thyroid cancer and tailbone pain thyroid cancer and tailbone pain

As prostate cancer grows, it can lead to bone pain. This might happen after a fall backward or from repeatedly sitting on something hard or narrow (like a wooden bench), especially while leaning back or slouching. What is thyroid cancer? What Is Spinal Decompression Therapy? Your healthcare provider can discuss the best treatment option for the type of thyroid cancer you have. Tailbone pain from childbirth is often caused by bone bruise or ligament strain. A single copy of these materials may be reprinted for noncommercial personal use only. Chordomas form from the left-over cells that were important in . Most thyroid cancers are asymptomatic. Cells are removed and analyzed to see if they are cancerous. Three unique symptoms of a tailbone injury include3: While in a seated position, tailbone pain may be relieved by leaning forward or leaning on one buttock, which decreases the amount of weight on the tailbone.3. Although any type of cancer can spread to the spine, the most likely are: The symptoms of a vertebral tumor on the tailbone are basically the same as for chordoma. Hypothyroidism: Should I take iodine supplements? The radiation kills the cancer cells and lessens pain. When cancer cells do this, it's called metastasis. Sometimes, though, the tailbone can fracture. This means the pain feels like it is coming from your tailbone when it's really coming from another part of your body. If the area is tender, it could mean there's a fracture. If you dont receive our email within 5 minutes, check your SPAM folder, then contact us The cause of a spinal tumor depends on what type it is primary or secondary . It might hurt when you stand up, have sex, or go to the bathroom. Scientists arent sure of the cause of most primary spinal tumors. This is also rare. During your appointment, your healthcare provider will: Depending on the results of these tests, your primary care or family healthcare provider may refer you to a healthcare provider who specializes in thyroid care (called an endocrinologist). Canker Sores: Festering words held back by the lips. Your provider may recommend special tests of your cancer cells to see which treatments might help. https://www.nccn.org/guidelines/guidelines-detail?category=3&id=1454. Blame. Unique coccyx morphology: Not everyone has the same number of tailbone bones. If these are positive for thyroid cancer, fortunately, the surgeon will do a comprehensive surgery to remove both the thyroid and the lymph nodes. Recognition and management of nonrelaxing pelvic floor dysfunction. A dental X-ray now and then will not increase your chance of getting thyroid cancer. Arcus senilis: A sign of high cholesterol? Lymph nodes frequently become swollen as a result of cancer, so its very important to be seen by a medical expert if you notice any enlargement or tenderness under your jaw or on either side of your neck. There is a problem with During your exam your doctor will look for: Your doctor may also press on your tailbone. The benefit of this is that you might be able to preserve your own thyroid function after surgery. other information we have about you. Causes of Tailbone Pain and Treatment Options. Breast Health Meet the Team . Coccyx pain is usually worse when sitting or when standing up from sitting. Watch:Coccydynia Video. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. It may be bone cancer or another type that spreads to into your bone, which is called metastatic cancer. A tumor or cancer in your colon or rectum can cause tailbone pain. Choosing a Mattress When You Have Back Pain. Loss of pain and/or temperature sensation. Symptoms of brain metastasis vary according to where the metastatic lesion(s) are located in the brain. Considering the possibility of interrupted blood flow to the thyroid gland but also to the head region from cervical spine disruption, I often ask my Hypothyroid Mom readers with symptoms related to the head region these questions: Do you experience dizziness, blurry vision, or ringing in your ears upon turning your head from side to side? Overactivity or irritation of these nerves may cause recurrent tailbone pain. These can help ease pain and avoid further injury as you heal. Pelvic floor muscle spasms: The tailbone is where a deep layer of pelvic floor muscles attach. Mayo Clinic: Mayo Clinic Q and A: Tailbone pain often goes away without medical treatment, Pilonidal cyst, Tailbone pain: How can I relieve it? Vertebral tumor., Cleveland Clinic: Can You Actually Break Your Tailbone Or Only Bruise It? Coccydynia (Tailbone Pain)., Royal Berkshire Hospital: Coccyx pain following childbirth., European Journal of Physical and Rehabilitation Medicine: Postpartum Coccydynia: A Case Series Study of 57 Women., Los Angeles Colon & Rectal: Hemorrhoids and Tailbone Pain. Antidepressant withdrawal: Is there such a thing? Mayo Clinic; 2021. When you dont have enough fat on your buttocks, your tailbone can rub against nearby tissues and cause pain. The chances that a nodule is cancerous are small. Also Check: Medicine For Thyroid Eye Disease. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Spinal decompression therapy is a broad category of treatments designed to provide pressure and pain relief along the spine. Damage to your parathyroid glands also can occur during surgery, which can lead to low calcium levels in your body. Can you exercise when you have an injured tailbone? doi:10.4184/asj.2014.8.6.705. Carpal tunnel syndrome. J Bone Jt Infect. Vertebral tumor. This is a special wedge-shaped cushion available over the counter. Talk to your doctor if it doesnt get better. markatger Member Posts: 314. Instead, use a coccygeal cushion. Cancer stage is indicated with a number between 1 and 4. Accessed Dec. 14, 2022. Vaccarella S, et al. There are a few possible causes of tailbone pain. 2021; doi:10.3390/ijms222312992. Worldwide thyroid-cancer epidemic? The symptoms of a vertebral tumor on the tailbone are basically the same as for chordoma. This means that patients can undergo lobectomy to remove half the gland instead of the entire gland. The surgery is not commonly done, but it can be efficiently performed by experienced orthopedic or spinal surgeons. It can take time to accept and learn to cope with a thyroid cancer diagnosis. If ONJ does occur, the doctor will stop the bone medicine. He teaches as an Assistant Professor of Orthopedics at Emory School of Medicine in Atlanta, Georgia. Pain from spinal tumors in your middle or lower back is more common, as tumors are more likely to develop in those regions of your spine. Changes in other genes have also been found. Most thyroid cancers don't cause any signs or symptoms early in the disease. Annals of Surgery. These systems carry fluids around your body, so they can carry cancer cells from one area of your body to another. (2012). How long it takes to recover will depend on your situation and the type of surgery you had. This is an injection that helps block pain signals. How can I sleep comfortably with tailbone pain? The bones of the tailbone can be injured directly, such as in a fall. If your thyroid hormones are too low after surgery (hypothyroidism), your health care team might recommend thyroid hormones. Clinical trials, physical therapy, and pain management may also be used to manage bone mets. Systemic treatments are: Local therapies target only the bone met and not the whole body: More information about the treatment of bone mets can be found in Bone Metastases Treatment. Read Also: How To Fix Thyroid Problems Naturally. Although papillary thyroid cancer often spreads to lymph nodes in your neck, the disease responds very well to treatment. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. You might also need thyroid hormone replacement after having surgery to remove part of the thyroid, but not everyone does. Persistent tailbone pain is known as coccydynia. They produce parathyroid hormone, which plays a role in regulating the body's blood level of calcium and phosphorus. Avoid constipation: Constipation can make tailbone pain worse. For thyroid cancer, some basic questions to ask include: If any additional questions occur to you during your visit, don't hesitate to ask. I'm Dr. Mabel Ryder, an endocrinologist at Mayo Clinic, and I'm here to answer some of the important questions you may have about thyroid cancer. You might have a test to see if your cancer is likely to be helped by radioactive iodine, since not all types of thyroid cancer respond to this treatment. } Are your symptoms occasional or continuous? Scientists are using brachyury to develop immunotherapy for chordoma. During this exam, the doctor inserts a lubricated, gloved finger into your anus and grasps your tailbone between thumb and forefinger. As the mass grows, it can cause pain. Depending on the cause and severity, pain from an injured tailbone can be mild to severe and range from a dull ache to sharp, stabbing pain. Your in-depth coping with cancer guide will be in your inbox shortly. Ligaments and muscles around the coccyx can get stretched and strained during delivery and cause pain. Common treatments for cancer include surgery, loss of sensation in the area of the groin, prolonged sitting on a narrow or hard surface, loosening of ligaments around the coccyx in the last trimester of pregnancy. Some experts say scoliosis is a possible cause of tailbone pain. Carrying too much weight puts extra pressure on your coccyx when you sit down. Who is most likely to get thyroid cancer? A doctor may recommend steroid or nerve block injections, coccygeal manipulation, and/or pelvic floor physical therapy to manage your tailbone pain.3 In rare cases and depending on the cause, surgical removal of the coccyx may be recommended. By Colleen Doherty, MD If your provider suspects that you may have a thyroid problem, you may be referred to a doctor who specializes in diseases of the endocrine system (endocrinologist). Has the cancer spread outside of the thyroid gland? Rarely, tailbone pain may be caused by an infection or cancer. Almost all thyroid nodules that can be seen should have a FNA thyroid needle biopsy. C7 disruption can pinch the nerves as well as the blood vessels including the blood vessels to your thyroid gland. Orthopaedic injuries in equestrian sports: a current concepts review. Your health care team uses information from your tests and procedures to determine the extent of the cancer and assign it a stage. The best way to partner with your team is to be open with your team about your questions, your fears and anxieties about your disease, and to be honest about your goals of care. This is because these activities cause repeat pressure or friction on the tailbone. How Are the Causes of Tailbone Pain Diagnosed? This is also rare. Medication: Chemotherapy, targeted therapy, immunotherapy, and hormone therapy treat the primary cancer and can go through the body to kill cancer cells, including bone met cells. If you have a pilonidal cyst, you may notice: If you have a pilonidal cyst, your doctor may numb the area and make an incision to drain the cyst. Depending on the location and type of the spinal tumor, other signs and symptoms in addition to pain can develop. Radioactive iodine treatment uses a form of iodine that's radioactive to kill thyroid cells and thyroid cancer cells that might remain after surgery. And there's no side effects when you're on the right dose. Society of Nuclear Medicine and Molecular Imaging. Tests might measure: These blood tests are also used to look for signs of cancer recurrence. Healthy thyroid cells absorb and use iodine from the blood. Yes, a thyroid nodule can cause a feeling like something is stuck in your throat, such as a piece of food. Endocrinologist Mabel Ryder, M.D., answers the most frequently asked questions about thyroid cancer. An endocrinologist may take another look at the thyroid nodule with ultrasound in his or her office and perform a fine-needle aspiration (FNA) biopsy to see whether cancer cells are present. Carpal Tunnel Syndrome: Anger and frustration at life's seeming injustices. For example, you might fall hard on your bottom while skiing. McGraw Hill; 2022. https://accessmedicine.mhmedical.com. Some causes of pain can be treated with physical therapy. Should I look out for signs of complications? This is especially true if the delivery is difficult. Pain during bowel movements and pain during sex are also common. Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Antidepressants and alcohol: What's the concern? It's safe. Finding new ways of coping with the symptoms of stress may improve your overall quality of life. Klippel Feil syndrome (KFS) is a congenital condition involving the fusion of one or more neck vertebrae, among other symptoms. These ideas may help: Having cancer can change your life in many ways. The American Cancer Society estimates that 44,280 new cases of thyroid cancer will be diagnosed in the U.S. in 2021. Experts estimate that this occurs in 0.1 to 5% of all cases of papillary thyroid cancer (the most common type of thyroid cancer). Isnt specifically associated with an injury, stress or physical activity but can get worse with strain, such as from exercise, sneezing or coughing. This may happen with certain cancers such as: When this happens, the tumor may cause tailbone pain. List your questions from most important to least important in case time runs out. Many muscles and ligaments attach to the tailbone. Learn the symptoms and your options for treatment. 2014;8(6):705710. Recovery may take a while. What might happen if I decide to have regular checkups but not have cancer treatment? Elsevier; 2020. https://www.clinicalkey.com. The increasing impact of overdiagnosis. A biopsy must be performed to confirm the diagnosis. In the lab, a doctor who specializes in analyzing blood and body tissue (pathologist) examines the tissue sample under a microscope and determines whether cancer is present. Coccyx pain in women after childbirth. J Am Acad PA. 2019;32(4):54-6. doi:10.1097/01.JAA.0000554227.56253.88, Dudareva M, Ferguson J, Riley N, Stubbs D, Atkins B, McNally M. Osteomyelitis of the pelvic bones: a multidisciplinary approach to treatment. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Your health care provider might recommend blood tests and an ultrasound exam of your neck once or twice a year. You may opt-out of email communications at any time by clicking on Moutvic M. (2018). Often, treatment of your primary cancer is the best treatment for bone metastasis. Brain metastasis from papillary thyroid carcinomas. Will I be able to work and do my usual activities during thyroid cancer treatment? By Elizabeth Quinn When a cyst gets infected, it causes swelling and pain. It may happen if you fall backward or get hurt while playing sports like skating and gymnastics. Palliative care teams aim to improve quality of life for people with cancer and their families. Aggressive thyroid cancers that grow more quickly may require additional treatment options to control the disease. It can also result from repetitive strain that comes with activities like cycling or rowing. Lumps in the thyroid are common and are usually benign. You may also get tailbone pain after sitting on a hard surface for a long period of time. Standing up or walking may ease the ache. Everyone eventually finds their own way of coping. Accessed Dec. 14, 2022. Some people also have a bone spur on the lowest tip of the tailbone. Cancer Clinical Trials . AskMayoExpert. Tailbone pain is felt at the base of your spine. Whatever the cause, if your aches dont get better, see your doctor. Taking a hot bath to relax muscles and ease pain. Cancer Stat Facts: Thyroid Cancer, Rapid growth of the nodule within a short period of time, Nodule that feels "stuck" or tightly attached to the surrounding tissue, Pain in the front of the neck where the thyroid gland is located may move or radiate up to the jaw or ears, Problems swallowing if the thyroid nodule gets too large and presses on your, Problems breathing if the nodule gets too large and presses on your, A persistent cough without other cold symptoms, Hoarseness, if cancer invades the nerve the controls the vocal cords. Newsletter: Mayo Clinic Health Letter Digital Edition, Book: Mayo Clinic Family Health Book, 5th Edition. Tailbone pain is common. privacy practices. This often includes: In very rare cases, you may need surgery to remove your tailbone. Bone metastasis may cause bony pain, fractures, and spinal cord compression. Lancet. Can I take some time to consider my options? Sex bias in differentiated thyroid cancer. Is there a risk of rhabdomyolysis from statins? People who have been exposed to a lot of radiation have a greater chance of getting thyroid cancer. Other causes of tailbone pain are less common. Melmed S, et al. Mayo Clinic; 2018. The tailbone might also look like its sticking out after weight loss or injury. Asian Spine J. Try not to feel embarrassed or self-conscious about it. Cancer in these areas is called colorectal cancer. During a fine-needle aspiration biopsy, your provider inserts a long, thin needle through your skin and into the thyroid nodule. In order to function properly, your thyroid gland requires proper blood flow to carry oxygen-rich blood via arteries to the thyroid gland and take the waste products away from the thyroid gland via veins. The symptoms of spinal tumors depend on several factors, including: Some spinal tumors cause no symptoms because theyre small enough to not press on and irritate nearby tissues. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. It certainly won't hurt to get a thyroid test, even if it isn't the source of your tailbone/leg/foot pain. To prevent tailbone pain, use good form when you sit down. But past radiation treatment of your head, neck, or chest can put you at risk of getting thyroid cancer. If you have a lot of pain or it interferes with your regular activities, see your doctor. In others, growth may eventually be detected and treatment can begin. Dont Miss: Natural Desiccated Thyroid Buy Online. Special pillows with a face cut out let you lie on your stomach with your head down. Spinal tumors can also cause radicular pain, which is pain that radiates from your spine to your hips, legs, feet or arms. This is a circular cushion with a hole in the middle. Causes of Buttock Pain and Treatment Options, Lower Right Back Pain: Causes and Treatment, Causes of Neck Pain and Treatment Options, Causes of Foot Pain and Treatment Options, Why Do My Ribs Hurt? You should be able to return to normal daily activities over time as you heal. The pain typically lasts for weeks to months and can become debilitating. Mayo Clinic does not endorse companies or products. Your doctor may also recommend a topical or oral nonsteroidal anti-inflammatory drug (NSAID). Some people may experience tailbone pain as a dull, throbbing ache. This is important because papillary thyroid cancer and other types of thyroid cancer commonly spread to lymph nodes in the neck. Click here for an email preview. Thank you, {{form.email}}, for signing up. Instead, youll need to be patient and go through physical therapy to get back into shape. the unsubscribe link in the e-mail. Tailbone pain tends to occur when sitting, standing for long periods, and rising from a seated position. Medullary thyroid cancer originates from these "C" cells, unlike the other types of thyroid cancer which originate from thyroid follicular cells (the cells that make thyroid hormone). Primary bone tumors may also occur on the tailbone or in the tailbone area. These ulcers form when long-term pressure limits blood flow to the area. U.S. Nuclear Regulatory Commission. There's also a risk that the nerves connected to your vocal cords might not work as expected after surgery, which can cause hoarseness and voice changes. While your tailbone pain doesnt necessarily mean you have cancer, there are forms of cancer that can affect the tailbone. Health Education & Content Services (Patient Education). Start Here. with cancer, plus helpful information on how to get a second opinion. Dont Miss: Stage 2 Papillary Thyroid Cancer. Male depression: Understanding the issues. I now am having dull pain back there. Most people diagnosed with thyroid cancer have an excellent prognosis, as most thyroid cancers can be cured with treatment. Since your spine has a significant blood supply and is near lymphatic and venous drainage systems, its generally vulnerable to metastasis. 2014;14(1):8487. 05/23/2018. 2023 Dotdash Media, Inc. All rights reserved. The alcohol causes the thyroid cancer cells to shrink. Back pain is the most common symptom of both benign and malignant spinal tumors. Tailbone pain can vary from person to person. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. The results aren't always clear. This can lead to an open sore that doesnt heal or tooth loss in that area. Your care team also considers your preferences when creating a treatment plan. This is a condition that causes a dull, aching pain. The jawbone can also become infected. 21st ed. If you have chordoma, your doctor may recommend treatment with: Tailbone pain is sometimes related to prostate cancer, a common cancer in men. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Examples include: Proctalgia fugax: This is a severe but fleeting episode of rectal pain. This will help soften stools and make bowel movements easier. This is the triangle-shaped bone at the base of your spine. Signs of infection, like warmth, redness, or discharge, A skin dimple, which could be a sign of a bone spur, Exercises to help you improve your posture, Reverse Kegels, or relaxation exercises for your pelvic floor. Research is ongoing in the prevention and treatment of bone metastases. You'll be given instructions for precautions you need to take during that time to protect other people from the radiation. Until you find what works for you, consider trying to: If you have signs and symptoms that worry you, start by seeing your family health care provider. You may develop this pain after direct trauma or spontaneously without a specific inciting factor. Some of the methods include getting an X-ray or MRI scan done . Tailbone pain, or coccydynia, can be a dull ache or a sharp pain at the bottom of your spine. It's most often used after surgery to find any cancer cells that might remain. Schumm MA, et al. Your care team will monitor you for bone mets throughout your cancer treatments. Coccydynia (tailbone pain). Doing these things over and over puts an ongoing strain on your muscles, ligaments, and spine, which leads to pain. Hypothyroidism: Does it cause joint pain? Cancer Stat Facts: Thyroid Cancer. AskMayoExpert. Here are some self-care strategies you can do at home. If there's a high likelihood that a nodule might be cancerous, additional tests are needed to confirm the diagnosis and determine what type of thyroid cancer is present. time. Higher doses may cause: Most of the radioactive iodine leaves your body in your urine in the first few days after treatment. As thyroid cancer grows, it may cause: A lump (nodule) that can be felt through the skin on your neck A feeling that close-fitting shirt collars are becoming too tight Changes to your voice, including increasing hoarseness Difficulty swallowing You may opt-out of email communications at any time by clicking on Some target the blood vessels that cancer cells make to bring nutrients that help the cells survive. doi:10.4184/asj.2013.7.4.322, Jeyarajah S, Purkayastha S. Proctalgia fugax. Advertising revenue supports our not-for-profit mission. If you sit on a hard chair or hard surface for too long, you may feel pain in your tailbone. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). It can also happen when youre driving or if on a heavily cushioned surface if youre in awkward position. When the radioactive iodine is injected in a vein or swallowed, any thyroid cancer cells in the body will take up the iodine. That can cause tailbone pain. Thyroid Cancer Treatment. Head Neck Oncol. But like other cancers, changes in the DNA of your cells seem to play a role. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Accessed Jan. 25, 2022. Have you ever been treated with radiation therapy? Anaplastic and medullary thyroid cancers usually aren't treated with radioactive iodine. Ganglion impar block in patients with chronic coccydynia. Elizabeth Quinn is an exercise physiologist, sports medicine writer, and fitness consultant for corporate wellness and rehabilitation clinics. Its rare, but the bones in your coccyx could break during delivery. at newsletters@mayoclinic.com. If we combine this information with your protected Postgrad Med. Medullary thyroid cancer. As the mass grows, it can cause pain. Weakness in the legs or arms. It is located in front of the upper part of the tailbone. Cholesterol ratio or non-HDL cholesterol: Which is most important? The infection can cause: A bone infection called osteomyelitis may also cause tailbone pain. Problems swallowing if the thyroid nodule gets too large and presses on your esophagus (the tube that connects your throat to your stomach) Problems breathing . Feb. 26, 2022. It is best to avoid these procedures while you are taking one of these medicines. Health Education & Content Services (Patient Education). Mayo Clinic; 2021. Thyroid disease: Can it affect a person's mood? In very rare cases, tailbone pain can be a sign of cancer. How quickly do I need to make a decision about thyroid cancer treatment? If you have prostate cancer, your doctor may recommend: A vertebral tumor is a tumor in your spine that affects your bones or vertebrae. .st1 { Natural remedies for depression: Are they effective? Your time with your provider is limited, so preparing a list of questions can help you make the most of your time together. What is the best treatment for this type of thyroid cancer? Specifically, hypothyroidism may lead to: Muscle aches, tenderness and stiffness, especially in the shoulders and hips. Oluseun Olufade, MD, is a board-certified orthopedist. WebMD does not provide medical advice, diagnosis or treatment. Broken bones. These treatments can have a rare but serious side effect called osteonecrosis of the jaw . In a small group of patients, the disease may be advanced. By blocking these chemicals, targeted drug treatments can cause cancer cells to die. Have you been diagnosed with any other medical conditions? Accessed at https://www.cancer.gov/types/thyroid/patient/thyroid-treatment-pdq#_1. What is depression? Having jaw surgery or having a tooth removed can trigger this problem. If this test does reveal an abnormal thyroid level, please do get a full thyroid panel workup to further determine what is happening there. Our website services, content, and products are for informational purposes only. A fractured tailbone can take four to six weeks. 14th ed. With greater science, with data from the laboratory and clinical trials, and with technology, we're able to improve the treatments for our patients. Allscripts EPSi. If you've been diagnosed with papillary thyroid cancer, you may be able to save part of your thyroid. Some people might have longer tailbones than others. This spread is called metastasis. It is most often found near the tailbone (called a sacral tumor) or where the spine meets the skull (called a clival tumor). Recommended Reading: Does Selenium Help Thyroid Eye Disease. This is an abnormal curve in the spine. Accessed Jan. 20, 2022. Performing specific. Rarely, the joint between your tailbone and your sacrum may be dislocated. Your provider uses the needle to remove some cells from the thyroid. In: Musculoskeletal Imaging. Ultrasound uses high-frequency sound waves to create pictures of body structures. National Cancer Institute.Surveillance, Epidemiology, and End Results Program. Increasingly, palliative care is being offered early in the course of cancer treatment. Everything you need to know about coccydynia. Colon cancer Some people with colon cancer feel pain in their tailbone. During needle biopsy, a long, thin needle is inserted through the skin and into the suspicious area. This test is most helpful for papillary and follicular thyroid cancers. 6th ed. Which operation your health care team might recommend depends on your type of thyroid cancer, the size of the cancer and whether the cancer has spread beyond the thyroid to the lymph nodes.