Rod Stewart, Thyroid Cancer, and a Singer's Voice

What he told Diane Sawyer

Rod Stewart spoke about his thyroid cancer diagnosis in an interview with Diane Sawyer that ABC News aired on February 7, 2001.

"It was a terrible shock," he told her. "I mean, I just went into total silence for a few days."

That is the only part of his experience quoted here. Nothing else about his treatment was confirmed by that interview, so nothing else is claimed. What follows is about the disease, and about why an operation on this particular gland matters so much to anyone who uses their voice.

A small gland in a crowded place

The thyroid is a butterfly-shaped gland at the front of the neck, just below the Adam's apple. It makes hormones that set the body's metabolic pace.

It sits in difficult company. Running just behind it, in the groove between the windpipe and the esophagus, is the recurrent laryngeal nerve. That nerve controls the muscles that open and close the vocal cords. Nearby runs the external branch of the superior laryngeal nerve, which drives the cricothyroid muscle. That muscle stretches the vocal cords and controls pitch.

Four parathyroid glands, each about the size of a grain of rice, are attached to the back of the thyroid. They regulate blood calcium.

All of this lives within a couple of centimeters.

Four cancers, one gland

The National Cancer Institute (NCI) names four main types.

Papillary and follicular cancers are called well-differentiated. They are the large majority and are highly treatable. Medullary thyroid cancer sits in the middle for outcomes and is sometimes inherited. Anaplastic thyroid cancer is aggressive and carries a poor prognosis.

Risk factors NCI lists include radiation exposure in childhood, family history of thyroid disease, MEN syndrome, RET gene variants, female sex, and Asian race. On radiation, NCI notes the long tail: thyroid cancers "appear as early as 5 years after radiation therapy and may appear 20 or more years later."

How a lump gets sorted out

Most thyroid cancer starts as a nodule you or a clinician can feel. Most nodules are not cancer. NCI puts the overall rate of cancer in a cold nodule, meaning one that does not take up iodine on a scan, at 12% to 15%, and higher in people under 40.

The workup is an ultrasound, then a fine-needle aspiration biopsy, which draws cells through a thin needle in the office. Laryngoscopy, a look at the vocal cords, is often done before surgery so the surgeon knows the starting point. Blood studies include thyroglobulin for differentiated cancers and calcitonin for medullary disease.

Get your neck checked if

Make an appointment for:

• A lump in the front of the neck that rides up when you swallow
• Any neck lump that has grown over the past few weeks
• Hoarseness lasting more than three weeks with no cold to explain it
• A feeling of tightness or pressure when swallowing solid food
• A swollen lymph node in the neck that has not settled in four weeks

Mention any radiation treatment to the head or neck in childhood, even decades ago. It changes how seriously a nodule is taken.

Seek same-day care for noisy or whistling breathing, or a neck mass that is enlarging quickly.

The operation, and what is genuinely at risk

Surgery may remove one lobe of the thyroid or the whole gland. StatPearls describes the two main risks.

Nerve injury is the first. Damage to the recurrent laryngeal nerve causes vocal cord paralysis and hoarseness. Damage to the superior laryngeal nerve causes loss of pitch control, because the cricothyroid muscle can no longer stretch the cord. Surgeons now monitor nerve signals during the operation. StatPearls reports that among patients who lose that signal during surgery, 83% to 85% develop vocal cord weakness or paralysis afterward.

Calcium is the second. StatPearls reports that up to one-third of people having the whole thyroid removed get transient hypocalcemia, meaning temporarily low blood calcium, which causes tingling around the mouth and in the fingers. About 1% to 2% develop permanent hypoparathyroidism and need long-term calcium and vitamin D.

If your voice is part of your work, say so before surgery. It is a reasonable thing to raise, and it is relevant to surgical planning.

Afterward

Removing the whole gland means lifelong thyroid hormone replacement. StatPearls describes a starting amount based on body weight, which is then adjusted up or down until blood tests show the target TSH level.

For some differentiated cancers, radioactive iodine follows surgery. Thyroid cells absorb iodine, so radioactive iodine concentrates in any remaining thyroid tissue and destroys it. NCI also notes that TSH suppression, meaning keeping the pituitary hormone low with medication, is part of treatment for differentiated disease, and that rising thyroglobulin in the blood signals recurrence.

The numbers, and the honest caveat

Thyroid cancer has among the best outcomes in oncology. SEER, NCI's cancer surveillance program, puts five-year relative survival at 98.3% for people diagnosed between 2016 and 2022. By stage it runs 99.9% for localized disease, 98.1% for regional disease, and 48.3% for distant disease. Localized cases make up 63% of the total, regional 31%, and distant only 3%. Median age at diagnosis is 51.

The American Cancer Society projects about 45,240 new cases against 2,320 deaths for 2026, a ratio unlike almost any other cancer. The death rate is 0.5 per 100,000 people.

There is a caveat in that data. Recorded incidence more than doubled between the mid-1970s and the mid-2000s while the death rate stayed nearly flat, close to 0.5 per 100,000 throughout. A disease becoming far more common without becoming more deadly usually means better detection of small tumors rather than a true epidemic.

NCI adds that age is the single most important prognostic factor, reporting 20-year survival of 98% in low-risk disease and 50% in high-risk disease. Those are group figures. They describe cohorts, not individuals.

Sources

• https://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq
• https://seer.cancer.gov/statfacts/html/thyro.html
• https://www.ncbi.nlm.nih.gov/books/NBK563279/
• https://abcnews.go.com/Health/video/feb-2001-rod-stewart-opens-diane-sawyer-thyroid-58568116