For a cyclist, a long-awaited health checkup revealed the unexpected

Thomas Drayton, a California native who grew up in Vancouver, BC, has always been athletic.

Shortly after turning 40, he started cycling. “I totally got into it,” he said. Drayton rode three or four times most weeks, suffering a handful of crashes over rough terrain that resulted in broken ribs, a consequence of “acting like I was 16 again.”

During his examination in the emergency room, he said: ‘The staff were always saying, ‘Wow, your blood pressure [110/70] Is so awesome!’ “

But in her early 40s, Drayton began noticing strange and seemingly unrelated symptoms.

His face was flushed even when he didn’t exercise. “I ignored it like rosacea,” he said, referring to the common skin condition that causes a flushed face, usually in fair-skinned, middle-aged people.

Sometimes, climbing the stairs of his two-story house, his heart would race and he would feel completely out of breath; cycling up a slight incline would initially leave him feeling “absolutely exhausted” and with a racing heart rate. Although Drayton has lived in Minnesota for more than 20 years, he suddenly seemed more sensitive to the cold and coughed repeatedly for a day or two after riding his bike in minus 50 degrees.

Because “I’m either stubborn and/or stupid,” Drayton said, he would push through and the discomfort would subside.

Younger cycling friends told the 49-year-old his shortness of breath was a result of being “so old”.

But age didn’t explain her periodic difficulty swallowing.

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Every few weeks he would take a sip of water or a bite of food and “it felt like it was stuck in my throat. It was painful and felt like a rock,” Drayton said. The feeling would go away if he hit her chest.

“I was like, ‘Oh, this is something that only happens to people,'” he recalls.

Drayton’s new girlfriend, a nurse practitioner, grew concerned last year that the CIO didn’t have a primary care doctor and hadn’t had a medical in since years. He was happy to “reassure” her and make an appointment.

Her September 2020 checkup seemed uneventful — until the internist started palpating her neck. She found a lump on her thyroid, the butterfly-shaped gland just below the Adam’s apple. “I can see it,” she said. She referred Drayton to an endocrinologist for an ultrasound and a biopsy.

As he lay on the exam table, Drayton could see the ultrasound technician carefully measuring a large mass displayed on the screen. The endocrinologist struggled to insert the biopsy needle, noting “That’s really solid,” before adding ominously, “That’s not a good sign.”

The pathology report detailed the outcome: Drayton had medullary thyroid cancer (MTC), a rare form of relatively common malignancy.

MTC comes from the marrow inside the thyroid gland, which contains C cells. These cells release calcitonin, a hormone that regulates calcium and phosphorus levels in the blood.

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The uncontrolled growth of C cells leads to high levels of calcitonin and signals the presence of cancer which is usually felt as a lump. In the early stages, the mass may be small and cause few symptoms, making malignancy difficult to detect – one of the reasons why medullary cancer tends to be diagnosed at a later stage than other forms. Once the cancer begins to grow, coughing, shortness of breath, swelling in the neck, and diarrhea are often present. In later stages, flushing may occur. Treatment involves removal of the thyroid, which can be curative in the early stages of the disease.

Although Drayton thought his shortness of breath, red face, cough and difficulty swallowing were unrelated, all were symptoms of his cancer.

There are two forms of MTC: sporadic, which occurs randomly, and a hereditary form which is familial and accounts for 25% of cases.

“I accepted it,” recalls Drayton, whose cancer was sporadic, “and decided that I would do everything I could to beat it.”

Several weeks later, he underwent surgery to remove his thyroid and eight surrounding lymph nodes, some of which contained cancer. This suggested that the malignancy could have spread to his bones, brain or lungs.

On Dec. 7, Drayton had just had a more specialized PET scan and was waiting to see a specialist at the Mayo Clinic when the result popped up on his phone.

“I just lost him,” he recalls and starts sobbing in the waiting room. The scan showed what he recalled as “the first large glowing mass where one of my vertebrae was supposed to be.” There was no doubt that the cancer had invaded his bones.

Drayton said the meeting with oncologist Ashish Chintakuntlawar left him in shock. He learned that his cancer was at stage 4C, the most advanced; it was incurable and difficult to treat due to a genetic mutation.

“It was overwhelming,” Drayton recalled. “I was still crossing my fingers that things weren’t so terrible.”

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When Drayton, who has two teenage children from a previous marriage, asked how long he would live, the oncologist replied that “it could be three years or 30 years”. Drayton found the answer disturbing.

He had always hoped to live longer than his father, who died at 65 of colon cancer before he was old enough to retire. “I’m 15 years younger now,” Drayton said.

“The course of this cancer can range from very indolent [slow-growing] to very aggressive” depending in part on the mutation, Chintakuntlawar said. “So for many patients with CMT, the question is not, ‘What should I be treated with?’ but ‘Do I need treatment?’ “In Drayton’s case, some of the drugs approved to treat advanced MTC are extremely toxic, and the possible risks outweigh the potential benefits.

It is impossible to know how early detection might have affected the course of Drayton’s disease. In general, Chintakuntlawar said, “you should raise the flag if you have a symptom that won’t go away.”

At the oncologist’s recommendation, Drayton underwent targeted radiation therapy to the metastases in his spine, but the treatment showed no improvement. He also received injections of a chemotherapy drug to delay the progression of his cancer and an osteoporosis drug to try to protect his bones.

Since her thyroid surgery, Drayton said her symptoms, other than the flushing, have largely disappeared.

“The hardest part is not being able to forget it for a few minutes,” said Drayton, who is due to see a specialist at the MD Anderson Cancer Center in Houston in July. “I try to accept it and keep moving forward without being totally controlled by it.”

Drayton is channeling his energy into planning and fundraising for a 465-mile solo bike ride through Minnesota in September to benefit the Thyroid Cancer Survivors’ Association.

The journey, which is expected to take five days, “is going to be painful and difficult”, he said. But, he added, “I like a challenge.”

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