September is Thyroid Cancer Awareness Month. Thyroid cancer is one of the few cancers that is actually on the rise in the United States and few people know about it.

Here are five important things to know about thyroid cancer.

1. Thyroid cancer may have no symptoms.

In some cases of thyroid cancer have absolutely no symptoms. In fact, some are detected only because ultrasound or imaging tests on other parts of the body picked up the nodules.

When thyroid cancer is symptomatic, typical symptoms include a palpable lump or nodule, hoarseness, and difficulty swallowing.

2. Small papillary thyroid cancer may not require aggressive treatment.

While the typical treatment for most thyroid cancer is a full thyroidectomy, followed by radioactive iodine (RAI) to kill of remnant thyroid tissue, experts are now saying that small papillary carcinomas may not require this full range of treatment.

Some recommend a watch-and-wait approach for papillary “microcarcinomas” and researchers are now saying that if surgery is called for, cancerous nodules less than 4.0 cm in size may require only a lobectomy — a partial thyroidectomy in which only a lobe/half of the thyroid gland is removed — versus a full thyroidectomy.

3. It may not be thyroid cancer – but the biopsy may not give you that information.

When you have a suspicious thyroid nodule, the first step is usually a fine needle aspiration (FNA) biopsy, to look for cancer. If cancer is found, a thyroidectomy is usually scheduled. However, an FNA is not always conclusive. In the United States, an estimated 450,000 patients have suspicious thyroid nodules biopsied, and as many as 30% of those nodules are classified as “indeterminate” or “inconclusive.”

This means that they can’t rule out cancer, but it’s not clear. Until recently, doctors recommended these patients have a thyroidectomy.

In 70 to 80 percent of those patients with indeterminate nodules, the nodule ended up being benign — not cancerous — and the patient lost their thyroid gland, and required lifelong hypothyroidism treatment.

A test that we use called the Veracyte Afirma Thyroid Analysis, however, when conducted on the FNA results, can provide near conclusive results and eliminate most indeterminate/inconclusive FNA results, as well as surgeries for benign nodules.

4. You may not need to go off your thyroid hormone replacement for a scan.

After thyroid cancer patients have had surgery, and radioactive iodine to eliminate any thyroid tissue remnants, patients must go on thyroid hormone replacement drugs — like Synthroid, Levoxyl, Tirosint, etc. to replace the body’s missing thyroid hormone. But in the past, periodically, these patients have had to go off their medications, wait for their TSH to reach high levels (i.e., 30, 40 etc.) and go through weeks of profound and debilitating hypothyroidism, prior to a scan to detect any cancer recurrence.

In recent years, however, a drug called Thyrogen has been used to help patients avoid this difficult hypothyroid period. Patients go off their thyroid hormone replacement and get a dose of Thyrogen, which allows for an accurate scan — without hypothyroidism symptoms.

Not all situations are suitable for Thyrogen, but there are definitely patients in the U.S. who could benefit from this drug who are still not getting it prior to their scans.

5. Thyroid cancer patients face an increased risk of secondary cancer.

While most forms of thyroid cancer – especially at Stages I, II and III — are highly survivable, many thyroid cancer patients are not told that they face an overall 30% increased risk of developing a second primary cancer. That risk is highest in the first year after treatment for non-melanoma skin cancer, prostate cancer, kidney cancer, adrenal gland cancer, and non-Hodgkin’s lymphoma.