2015 NCCN Guidelines® for Thyroid Carcinoma Recommend LENVIMA™ (lenvatinib) as Preferred Agent

http://www.prnewswire.com/news-releases/2015-nccn-guidelines-for-thyroid-carcinoma-recommend-lenvima-lenvatinib-as-preferred-agent-300156158.html

WOODCLIFF LAKE, N.J., Oct. 8, 2015 /PRNewswire/ -- Eisai Inc. announced the decision of the National Comprehensive Cancer Network^® (NCCN^®) to recommend LENVIMA™ (lenvatinib) as the preferred agent for the treatment of patients with progressive and/or symptomatic metastatic differentiated thyroid cancer, including papillary, follicular and Hürthle cell thyroid carcinoma, that no longer responds to radioactive iodine therapy in the 2015 NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Thyroid Carcinoma. The panel based its recommendation on the response rate seen in the pivotal Phase 3 SELECT clinical trial. 

LENVIMA, a receptor tyrosine kinase inhibitor discovered and developed by Eisai, was approved by the U.S. Food and Drug Administration in February 2015 for the treatment of locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer (RAI-R DTC).

The most common types of thyroid cancer, papillary and follicular (including Hürthle cell), are classified as differentiated thyroid cancer (DTC) and account for approximately 95% of all cases. While most DTC patients are curable with surgery and radioactive iodine treatment, the prognosis for those patients whose cancers persist or recur is poor. There are a limited number of treatment options for this radioactive iodine-refractory form of thyroid cancer.

"We are pleased that the NCCN has recommended the use of LENVIMA as the preferred treatment option for patients with progressive and/or symptomatic metastatic differentiated thyroid cancer who have become refractory to radioactive iodine therapy," said RuiRong Yuan, MD, Chief Medical Officer, Eisai Global Oncology Business Unit, and Vice President, Medical Affairs, Americas Region, Eisai Inc. "This decision underscores the role of LENVIMA and provides oncologists and endocrinologists with an evidence-based, consensus-driven guide for decision-making when treating patients with this rare and difficult-to-treat cancer."  

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) document provides evidence-based, consensus-driven management to help patients receive preventive, diagnostic, treatment, and supportive services that are most likely to lead to optimal outcomes. The intent of the NCCN Guidelines is to assist in the decision-making process of individuals involved in cancer care—including physicians, nurses, pharmacists, payers, patients and their families—with the ultimate goal of advancing patient care in the fight against cancer.

About LENVIMA™ (lenvatinib)

LENVIMA™ (lenvatinib) is indicated for the treatment of patients with locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer (DTC).

LENVIMA, discovered and developed by Eisai, is a receptor tyrosine kinase (RTK) inhibitor that inhibits the kinase activities of vascular endothelial growth factor (VEGF) receptors VEGFR1 (FLT1), VEGFR2 (KDR), and VEGFR3 (FLT4). LENVIMA also inhibits other RTKs that have been implicated in pathogenic angiogenesis, tumor growth, and cancer progression in addition to their normal cellular functions, including fibroblast growth factor (FGF) receptors FGFR1, 2, 3, and 4; the platelet derived growth factor receptor alpha (PDGFRα), KIT, and RET. LENVIMA™ (lenvatinib) was approved under Priority Review designation for locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer by the FDA in February 2015. Eisai was granted Orphan Drug Designation (ODD) for lenvatinib in various types of thyroid cancer in the United States, Japan, and Europe.

Important Safety Information

Warnings and Precautions

• Hypertension reported in 73% of patients on LENVIMA vs 16% for placebo (44% vs 4% ≥grade 3). Blood pressure should be controlled prior to treatment. Withhold dose for grade 3 hypertension despite optimal antihypertensive therapy; resume at reduced dose when controlled at ≤grade 2. Discontinue for life-threatening hypertension.
• Cardiac dysfunction reported in 7% of patients on LENVIMA vs 2% for placebo (2% vs 0% ≥grade 3). Monitor for signs/symptoms of cardiac decompensation. Withhold for grade 3 cardiac dysfunction. Resume at reduced dose or discontinue based on severity and persistence of cardiac dysfunction. Discontinue for grade 4 cardiac dysfunction.
• Arterial thromboembolic events reported in 5% of patients on LENVIMA vs 2% for placebo (3% vs 1% ≥grade 3). Discontinue following an arterial thrombotic event. The safety of resuming LENVIMA after an arterial thromboembolic event has not been established, and LENVIMA has not been studied in patients who have had an arterial thromboembolic event within the previous 6 months.
• ALT and AST increases (≥grade 3) occurred in 4% and 5% of patients on LENVIMA vs 0% for placebo. Across clinical studies in which 1108 patients received LENVIMA, hepatic failure (including fatal events) was reported in 3 patients and acute hepatitis in 1 patient. Monitor liver function before initiation, then every 2 weeks for first 2 months, and at least monthly thereafter during treatment. Withhold dose for liver impairment ≥grade 3. Resume at reduced dose or discontinue based on severity/persistence of hepatotoxicity. Discontinue for hepatic failure.
• Proteinuria reported in 34% of patients on LENVIMA vs 3% for placebo (11% vs 0% ≥grade 3). Monitor for proteinuria before and during treatment. Withhold dose for ≥2 grams of proteinuria/24 hours. Resume at reduced dose when proteinuria is <2 discontinue="" for="" gm="" hours.="" li="" nephrotic="" syndrome.="">
• Events of renal impairment reported in 14% of patients on LENVIMA vs 2% for placebo (3% vs 1% ≥grade 3). Withhold LENVIMA for grade 3 or 4 renal failure/impairment. Resume at reduced dose or discontinue, depending on severity/persistence of renal impairment.
• Events of gastrointestinal (GI) perforation or fistula reported in 2% of patients on LENVIMA vs 0.8% for placebo. Discontinue in patients who develop GI perforation or life-threatening fistula.
• QT/QTc interval prolongation reported in 9% of patients on LENVIMA vs 2% for placebo (2% vs 0% ≥grade 3). Monitor ECG in patients with congenital long QT syndrome, CHF, bradyarrhythmias, or patients taking drugs known to prolong the QT interval. Monitor and correct electrolyte abnormalities in all patients. Withhold dose for ≥grade 3 QT interval prolongation. Resume at reduced dose when QT prolongation resolves to grade 0, 1, or baseline.
• Hypocalcemia ≥grade 3 reported in 9% of patients on LENVIMA (2% for placebo). Monitor blood calcium levels at least monthly and replace calcium as necessary. Interrupt and adjust LENVIMA as necessary. In most cases, hypocalcemia responded to replacement and dose interruption/reduction.
• Across clinical studies in which 1108 patients received LENVIMA, reversible posterior leukoencephalopathy syndrome (RPLS) was reported in 3 patients. Withhold LENVIMA for RPLS until fully resolved. Resume at reduced dose or discontinue based on the severity and persistence of neurologic symptoms.
• Hemorrhagic events occurred in 35% of patients on LENVIMA vs 18% for placebo (2% vs 3% ≥grade 3). The most frequently reported hemorrhagic event was epistaxis (11% grade 1 and 1% grade 2). Discontinuation due to hemorrhagic events occurred in 1% of patients on LENVIMA. There was 1 fatal intracranial hemorrhage case among 16 patients who received LENVIMA and had CNS metastases at baseline. Withhold dose for grade 3 hemorrhage. Resume at reduced dose or discontinue, based on severity/persistence of hemorrhage. Discontinue for grade 4 hemorrhage.
• LENVIMA™ (lenvatinib) impairs exogenous thyroid suppression. In patients with a normal baseline TSH, elevation of TSH level above 0.5 mU/L was observed post baseline in 57% of patients on LENVIMA (14% for placebo). Monitor TSH levels monthly and adjust thyroid replacement medication as needed in patients with DTC.
• LENVIMA may cause fetal harm when administered to a pregnant woman. Advise females of reproductive potential to use effective contraception during treatment with LENVIMA and for at least 2 weeks following completion of therapy.

Adverse Reactions

• The most common adverse reactions observed in LENVIMA-treated patients vs placebo-treated patients were hypertension (73% vs 16%), fatigue (67% vs 35%), diarrhea (67% vs 17%), arthralgia/myalgia (62% vs 28%), decreased appetite (54% vs 18%), weight decreased (51% vs 15%), nausea (47% vs 25%), stomatitis (41% vs 8%), headache (38% vs 11%), vomiting (36% vs 15%), proteinuria (34% vs 3%), palmar-plantar erythrodysesthesia syndrome (32% vs 1%), abdominal pain (31% vs 11%), and dysphonia (31% vs 5%).

Use in Specific Populations

• Because of the potential for serious adverse reactions in nursing infants, advise women to discontinue breastfeeding during treatment.
• LENVIMA may result in reduced fertility in females of reproductive potential, and may result in damage to male reproductive tissues, leading to reduced fertility of unknown duration.

For more information about LENVIMA, click here for the full Prescribing Information or visit www.LENVIMA.com.

About Eisai Inc.At Eisai Inc., human health care is our goal. We give our first thoughts to patients and their families, and helping to increase the benefits health care provides. As the U.S. pharmaceutical subsidiary of Tokyo-based Eisai Co., Ltd., we have a passionate commitment to patient care that is the driving force behind our efforts to help address unmet medical needs. We are a fully integrated pharmaceutical business with discovery, clinical, manufacturing and marketing capabilities. Our key areas of commercial focus include oncology and specialty care (Alzheimer's disease, epilepsy and metabolic disorders). To learn more about Eisai Inc., please visit us at www.eisai.com/US.

Eisai Inc. has affiliates that are part of a global product creation organization that includes R&D facilities in Massachusetts, New Jersey and Pennsylvania, as well as a global demand chain organization that includes facilities in Maryland and North Carolina. Eisai's global areas of R&D focus include neuroscience; oncology; metabolic disorders; vascular, inflammatory and immunological reaction; and antibody-based programs.

	Media Inquiries	Investor Inquiries
	Laurie Landau	Alex Scott
	Eisai Inc.	Eisai Inc.
	(201) 746-2510	(201) 746-2177

SOURCE Eisai Inc.


RELATED LINKS
http://www.eisai.com

WebMD: Experts Link Chemicals to Diabetes, Obesity

https://fepblue.webmdhealth.com/!newsletters?id=AD7jaLg1x2P97Mb5udhcAWrMK6Ql5BfFYnDzGqODA90w0&s=14148&mrdid=50f9b189-166e-e511-a515-a0369f30171a

By Brenda Goodman, MA

Reviewed by Brunilda Nazario, MD

Sept. 28, 2015 -- People who are trying to lose weight or manage diabetes should try to change their lifestyle not only to exercise or cut calories, but also to avoid chemicals that may be contributing to their condition, experts say.
“You may have a healthy meal, but if it’s in a plastic container, it’s leaching chemicals,” said Andrea Gore, PhD, a pharmacologist at the University of Texas at Austin in a webinar for reporters on Monday.
Gore is the chair of a task force that issued on Monday a new statement on the harm from hormone-disrupting chemicals. The statement, which is based on a review of more than 1,300 studies, says there’s convincing evidence to support a link between hundreds of hormone disruptors and several chronic health problems, including:

• Diabetes
• Obesity
• Heart disease
• Infertility
• Hormone-sensitive cancers in women (breast, endometrial, ovarian)
• Prostate cancer
• Thyroid problems
• Poor brain development and brain function in young children

Researchers say the statement is significant because it comes from a group of doctors that treat people for hormone problems instead of scientists who study the effects of chemicals in animals or on cells.
Gore said the evidence for these effects is now strong enough that everyone should take steps to avoid chemicals that block or mimic the action of hormones in the body.
She also called on doctors who are treating patients for infertility to tell their patients to avoid hormone disruptors, which are known to decrease semen quality and interfere with how ovaries work. She said doctors who are counseling pregnant women and the parents of young children should also warn about chemical exposures.
“In particular, we’re worried about fetuses, infants, children, etc.,” she said, because exposure to the chemicals during development could set the stage for disease down the road.
Avoiding these kinds of chemicals is easier said than done, however, since no one knows how many of them exist or exactly how they’re being used. That’s because chemicals aren’t tested for safety before they used in products that are sold to consumers.
There are about 85,000 chemicals known to be used in the U.S. No one knows how many might disrupt hormones.
“Not all of them are EDCs [endocrine-disrupting chemicals], but if even 1% of them were EDCs, that would be 850 chemicals,” Gore said.
Some of the best-known hormone-disrupting chemicals include:

• Bisphenol A (BPA) and bisphenol S, which are used in some plastics, metal food cans, and cash register receipts
• Phthalates, a class of chemicals that are used to soften plastic and also used in some perfumes, soaps, shampoos, and cosmetics
• Some pesticides, like DDT
• Triclosan, an antibacterial chemical

“They act at very low doses,” she said.
The statement calls for better safety testing to determine which chemicals could pose problems, tighter regulation, and more research on the health effects.
Environmental health experts cheered the new statement.
“I’m thrilled,” said Richard Stahlhut, MD, a visiting research scientist at the University of Missouri-Columbia.
“The endocrinologists had to be the first ones on board, and fortunately, they are,” he said. “If they’re not on board, then maybe people like me are crazy,” said Stahlhut, who studies the hormone-disrupting effects of chemicals like BPA.
Chemical manufacturers said the statement went too far.
“The statement incorrectly characterizes as settled the still-unproven hypothesis regarding risks of low levels of exposure to particular chemicals. In doing so, the [Endocrine] Society discounts the extensive reviews by experts at the U.S. Environmental Protection Agency and the European Food Safety Authority that were unable to substantiate the health significance of the so called low-dose effects,” said the American Chemistry Council in a statement.
“Furthermore, the Endocrine Society’s report fails to differentiate between chemicals that are 'endocrine-active,' meaning they interact with the endocrine system, and those that are 'endocrine disruptors,' meaning that the levels of exposure associated with that interaction cause scientifically-proven adverse health effects,” the statement said.
Some retailers and manufacturers aren’t waiting for the dust to settle on the chemical debate.
On Monday, Bloomberg News reported that Target is expanding the list of chemicals it would ask suppliers to take out of their products. The expanded list will included nearly 600 chemicals on Health Canada’s roster of prohibited cosmetic ingredients. It will include triclosan, which is found in antibacterial soaps and some toothpastes.
Walmart also has a list of substances it asks retailers to avoid, though it doesn’t post the list publicly, Bloomberg reported.
Until more is known, Gore said consumers could reduce their exposure to known endocrine disruptors by avoiding bottled water in plastic bottles and being careful not to heat or microwave food in plastic containers.
Stahlhut said people who are concerned about chemical exposure should try to do the best they can, but because it’s impossible to avoid all potential exposures, to “Try to be Zen about it. Don’t drive yourself crazy.”
He said he tries to eat and drink out of stainless steel or glass containers instead of plastic. He especially tries to avoid heating food in plastic. He said he tries to avoid chemicals in the nonstick coatings by cooking in cast-iron pans. And he steers clear of soaps and toothpaste with triclosan.
“Make the easy choices when you can. Make the harder choices when you can afford it,” he said.

Finding Calm in the Face of Cancer

A good list of ideas to help calm yourself when fearful, etc.  Of the list the author has here, I find mindless comedies (Laurel and Hardy's "The Music Box" never fails to help) and Deep Breathing to be the most helpful.

http://www.curetoday.com/community/susan-fariss/2015/09/finding-calm-in-the-face-of-cancer?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra_email_10-6-15

Chemotherapy: What You Need to Know Before You Begin Cancer Treatment

Pretty good overview of preparing for chemo and/or radiation.  Has some good, practical ideas.


  http://www.webmd.com/cancer/facing-chemotherapy-15/getting-ready/before-you-begin-cancer-treatment?page=1

Hilton Head Island pitcher overcame cancer, other obstacles on his way to The Show

http://hiltonheadmonthly.com/sports/hilton-head-recreation/2843-hilton-head-island-pitcher-overcame-cancer-other-obstacles-on-his-way-to-the-show

A good non-goopy article about a Thyroid Cancer survivor.

BY JUSTIN JARRETT | P HOTO BY POUYA DIANAT

To anyone else, it looked like a routine spring training appearance. A quick inning of work on one of dozens of indistinguishable Grapefruit League afternoons.
For Ryan Kelly, it was the biggest game of his life, because as far as he knew, it might be his last.

Three days later, Kelly had surgery to remove his cancerous thyroid, an ailment that was discovered during a routine physical just days earlier.
Kelly thought it might be the end of his long journey through professional baseball, but it turned into a beginning of a new, more fruitful quest that culminated with his long-awaited arrival in the big leagues.

THE ‘C’ WORD

When Kelly reported to spring training with the Atlanta Braves in February 2014, he did so with realistic hopes it was his time to reach the big leagues. The former Hilton Head Island High School star had pitched well at Triple-A Tucson in the San Diego Padres organization the previous season and signed a free-agent contract with the Braves in the offseason.
A month later, he was more concerned with his health than the status of his baseball career. He learned that March that he had thyroid cancer, and the road to the majors suddenly looked longer and more treacherous than ever.
There were complications during surgery, followed by weeks of radioactive iodine treatments. Kelly missed two months, an eternity for someone who can’t stand being on the disabled list, and began his season at Single-A Lynchburg, a long way from the majors. It took the full season for him to get back to full strength, and he was assigned to play in the Puerto Rican Winter League for the first time in his career to get in some of the work he missed.
“People think I’m crazy when I say it, but it was one of the best things that ever happened for me in my life,” Kelly says, noting the thyroid cancer had been the source of his difficulty staying at his optimum weight and maintaining his stamina.
More than that, though, it offered a dose of perspective. The notion that his baseball career might be over — as frustrating as it had sometimes been — provided added motivation.
“This is all I know,” Kelly said. “For there to be a chance for me to have that taken away, it hit me pretty deep. I wasn’t ready to give up playing. It completely changed that side of it. It made the game easier, because I had a lot less to worry about.
“It became fun again.”

LEARNING TO PITCH

That winter in Puerto Rico wound up being pivotal to Kelly’s development. He experimented with “pitching backward” — starting at-bats with off-speed pitches to keep hitters guessing and disrupt their timing — and learned to pitch inside more. The lessons he picked up carried over to the next spring.
Kelly began the 2015 season at Double-A Mississippi and was dominant. In his first 17 appearances, he posted a 0.48 ERA and 10 saves while holding opponents to a .197 batting average, earning a promotion to Triple-A Gwinnett. He was nearly as dominant there, going 1-1 with five saves and a 2.13 ERA in 10 outings.
“What got me that far was God-given talent — I was lucky enough to be able to throw hard and had good stuff, and that kind of carried me through,” Kelly said. “When I finally learned how to pitch, which probably took me longer than I’d care to admit, that’s when I really started to have success.”

THE CALL

On June 27, 2015, more than nine years after the Pittsburgh Pirates selected him in 26th round of the 2006 MLB Draft, Kelly got the call. He was going to The Show. The next afternoon, Kelly was in the Atlanta Braves’ bullpen — in Pittsburgh, oddly enough — eager for his big-league debut.
After an arduous nine-year trek to the bigs, Kelly had to wait two more days for his moment. With a group of family and friends cheering from the stands, Kelly ran in from the Turner Field bullpen on June 30 to face the heart of the Washington Nationals’ lineup.
Yunel Escobar greeted Kelly with a seeing-eye single through the middle, and then came his welcome-to-the-big-leagues moment. Bryce Harper, one of the brightest young stars in the game, roped a first-pitch single into right field. Kelly recovered nicely, getting a double-play grounder and a swinging strikeout to escape with only one run and elicit a celebration among his cheering section.
In hindsight, Kelly didn’t relish the moment as much as he would have liked.
“I was trying to keep my cool so much that I think I kind of brought myself down further than I would like to be,” Kelly said. “I didn’t want to let the bright lights and the fans and everything get involved with my outing. I didn’t really get to soak in everything.”
For the journey that led him so many places — from Hilton Head to Walters State Community College in Tennessee, to minor-league stops in Florida, Pennsylvania, West Virginia, Myrtle Beach, Arizona, San Antonio, Oregon, Virginia, Mississippi and Puerto Rico — to wind up in Atlanta, where so many friends and family could make the short trip to see it in person, made it all the more rewarding.
“When I first got the call, I was overwhelmed with joy,” Kelly said. “Not just for myself, but my family, everyone that’s been on the journey with me. It’s been just as tough a road for them as it has been for me.
“It was definitely everything that I thought it would be.”

 

What It’s Really Like to Have Thyroid Cancer

https://www.yahoo.com/health/what-its-really-like-to-have-thyroid-cancer-172224707.html

Health on Yahoo

September 30, 2015

About a little over a year ago, I found myself reclined in an exam chair about to have a big needle jabbed into my neck.

“Big pinch,” the doctor said, as he gave me the local anesthetic. I just stared at the ceiling, trying to remain calm despite the fear and the burning bee sting sensation.

I spent the previous evening drinking wine and Googling, “cancer in your neck,” “biopsy needle,” “lump in neck,” and “thyroid cancer death”—while my six-year-old son, Jack, and our brand new Golden Retriever puppy, Lucia, slept peacefully unaware that their single mom had a very suspicious 4-centimeter lump on her thyroid gland. Two weeks prior, my regular doctor had discovered the lump during a routine physical. An ultrasound and CT scan later, this needle was to determine whether it was cancer.

But it didn’t.

That’s the first thing I learned about having cancer: it can take an awfully long time to confirm that you actually have it.

Saying goodbye to my gland
At my next appointment, my doctor, Erik Cohen, MD, of Carol G. Simon Cancer Center at Morristown Medical Center, explained that my biopsy was “inconclusive,” yet “suspicious.” Surgery was scheduled.

On the day of, I pushed through the revolving glass door and before I knew it, the anesthesiologist said, “I’m going to give you something to relax.” A happy feeling took over, and then total, peaceful blackness. When I woke up, my throat was sore from the breathing tube, there was a drain in my neck, an IV in my arm, blood pressure cuffs on my legs, and wires everywhere.

“Did you take out my whole thyroid?” I struggled to ask when I saw Dr. Cohen. The thyroid is a butterfly-shaped gland in the neck that powers your metabolism. It also plays a role in regulating body temperature and mood. I really wanted to keep as much of mine as I could.

Dr. Cohen explained he removed the tumor and right side, and that the tests in the OR presented mixed reviews—again. He needed more pathology tests. Still, the left part of my gland remained. A small win, I thought.

Related: 15 Thyroid Cancer Facts Everyone Should Know

The big bad reveal
There are approximately 60,000 new cases of thyroid cancer diagnosed each year, with women accounting for 75% of cases. At my post-op appointment, I knew immediately that I was one of those some-60,000 by the way Dr. Cohen looked at my chart. “So, as it turns out…” he began.

My official diagnosis: follicular variant of papillary thyroid carcinoma (FVPTC). Sitting on the exam table, I was having trouble reconciling this information with the other facts of my life. But I’m only 33, I thought to myself. I’ve never smoked a cigarette a day in my life. I drink green juice and exercise. And the most important: I can’t be sick. I’m Jack’s mom.

Some more facts I was learning: thyroid cancer has a survival rate of nearly 97% after five years. These facts asserted that “in general” my kind of cancer is “good.” But what about that other 3%? And oh yeah, Dr. Cohen explained, I now needed another surgery.  The rest of my thyroid had to go, and I probably also needed radioactive iodine therapy, a type of radiation treatment also known as “RAI.”

This was not the first time life had thrown me a curveball, so I tried to remain calm, telling myself I always find a way to work things out, or at least find an inch of silver lining. But I did not convince myself at all.

Related: 14 Reasons You’re Always Tired

A new normal
After my second surgery rendered me completely thyroid-less, I was started on 100 mg of Synthroid, a standard drug that replaces the hormones the thyroid gland naturally produces.

I am so thankful my cancer was treatable, and that medication exists to replace what my vital gland once did. But let me tell you, life without a thyroid is not a piece of cake. I was perpetually tired and depressed, but also anxious and constantly obsessing about my weight and diet. I was cold when it was warm outside, and sweating when the AC was on.

On top of all that, I still had RAI treatment to look forward to.

Normally, the thyroid gland absorbs iodine in your body. So when thyroid cancer patients take radioactive iodine in pill or capsule form, the radiation concentrates in any leftover thyroid cells and destroys them, without affecting the rest of the body.

To prep for this, I was put on a low-iodine diet (no iodized salt, dairy, eggs, pizza, cheese or seafood for me!), and given thyrogen injections to rapidly raise my thyroid hormone levels to make the radiation effective at killing as many lingering cancer cells as possible.

When I showed up in the Nuclear Medicine department in the basement of the hospital, the radiologist entered in a mask, lead apron, and gloves to protect himself from the thing he wanted me to swallow. I signed the papers saying I would isolate myself from others for 5 days and not get pregnant for a year. Scared and fascinated at the same time, I swallowed the pill and left the hospital with enough radiation to set off alarms at airports.

I felt like I had the flu, and because I could still set off a Geiger counter, I had to sweat it out alone. I had weepy moments but I got through it, and a few short days later my son and my dog got to come home. Jack busted through the door like a ball of energy and Lucia jumped on me, so excited she peed right there. Having Jack back in my arms, his cookie crumbs on the couch, and new drawings on the fridge made my home whole again. Since I could eat again we celebrated with pizza—extra cheese—and frozen yogurt. And I knew a year of hell was worth being healthy for him.

One year later
Now I see an endocrinologist every few months, and I’m still struggling to find a good balance.

Every “thyca” survivor I’ve befriended has gone down this same endo rabbit hole, trying to find a doctor that understands. I need more than a pill; I need energy, a healthy weight, happiness. My meds have been adjusted four times this year in an effort to achieve this, and I’m trying to come to terms with the fact that I might never be symptom-free. That’s why I bristle when I hear people say thyroid cancer is a “good” cancer—there’s just no such thing.

But on September 10 I celebrated one year in remission, and that does feel good. It was the hardest year of my life but I got so much out of it. Being part of the “Big C club” is scary but it reminds me every day how amazing life is.

If I could tell one person to check their neck today and they listened, this article will have done its job. You can examine your own thyroid by feeling just above the collarbone on either side of the trachea with your fingertips—something I never did. Look out for any swelling or lumps. Don’t wait to see your doctor if you feel anything strange.

Related: 19 Signs Your Thyroid Isn’t Working Right

15 thyroid cancer facts everyone should know

http://www.foxnews.com/health/2015/10/01/15-thyroid-cancer-facts-everyone-should-know/