully removed my thyroid gland without any damage to the nerve to my
voice box, who removed the neck lymph nodes carefully and sent it for biopsy.
The pathologists who did the biopsy and confirmed that the spread was limited
only to a few nearby lymph nodes.
My case is a reminder that medicine is as much about vigilance and
intuition as it is about technology.
So, if you—or someone you care about—has a neck swelling, don’t
ignore it. Even if it is painless. Even if your lab tests are normal. Even if
you feel fine. Ask your doctor about an ultrasound. Make sure the scan is
detailed and done by someone experienced in thyroid imaging. And follow through
if something looks suspicious.
Because early detection doesn’t just improve outcomes. Sometimes, as
in my case, it changes everything.
P.S.
One year after the diagnosis, I am doing well.
My last whole-body
scan had shown no remnant thyroid cancer cells anywhere in my body.
 |
| As a panel moderator at the recently concluded DIA Medical Writing Conference 2025 |
Grateful to these people in my cancer journey
Dr. Sanjusmita
Tripathy, Dr. Preeti Srivastava, Dr. Sharmistha Sarangi, Dr. Biswajit Mishra,
Dr. Sandeep Mohanty, Dr. Ranjan Mohanty, Dr. Pradyumna Kumar Sahoo, Dr. Manas
Ranjan Baisakh, Dr. Rabi Narayan Mallick, Dr. Manoranjan Mohapatra, Dr. Saroj
Kumar Sahu, Dr. Tushar Mohapatra, Dr. Saurendra Das, Ar. Santrupthy Das, Mr. Animesh
Das, Dr. Bibhupada Mohanty, Mrs. Yashodhara Das, Mrs. Alaka Das, Mr. Nilolohit Mohanty, Mrs. Mandakini
Mohanty, Ms. Swetapadma Acharya, Dr. Purvish Parikh, Dr. Pratap K. Das, Dr.
Ghanashyam Biswas, Dr. Soumya Surath Panda, Mr. Ravi Shankar Sharma, Mr. Debakanta Kar and many others.
Also, Zulie bhai (Late
Dr. ZH Khan) who always encouraged me to spread awareness for early detection
of cancer.
When you have
cancer, you do not travel alone. And that’s what
makes all the difference. I share my story now so others will listen sooner—to
their bodies, to their instincts, and to those who care enough to speak up.
Because sometimes, one scan and one set of careful eyes is all it takes to
change the ending.
