This information is about a type of non-Hodgkin lymphoma called thyroid lymphoma. It should ideally be read with our general information about non-Hodgkin lymphoma.
Occasionally, another type of lymphoma known as Hodgkin lymphoma may start in the thyroid gland. We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having treatment.
Non-Hodgkin lymphoma is a cancer of the lymphatic system. The lymphatic system is part of the body’s immune system and helps us fight infection. It's made up of organs such as the bone marrow, thymus, spleen, and the lymph nodes (or lymph glands). Lymph nodes are connected by a network of tiny lymphatic vessels that contain lymph fluid.
There are lymph nodes all over the body. As lymph fluid flows through the lymph nodes, the nodes collect and filter out anything harmful or anything that the body doesn't need. This includes bacteria, viruses, damaged cells and cancer cells.
Lymph fluid contains cells known as lymphocytes. These are a type of white blood cell that help the body fight infection and disease.
Lymphocytes start to grow in the bone marrow (where blood cells are made). The two main types of lymphocyte are B-cells and T-cells.
B-cells mature in the bone marrow, while T-cells mature in the thymus gland behind the breast bone. When they're mature, both B-cells and T-cells help fight infections.
Lymphoma is a disease in which either T-cells or B-cells grow in an uncontrolled way. Thyroid lymphoma is usually a disease of B-cells.
The thyroid is a small gland in the front of the neck, just below the voice box (larynx). It's made up of two parts or lobes . The thyroid is one of a network of glands throughout the body that make up the endocrine system. This system is responsible for making hormones, which help to control and influence different functions of the body.
The thyroid is sometimes known as the 'activity gland' because it keeps the body working at its normal rate (metabolism). It does this by making two hormones called thyroxine (T4) and triiodothyronine (T3).
In order to make thyroxine, the thyroid gland needs a regular supply of iodine. We get iodine in our diet from fish, dairy products and table salt, which has iodine added to it.
Thyroid lymphoma is rare. It can occur at any age but is most likely to occur after the age of 60. It's more common in women than in men.
Types of thyroid lymphoma
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Most non-Hodgkin lymphomas start in the lymphatic system. However, some start outside the lymphatic system. When this happens, the lymphoma is described as being extranodal. Thyroid lymphoma is a type of extranodal lymphoma.
There are many different types of non-Hodgkin lymphoma. The main types that affect the thyroid gland are:
diffuse large B-cell lymphoma
MALT lymphoma (mucosa associated lymphoid tissue).
Other types of lymphoma, including follicular lymphoma, can also start in the thyroid gland.
Signs and symptoms of thyroid lymphoma
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The most common symptom is a lump in the front of the neck. Sometimes there may be a larger swelling around the lower neck. This may cause symptoms such as neck pain, a hoarse voice, difficulty swallowing and breathlessness.
How thyroid lymphoma is diagnosed
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Thyroid lymphoma can sometimes be difficult to diagnose and you may have several tests and investigations.
Ultrasound thyroid scan
Sound waves are used to make up a picture of the inside of the neck and thyroid. Once you are lying comfortably on your back, a gel is spread over your neck. A small device (like a microphone) that produces sound waves is passed over the area. The sound waves are changed into a picture by a computer.
Fine needle aspiration cytology
A small needle is passed gently into the swelling in your neck. Sometimes an ultrasound is used to help guide the needle to the right area. The doctor then takes a sample of cells, which are examined under a microscope to check if there are any cancer cells.
A definite diagnosis is made by doing a biopsy. This involves a small operation to remove a piece of thyroid tissue. Cells from the tissue are examined under a microscope. Biopsies may also be taken from other body tissues.
Staging and grading of thyroid lymphoma
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The stage of a cancer is the term used to describe the extent of the cancer – whether it affects the thyroid alone, or has spread to lymph nodes or elsewhere in the body.
Additional tests – including blood tests, x-rays, scans, and bone marrow samples – are used to get more information about the type of lymphoma and how far it has spread in the body. Doctors use this information to decide which treatment is most appropriate for you. You can read more about staging tests in our general information about non-Hodgkin lymphoma.
Non-Hodgkin lymphomas are divided into two groups: indolent (sometimes called low-grade) and aggressive (sometimes called high-grade). Indolent lymphomas are usually slow‑growing, and aggressive lymphomas grow more quickly. Sometimes an indolent lymphoma can change (transform) into a more aggressive type of lymphoma.
Thyroid lymphoma can be fast-growing or slow-growing, depending on which type it is.
MALT lymphomas are usually indolent and grow slowly.
Diffuse large B-cell lymphomas are aggressive and tend to grow more quickly.
Treatment for thyroid lymphoma
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Treatment for thyroid lymphoma depends on its grade and whether or not it is confined to the thyroid. One type of treatment or a combination of treatments may be used.
Radiotherapy is the use of high-energy rays to destroy cancer cells, while causing as little harm as possible to the healthy cells.
For people who have slow growing lymphoma that’s confined to their thyroid, radiotherapy may be the only treatment they need.
Radiotherapy is usually given Monday–Friday, with a rest at weekends. Your cancer specialist will tell you how long your radiotherapy will last for.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It can be given as tablets or into a vein (intravenously).
You may be given just one type of chemotherapy drug or you may be given two or more chemotherapy drugs together (Combination chemotherapy regimen).
Chemotherapy is often given with a drug called rituximab. Chemotherapy treatments for thyroid lymphoma include:
Chlorambucil taken as tablets.
CVP or R-CVP. CVP is made up of the chemotherapy drugs cyclophosphamide and vincristine, and the steroid prednisolone. Rituximab is often given with CVP. This is called R-CVP.
CHOP or R-CHOP. CHOP is made up of the chemotherapy drugs cyclophosphamide, doxorubicin and vincristine, and the steroid prednisolone. Rituximab is often given with CHOP. This combination of drugs is called R-CHOP.
Monoclonal antibodies are drugs that recognise, target and stick to particular proteins on the surface of cancer cells, and can stimulate the body’s immune system to destroy the cells.
The monoclonal antibody most commonly used to treat thyroid lymphoma is rituximab. It’s usually given in combination with chemotherapy.
Steroids are often given with chemotherapy to help treat lymphomas. They also help you feel better and can help reduce nausea (feeling sick).
Surgery to remove the thyroid isn't a common treatment for thyroid lymphoma. It is occasionally done in people with slow-growing (indolent) lymphoma.
Thyroid hormone replacement
Often people who have been treated with radiotherapy or surgery will need thyroid hormone replacement treatment, as the thyroid becomes less active. This involves taking tablets to replace the hormones normally produced by the thyroid.
Clinical trials for thyroid lymphoma
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New treatments for thyroid lymphoma are being researched all the time. Your doctor may invite you to take part in a clinical trial to compare a new treatment against the best available standard treatment.
Your doctor must discuss the treatment with you, and have your informed consent before entering you into a trial.
Before any trial is allowed to take place, it must be approved by a research ethics committee, which protects the interests of those taking part.
You may decide not to take part or to withdraw from the trial at any stage. You will then receive the best standard treatment available.
Information and support
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Everyone has their own way of dealing with their illness and the different emotions they experience. Some people find it helpful to talk things over with family and friends or their doctor or nurse. You can also contact Macmillan’s cancer support specialists or the organisations below for more information and support.
The Lymphoma Association gives emotional support, advice and information on all aspects of NHL. It has a national network of people with lymphoma and local groups.
Leukaemia CARE is a national group promoting the welfare of people with leukaemia and related blood disorders, including NHL. It has regional support groups in many counties.
This section has been compiled using information from a number of reliable sources, including:
Canellos, et al. The Lymphomas. 2nd edition. 2006. Saunders Elsevier.
Lee, et al. Wintrobe’s Clinical Hematology. 12th edition. 2009. Lippincott Williams and Wilkins.
Onal C, et al. Treatment results and prognostic factors in primary thyroid lymphoma patients: a Rare Cancer Network study. Annals of Oncology 22: 156–164, 2011.
Wartofsky L and Van Nostrand D. Thyroid Cancer. 2nd edition.2006. Humana Press.
With thanks to: Professor Rajnish Gupta, Consultant Medical Oncologist; and all of the people affected by cancer who reviewed this edition.
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