Thyroid lymphoma

Thyroid lymphoma is non-Hodgkin lymphoma (NHL) that starts in the thyroid gland.

The thyroid gland sits just below the voice box. It makes hormones that control the body’s metabolism – the rate at which the body works.

Non-Hodgkin lymphoma is a cancer in which white blood cells, called lymphocytes, become abnormal. In thyroid lymphoma, lymphoma cells build up in the thyroid causing a lump or swelling in the front of the neck.

If the swelling is large this may cause pain, hoarseness, difficulty swallowing or breathlessness.

To diagnose lymphoma a doctor removes a sample of cells or tissue from the thyroid to check for lymphoma cells. You will also have tests and scans to find out whether the lymphoma has spread elsewhere. This is called staging.

There are different types of NHL that can start in the thyroid gland, some are slow growing and some are fast growing. Treatment depends on the type and stage of the NHL. It may involve radiotherapy or chemotherapy on its own or combined with monoclonal antibody therapy.

Thyroid lymphoma

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.

Rarely, another type of lymphoma known as Hodgkin lymphoma may start in the thyroid gland. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having treatment.


Non-Hodgkin lymphoma

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.

Lymphatic system
Lymphatic system

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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 that the body doesn't need or is harmful. 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 gland

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 called 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 different functions of the body.

Position of the thyroid gland
Position of the thyroid gland

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The thyroid keeps the body working at its normal rate (metabolism). It does this by making two hormones called thyroxine (T4) and triiodothyronine (T3).

The thyroid gland needs a regular supply of iodine to make thyroxine. We get iodine in our diet from fish, dairy products and table salt, which has iodine added to it.


How common is Thyroid lymphoma?

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

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 and mucosa-associated lymphoid tissue (MALT) lymphoma.

Other types of lymphoma, including follicular lymphoma, can also start in the thyroid gland.


Signs and symptoms of thyroid lymphoma

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 other symptoms including:

  • neck pain
  • a hoarse voice
  • difficulty swallowing
  • breathlessness.


How thyroid lymphoma is diagnosed

Thyroid lymphoma can sometimes be difficult to diagnose and you may have several tests.

Ultrasound scan of the thyroid

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 that makes sound waves is placed directly on the skin over the area. The sound waves are changed into a picture by a computer.

Fine needle aspiration

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 small sample of cells, which are examined under a microscope to check for cancer cells.

Excision biopsy

A definite diagnosis can usually be made by doing a biopsy. This is done under a general anaesthetic. The doctor will make a small cut in the skin close to the thyroid and remove a small sample of tissue. Cells from the tissue are examined under a microscope.


Staging and grading of thyroid lymphoma

Staging

The stage of a cancer is the term used to describe its size and whether it has spread. In thyroid cancer it looks at whether it is only in the thyroid gland or has spread to lymph nodes or other parts of the body.

Grading

Non-Hodgkin lymphomas are usually divided into two groups:

  • indolent lymphomas (sometimes called low-grade lymphomas), which are usually slow-growing
  • aggressive lymphomas (sometimes called high-grade lymphomas), which grow more quickly and usually need to be treated soon after diagnosis.

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.

You usually have other tests to find out about the type of lymphoma and its stage. These may include blood tests, x-rays, scans and having a sample of bone marrow taken.

The results of these tests help doctors decide which treatment is most appropriate for you. You can read more about staging and grading in our general information about non-Hodgkin lymphoma.


Treatment for thyroid lymphoma

Treatment for thyroid lymphoma depends on a number of factors including:

  • the type of lymphoma
  • its stage
  • your general health.

You may have only one type of treatment or a combination of treatments.

Radiotherapy

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 only in their thyroid, radiotherapy may be the only treatment they need. Treatment is given in the hospital radiotherapy department, usually from Monday to Friday, with a rest at the weekends. The length of your treatment will depend on the type and size of the cancer. Your doctor will explain how long your course of treatment might be.

Radiotherapy doesn’t make you radioactive and it’s perfectly safe for you to be with other people, including children, throughout your treatment.

Chemotherapy

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:

  • CHOP, which includes the chemotherapy drugs cyclophosphamide, doxorubicin and vincristine, and the steroid prednisolone. You may also be given a monoclonal antibody drug called rituximab (Mabthera ®) in the combination (R-CHOP).
  • CVP, which includes the chemotherapy drugs cyclophosphamide and vincristine and the steroid prednisolone. You may also be given the monoclonal antibody rituximab (R-CVP).
  • The chemotherapy drug chlorambucil, which may be given with or without rituximab.

Monoclonal antibodies

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 (Mabthera ®). It’s usually given in combination with chemotherapy.

Steroids

Steroids are drugs that may be used to help make chemotherapy more effective. They also help you feel better and can reduce feelings of sickness.

They're usually given as tablets, but may also be given as an injection into a vein (intravenously). Possible side effects of steroids include weight gain, restlessness, agitation and sleep disturbance. These are temporary and usually go away when treatment finishes.

Surgery

Surgery to remove the thyroid isn't a common treatment for thyroid lymphoma. Research has shown that it does not increase the chance of curing 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

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. They will discuss the treatment with you, so that you have a full understanding of what it means to take part. You can leave the trial at any stage. You will then receive the best current treatment available.


Your feelings

Finding out you have thyroid lymphoma can be difficult. Everyone has their own way of dealing with their illness and the different emotions they have. 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.


Other useful organisations

The Lymphoma Association

The Lymphoma Association gives emotional support, advice and information on all aspects of Hodgkin lymphoma and non-Hodgkin lymphoma. It has a national network of people with lymphoma and local groups.

Leukaemia CARE

Leukaemia CARE is a national group promoting the welfare of people with leukaemia and other blood disorders, including non-Hodgkin lymphoma. Has regional support groups in many counties.