Possible Causes of Rehnquist's Fever

July 13, 2005 — -- Chief Justice William Rehnquist, who is being treated for thyroid cancer, has been hospitalized with a fever.

Dr. Robert Ferris of the University of Pittsburgh Cancer Institute told ABC News of several possible causes for the fever, though no information has been released by physicians treating Rehnquist.

Aspiration Pneumonia: This is high on the list because for the past few months the chief justice has been breathing through his trachea following a tracheotomy. With thyroid cancer, he could have a paralyzed vocal cord from the tumor impinging on the laryngeal nerve, which controls the function of the vocal cords.

Pulmonary Metastasis: Spread of cancer to the lung, causing the fever.

Tumor Lysis Syndrome: When chemotherapy kills tumor cells, this releases an inflammatory response that could cause a fever.

Urinary Tract Infection: Secondary to dehydration, this is very common in the elderly.

Post-Obstructive Process: If Rehnquist had cancer in his lung that eroded through his bronchus (one of the two main stems of the windpipe), this leads to a collapse of a lung and a lobar pneumonia-complete section of lung.

Facts on Thyroid Cancer

Rehnquist is among the estimated 23,600 Americans who are diagnosed with thyroid cancer each year. The following are some facts about this treatable form of cancer.

The thyroid gland is located at the lower part of the front of the neck. The function of the thyroid gland is to produce hormones that regulate the body's metabolism.

Thyroid cancer is most often diagnosed between the ages of 25 and 65. Two to four times more women than men are diagnosed with thyroid cancer.

Of the four main types of thyroid cancer -- papillary, follicular, medullary and anaplastic -- papillary carcinoma is the most common type. It usually grows slowly and is often curable. Other, less common types of thyroid cancer are more aggressive and can be fatal.

Exposure to high levels of radiation in childhood has been identified as a cause of thyroid cancer. People who as children lived near the Chernobyl nuclear power plant in Ukraine at the time of the 1986 accident have rates of thyroid cancer more than 30 times that of other populations.

Thyroid cancer often appears as a small lump or swelling on the front of the neck. These small lumps, called nodules, are fairly common and are usually benign. Other symptoms of thyroid cancer can include hoarseness, difficulty swallowing, an enlarged neck node or a persistent cough.

A tracheotomy, which was performed on Rehnquist, is a surgical procedure that involves cutting into the trachea (windpipe) and inserting a small tube to assist with breathing.

A tracheotomy is an unusual procedure and is performed in only 2 percent to 10 percent of thyroid cancer surgeries.

A tracheotomy is performed when an invasive tumor has affected the larynx (voice box), trachea or the nerves leading to the larynx. It may also be performed when the surgery is complicated by injury to the vocal cords.

Surgery to remove a malignant thyroid nodule is the most common treatment to manage thyroid cancer. In some cases, the entire thyroid gland may need to be removed.

Some patients may need radioiodine therapy, in which the patient ingests a radioactive iodine solution. Thyroid cells absorb the radioactive iodine, but most other cells in the body do not absorb any of the radioactive iodine.

Depending on the treatment, the patient may need to take thyroid hormone pills to replace the hormones that the thyroid gland no longer produces.

For the majority of patients, life after thyroid cancer treatment can return to normal. In cases where only part of the thyroid was removed, no further treatment is usually necessary.

Thyroid patients are monitored periodically for life. During this monitoring the patient may have radioactive iodine scans, blood tests or ultrasound.

Sources: American Cancer Society; Memorial Sloan Kettering Cancer Center; Paul W. Ladenson, Johns Hopkins Kimmel Cancer Center