Those two-person meetings in the Kremlin sitting at the ends of a 6-meter long table. A particular swelling of the face. The mood swings and the nervousness reported by the rumors bounced in the world press, which would report elements collected by the 007. They could be nothing, simple facts unhooked from each other. But they become coherent suggestions if you approach the hypothesis that Vladimir Putin has a thyroid cancer, launched by an independent Russian media, ‘Proekt’. “Obviously we cannot make any kind of inference with respect to the specific patient “, explains Andrea Giustina to time.news Health, full professor of endocrinology at the Vita-Salute San Raffaele University and head of endocrinology at the San Raffaele hospital in Milan. “But some of the elements reported offer interesting insights.”
“Thyroid nodules – he said – are very frequent in the population. Also considering those discovered ultrasonographically”, therefore of very small size, “about 20% of people have one, but most of these are not malignant tumors, only 1 to 5% are estimated to be. Of course, by parameterizing this minimum percentage to the high diffusion of thyroid nodules, the numbers are not so low. In people of a certain age, like Putin, therefore, some series estimate that up to one in two may have a thyroid nodule. It is a frequent pathology and in the case of malignant tumors they are usually not particularly aggressive, above all because they are diagnosed fairly quickly and because there are effective therapies “. There is a female prevalence in these tumors, adds Giustina,” but the males they often have more aggressive forms and are placed in a higher risk band by default “.
When these nodules are about one centimeter in size they begin to become palpable and visible, because the thyroid is very superficial in the neck. “A man, shaving a beard which is a daily and repetitive gesture, can immediately detect even quite slight variations – observes Giustina – The doctor arranges an ultrasound to distinguish those that are cysts, not risky from an oncological point of view, from the nodule solid, in which case a fine needle aspiration is done and cytological examination is carried out on the collected sample, which tells us the probability that these cells are cancerous “. Faced with a diagnosis of malignant tumor “the patient must undergo a thyroidectomy, that is, he must completely remove the thyroid”. And some elements concerning the therapies seem to coincide with the information filtered on the ‘Tsar’ and with the observations on his physical appearance, according to the picture described by the expert.
A first food for thought concerns the administration of radioactive iodine which is one of the therapies that is done for these tumors. “It can happen immediately after surgery, but also after some time because there are still cancer cells that have grown back – explains the endocrinologist – Iodine is done in hospital, because it is taken in quite high quantities and the patient remains very radioactive. for a certain period of time (iodine has a half-life of 7-8 days), but this radioactivity persists even after discharge, and therefore it is not recommended for a few weeks to have contact with people. is not to sit at a table with others for a long time and observe a distance of at least a couple of meters when you are together with these people for a long time “, describes Giustina. An element that could therefore explain different situations in which the Russian leader was portrayed.
Returning to the type of tumor that can affect the thyroid, “according to a histological analysis of the tissue that is examined – describes Giustina – the most frequent tumor in more than two thirds of patients is papillary tumor, which has a local aggression”, with a disease that extends only to the glands in the neck. “Follicular cancer, on the other hand, is more aggressive, but less frequent (about 20% of thyroid cancers) and can cause distant metastases, especially in the lungs, but also in the bone. Most of these neoplasms do not secrete thyroid hormone and do not cause particular general symptoms. Then there are more aggressive thyroid tumors, such as medullary carcinoma, which can cause gastrointestinal symptoms, for example, because it produces excess calcitonin. Tumors that do not capture iodine and are therefore less easily treatable than the others “. Most papillary and follicular tumors, on the other hand, “capture radioactive iodine. This works as a targeted radiotherapy and destroys all possible tumor residues even in metastases”.
For the expert there could be two elements that have relevance, also in relation to the Putin affair. After the removal of the thyroid, the patient “must undergo a therapy that blocks the production of Tsh”, a hormone that “must be eliminated because it is a possible stimulus for the growth of tumor residues”. This affects the mood, “to all intents and purposes the patient is as if he were in hyperthyroidism. And therefore he can present unstable mood, irritability, anxiety, agitation, insomnia, sweating, nervousness, difficulty in maintaining a precise position. to a weight loss “.
But there are also phases in which the patient instead registers weight gain. “Those who have been operated on must undergo periodic checks with a total body scintigraphy, which involves the administration of iodine to check if areas that capture it appear and therefore reveal any metastases – explains Giustina – When this test is performed, the therapy is interrupted for at least one month. Then these patients become totally hypothyroid, with weight gain, depression, fatigue. All this is poorly tolerated, because it means going from a state of excess thyroid hormone to one of complete absence, and creates many problems of quality of life “.
The last point concerns doctors. Giustina confirms that the specialists who revolve around the patient with thyroid cancer are the endocrinologist, the general surgeon or the otolaryngologist, the nuclear doctor, more rarely the oncologist. Some of these are precisely the figures mentioned in the rumors among the experts who would accompany Putin.