Thyroid cancer is a serious condition affecting the thyroid gland, a small butterfly-shaped gland in the neck. If you or someone you know has been diagnosed with thyroid cancer, it's essential to understand the potential effects and symptoms it can cause.
Additionally, as thyroid cancer can sometimes spread to nearby areas, it's essential to be aware of any unusual sensations or discomfort you may experience in your neck or surrounding areas, like the shoulder.
In this article, we'll tell you important things about thyroid cancer, such as its symptoms and possible effects. By the end of this article, you'll know more about the condition and what you can do to deal with it and keep your overall health and well-being in good shape.
Can Thyroid Cancer Cause Neck And Shoulder Pain?
Thyroid cancer can cause neck pain, but it is usually not a presenting symptom of the disease. In fact, it is reported mainly in advanced disease and not as an isolated finding (neck pain only). The most common presenting feature of thyroid cancer is either neck swelling or incidentally detected thyroid nodules on neck imaging.
Neck involvement is expected because the thyroid gland itself is located in the neck region.
According to the American Cancer Society, neck pain in thyroid cancer is described as pain in the front of the neck, sometimes going up to the ears.
Additional thyroid cancer symptoms presenting in the neck are:
- A lump in the neck, which can grow fast
- Hoarseness, weak voice, or other changes to the voice that don’t go away
- Swelling in the neck
- Inability to swallow
- Inability to breathe
- Sensitivity in the neck
These symptoms are primarily due to the thyroid nodules pressing on the trachea (windpipe) or the esophagus.
To sum it up about neck pain: isolated neck pain without swelling or nodules present is most likely not due to thyroid cancer.
Shoulder pain, on the other hand, is a very (if not extremely) rare presenting symptom of thyroid cancer. (we have presented some case reports just after this section)
In fact: Shoulder pain is mainly reported after surgical treatment for thyroid cancer. Although, the possibility of having this kind of pain after thyroid surgery usually depends on the procedure. Studies suggest spinal accessory nerve (SAN) palsy is often the main cause of shoulder pain after surgery. The SAN runs from the neck to the shoulder and is essential for moving these body parts.
Since we’re discussing symptoms of thyroid cancer: The bad thing about thyroid cancer is that it doesn't always show signs, which makes it hard to find and diagnose (we mentioned earlier how it is commonly found as an incidental finding).
Additionally, some possible signs aren't even caused by true thyroid cancer. Sometimes, these symptoms are caused by a thyroid nodule, which is not always cancerous. Thyroid diseases that may cause nodules to develop in the thyroid gland include overgrowth of thyroid tissue, goiter, and iodine deficiency.
Even though most thyroid nodules are not cancerous and don't cause problems, your doctor should check out any unusual swelling in your neck, especially if you have trouble breathing or swallowing. Figuring out if there’s a chance of cancer is crucial.
Can Thyroid Cancer Spread to the Shoulder?
Thyroid cancer can spread to the shoulder. Although quite uncommon, bone metastasis, or the spread of cancer cells from the original site to a bone, can happen to patients with a history of thyroid cancer. According to this journal article, bone metastases occur in only around 4% of patients with thyroid cancer.
Bone metastases can cause pain, fractures, and spinal cord compression, which can have a big effect on the quality of life.
Common sites of bone metastasis for patients with thyroid cancer are:
- The vertebrae or spine,
- Femur (thigh bone),
- Skull
- The pelvis (the lower part of the trunk, between the abdomen and the thighs),
- Scapula, or the shoulder blade.
Thyroid cancer can also spread to nearby lymph nodes and other tissues of the shoulder area. This form of spreading may also cause pain and other symptoms.
People who have had thyroid cancer before should watch out for signs in case the cancer has returned or spread to other parts of the body.
Case Studies On Thyroid Cancer And Shoulder Pain
Some case studies report a possible link between thyroid cancer and shoulder pain. However, most cases reported are of patients already diagnosed with thyroid cancer earlier. Cases where shoulder pain is the first presenting symptom of thyroid cancer are very rare and hard to find.
That said, here are a few examples:
- The first article discusses a case study in which a 52-year-old woman had pain in her right shoulder and neck. This woman had thyroid cancer in the past. Imaging tests showed that the cancer had spread to the lymph nodes in her neck and the soft tissues around her shoulder joint.
- A similar case happened to a 56-year-old man who complained of pain in his right shoulder. Diagnostic imaging showed that the humerus had a lesion. A bone biopsy showed the presence of papillary thyroid carcinoma (PTC) in his right shoulder.
- Another report talked about the case of a man in his 30s who had papillary thyroid cancer (PTC).
The cancer had spread to the nerves in his shoulder, called the brachial plexus. The brachial plexus is a network of nerves that allows movement and sensation in the shoulder, arm, and hand.
He had surgery to remove the lump on the left side of his neck, which greatly hurt his left arm and shoulder. The tumor was found on the left recurrent laryngeal nerve, which took a long operation to remove.
The PTC had also spread to the brachial plexus, so the neurosurgeon had to remove more tumors from the nerves' upper and middle parts.
What Kind Of Neck Pain Is Associated With Thyroid Cancer?
As previously mentioned, the kind of neck pain reported in thyroid cancer is a pain in the front of the neck, sometimes going up to the ears.
Thyroid cancer can cause this kind of neck pain in a few different ways:
- Pressure or discomfort from a lump or swelling in the neck. A lump or swelling in the neck can cause pressure or pain, especially when lying down or turning the head. This is often a sign of a thyroid nodule, which can be benign or cancerous.
- Pain from metastasis to the neck: In rare cases, thyroid cancer can spread to other parts of the body, such as the neck, where it can cause pain. This is more likely to happen when the cancer is in its later stages.
- Pain from a complication of treatment: Neck pain can also be a side effect of treating thyroid cancer. Removing the thyroid gland (thyroidectomy) or radiation therapy may cause neck pain. The pain may be due to changes in the neck's structure, scarring, or damaged nerves.
When cancer spreads to the trachea, larynx, or esophagus, it can cause coughing, voice hoarseness, or trouble swallowing. According to this article, up to 70% of people with MTC who have a palpable thyroid nodule also have metastases in the neck. An additional 10% have metastases in other parts of the body.
Treatment usually involves removing the whole thyroid and a central neck dissection on both sides.
Can Thyroid Cancer Spread After A Total Thyroidectomy?
If the thyroid cancer has metastasized priorly, it can still spread after total thyroidectomy.
For example: A 2015 study looked at people with papillary thyroid cancer (PTC) that had spread to their neck lymph nodes. The results showed that these people were more likely to get cancer again than those with tumors only in the thyroid gland.
Another study showed similar results. The findings showed that these factors predict the recurrence of thyroid cancer:
- Lymph node (LN) metastasis. The chance of cancer recurrence increases when lymph node metastases are 3 cm or larger.
Although this type of recurrence is usually not life-threatening, it can still be stressful for patients and doctors. For people with PTC who have signs of a high chance of recurrence, a thorough lymph node dissection is recommended.
To confirm the presence of LN metastasis, patients may need to see a doctor for a physical examination. They may also need imaging tests such as CT or PET scans.
- Tumor size. If the tumor found in the thyroid is bigger than 2 cm, it may mean that the PTC will come back in the lymph nodes, lungs, or bones. That’s because the chances of undetected metastasis are increased in bigger tumors.
- Extrathyroidal extension. An extrathyroidal extension is when the tumor spreads beyond the thyroid. This may spread to nearby soft and connective tissues, the larynx, trachea, esophagus, or the recurrent laryngeal nerve.
- Thyroglobulin (Tg) levels. A 2020 study looked at the levels of thyroglobulin and the return of cancer after radioactive iodine treatment. High thyroglobulin levels during radioactive iodine (RAI) therapy may predict cancer recurrence.
RAI therapy is given to people with thyroid cancer who are at moderate or high risk of getting it back. RAI therapy can treat thyroid cancer since the thyroid gland absorbs almost all of the iodine in the body.
The RAI mostly builds up in the thyroid cells, where the radiation can destroy the thyroid gland and the cancerous cells that take up the radioactive iodine. The radiation from RAI therapy has little effect on the rest of the body.
If thyroglobulin levels start to rise after undergoing RAI therapy, it could mean that the cancer has come back. More tests, like radioactive iodine or PET scans, may be needed. It is important to keep an eye out for recurrences, especially in the first five years.
What Are The Signs Of Thyroid Cancer Returning?
Sings of thyroid cancer returning depend on the type of cancer. The stage and where and how far it has spread are also key factors. Here are some common signs and symptoms that may indicate that thyroid cancer has returned:
- A lump or swelling in the neck, which might or might not hurt.
- Difficulties with breathing or swallowing.
- Changes in how your voice sounds or hoarseness.
- A cough that won't go away.
- Feeling tired or weak all the time.
- Unintended weight gain or weight loss.
- Bone or joint pain, which may indicate that cancer has spread to these places.
It's important to remember that many conditions can cause these symptoms. But if you have had thyroid cancer before and have any of these symptoms, you should immediately see a doctor. They can help you determine what's causing your symptoms and give you the right treatment if needed.
Where On The Body Can Thyroid Cancer Return?
Thyroid cancer may recur in these areas:
- Thyroid tissue that may be left behind after surgery
- Lymph nodes in the neck
- Other parts of the body, like the lungs and bones.
Thyroid cancer can come back even if it has been treated and even if your thyroid has been taken out. This could happen if cancer cells spread to other parts of the body before the thyroid is removed, as we mentioned earlier.
The good news is that even the most common types of thyroid cancer (such as the papillary and follicular variants) usually do not recur. And even if thyroid cancer comes back, the outlook is still good. It can usually be treated, and most people will respond well to treatment.
If you want more detail: A major determinant of thyroid cancer recurrence is how aggressive it is. If your cancer is aggressive or grows outside your thyroid, it is more likely to return. When thyroid cancer recurs, it usually shows up within the first five years after the initial diagnosis. Your healthcare provider can tell you if your cancer is more likely to return based on how it was found and treated and also give you proper medical care.
Is Having Neck Pain Years After Thyroidectomy A Sign Of Thyroid Cancer Returning?
Having neck pain after a thyroidectomy does not always mean cancer has returned. But you should see a doctor if you have any new or long-lasting symptoms after a thyroidectomy. Some of these symptoms could mean that cancer has returned or you may have a new problem.
On the other hand, neck pain up to 6 months after surgery is usually considered normal and expected.
Thyroidectomy patients have much less neck mobility and more “myofascial trigger points” (the medical term for, let’s say, neck problems).
Patients with a thyroid removed could deal with neck pain and disability with the help of multidimensional programs. These programs may include pain control techniques, range of motion exercises, and trigger point therapy.
Other Causes Of Neck Pain After Thyroidectomy
Neck pain after thyroidectomy may also be a sign of the following conditions:
- Long-term Upper Aerodigestive Symptoms (UADS)
Long-term upper airway digestive symptoms (UADS) affect the mouth, throat, and esophagus. They can be caused by changes in the neck and throat after a thyroidectomy.
While UADS do not usually impact a patient's quality of life, studies show they are one of the most common complications after thyroidectomy. It’s estimated that 15% of patients had trouble swallowing after the surgery. Meanwhile, around 20% show signs of "neck strangling," a sensation like having a foreign object in the throat or a tight shirt collar.
These postoperative symptoms may result from changes to the muscles and tissues in the neck caused by the surgery and may occur two to five years after the procedure.
Neck pain after a thyroidectomy may be a sign of reflux laryngopharyngitis. This happens when stomach acid flows back into the throat and irritates the larynx (voice box) and pharynx (throat).
This can occur because the surgery changes the neck's shape and affects the muscles that prevent acid reflux. Neck pain is a common symptom of this condition, along with hoarseness, coughing, and trouble swallowing.
- Neck hematoma
Neck pain after a thyroid removal could indicate a neck (cervical) hematoma. This blood collection outside of a blood vessel can happen if the vessels in the neck are damaged during the procedure.
Hematomas can cause pain, swelling, and tenderness in the area where they are. They may get so big that they make breathing, swallowing, or talking hard. Hematomas are a rare but serious problem that can happen after a thyroidectomy. They need to be treated right away by a doctor.
To figure out if a patient has a cervical hematoma, a doctor will do a physical exam and may also order an ultrasound or CT scan. Most of the time, the blood needs to be drained, but in some cases, surgery may be needed. Treatment options depend on the size and location of the hematoma, as well as the patient's health and medical history.
Bonus Info: The Four Types Of Thyroid Cancer
There are four main kinds of thyroid cancer if you want more detail:
- Papillary thyroid cancer (PTC). This is the most common type of thyroid cancer. Also known as papillary carcinoma, about 80% of all cases of thyroid cancer are of this type. It can happen at any age, but people ages 30 to 50 are most likely to get it.
Even if papillary thyroid cancer cells have spread to the lymph nodes in the neck, they are usually small. Also, most people respond well to treatment.
- Follicular thyroid cancer (FTC). This rare type of thyroid cancer is most common in people aged 50 and above. FTC makes up about 10–15% of all cases of thyroid cancer. FTC cells rarely spread to the lymph nodes in the neck. But some big aggressive cancers can spread to other parts of the body. Most of the time, follicular thyroid cancer spreads to the lungs or bones.
- Medullary thyroid cancer (MTC). This rare type of thyroid cancer starts in the C cells of the thyroid gland. These cells produce the thyroid hormone calcitonin. About 5-7% of all cases of thyroid cancer are of this type. It tends to grow faster than papillary or follicular thyroid cancer.
When calcitonin levels in the blood are high, it can be an early sign of medullary thyroid cancer. Some medullary thyroid cancers are caused by a gene (RET gene) that is passed down from parents to children. When medullary thyroid cancer runs in the family, the risk of getting thyroid cancer goes up.
- Anaplastic thyroid cancer (ATC). This kind of thyroid cancer makes up less than 2% of all cases. ATC is rare and grows fast, making it hard to treat. But treatments can help slow the disease's progress.
Most people with anaplastic thyroid cancer are over 60 years old. ATC may cause very serious signs and symptoms. An example of this is having a swollen neck, making it hard to breathe and swallow.
Depending on how big the tumor is and how likely it is to spread, thyroid cancer may be treated with neck surgery.
Takeaway
Shoulder pain isn't a common sign of thyroid cancer. Yet, in rare cases, advanced thyroid cancer can spread to other parts of the body, including the bones and lymph nodes, where it can cause pain. Neck pain, on the other hand, is more frequently reported.
This article shows through case studies that there may be a link between thyroid cancer and shoulder pain.
Even after a total thyroidectomy, there is a chance that the cancer may spread and come back, causing neck pain and other symptoms.
If you've had thyroid cancer and shoulder pain, you should see your doctor to find out what's wrong. Your doctor may do a physical examination or order imaging tests like an X-ray, CT, or bone scan. They may also need other tests to determine why your shoulder hurts and ensure that cancer hasn't spread.
