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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
Find out how we produce our information|
This information is about a type of non-Hodgkin lymphoma| called thyroid lymphoma.
Occasionally, another type of lymphoma called Hodgkin lymphoma| may arise in the thyroid gland. Our cancer support specialists| can give you information about Hodgkin lymphoma of the thyroid gland.
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.
The lymphatic system
View a large copy of the diagram of the lymphatic system|
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 that the body doesn't need. This includes bacteria, viruses, damaged cells and cancer cells.
Lymph fluid contains cells known as lymphocytes. Lymphocytes 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. It's 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.
Position of the thyroid gland
View a large copy of the diagram of the thyroid gland|
The thyroid is sometimes known as the 'activity gland' because it produces the two main hormones, thyroxine (T4) and triiodothyronine (T3). These hormones keep the body working at its normal rate (metabolism). The thyroid gland needs a regular supply of iodine (which is added to table salt and found in fish and dairy products) to produce thyroxine.
There are many different types of non-Hodgkin lymphomas. Most of them start in the lymphatic system. However, some can start in organs or tissue outside the lymphatic system. When this happens, the lymphoma is described as being extranodal. Thyroid lymphoma is a rare type of extranodal lymphoma.
There are different types of non-Hodgkin lymphomas that can affect the thyroid gland. The main ones are:
Other rarer types of lymphoma, including follicular lymphoma|, can start in the thyroid gland. We have more detailed information on all these and other types of lymphomas|.
Most people develop a lump in the thyroid. Sometimes there may be a larger swelling around the lower neck. This may make a person's voice hoarse or cause difficulty in breathing or swallowing.
Some people may have a history of Hashimoto’s thyroiditis, an inflammatory condition of the thyroid that is linked with thyroid lymphoma.
Thyroid lymphoma can sometimes spread to the lymph nodes nearby. The MALT type can involve the stomach or bowel (digestive tract). It's not common for thyroid lymphoma to spread to the bone marrow (where blood cells are made).
Thyroid lymphoma can sometimes be difficult to diagnose. Before a firm diagnosis can be made, a number of tests and investigations may be needed:
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 and can show whether the lump is solid or just fluid in a cyst.
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.
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 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. This information is used to help decide which treatment is most appropriate for you.
Thyroid lymphoma can spread to the lymph nodes and bone marrow, but this is uncommon. The term used to describe where the lymphoma is in the body is called staging|.
Non-Hodgkin lymphomas are divided into low and high-grade groups. Thyroid lymphoma can be either depending on the type of lymphoma you have.
MALT lymphomas tend to be low-grade. Low-grade lymphomas are usually slow-growing.
Diffuse large B-cell lymphomas are high-grade. High-grade lymphomas tend to grow more quickly.
Sometimes a low-grade lymphoma can change (transform) to a high-grade lymphoma.
The treatment you have depends on if you have a low or high-grade lymphoma and whether or not it is confined to the thyroid.
Radiotherapy| is the use of high-energy rays to destroy cancer cells while causing as little harm as possible to the healthy cells.
Your cancer specialist will tell you how long your radiotherapy will last for. The treatment will be given to you in the radiotherapy department, usually every weekday with a rest at weekends.
If the lymphoma is confined to the thyroid, radiotherapy to the thyroid may be the only treatment you need.
Radiotherapy is used to treat the thyroid, but only after you have had chemotherapy.
Chemotherapy| is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
Chemotherapy 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|).
It is often given in combination with a drug called rituximab (Mabthera®), which is a monoclonal antibody.
If the lymphoma has spread outside the thyroid or comes back after your first treatment, chemotherapy is usually given.
This may be with chemotherapy tablets called chlorambucil|. Or you may have a combination of chemotherapy and steroid drugs known as CVP| (cyclophosphamide, vincristine and prednisolone). Rituximab can be given along with these drugs (R-CVP|).
Chemotherapy is an important treatment for high-grade lymphoma. Because these lymphomas are fast-growing, chemotherapy is usually the first treatment and it's given soon after diagnosis.
If the lymphoma is contained within the thyroid you will usually have a short course of chemotherapy (3-4 cycles). If it has spread outside the thyroid 6-8 cycles of chemotherapy are usually given.
Treatment is usually a combination of drugs called R-CHOP|. This includes the chemotherapy drugs vincristine, cyclophosphamide and doxorubicin, as well as prednisolone (a steroid) and a monoclonal antibody called rituximab.
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.
Rituximab (Mabthera®)| is often given in combination with chemotherapy to treat low-grade and high-grade lymphomas.
Steroids| are drugs that are often given with chemotherapy to help treat lymphomas. They also help you feel better and can help nausea (feeling sick).|
Surgery to remove the whole thyroid isn't a common treatment for thyroid lymphoma. It is occasionally done in people with low-grade lymphoma.
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.
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.
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 our cancer support specialists| or the organisations below for more information and support.
This section has been compiled using information from a number of reliable sources, including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.