‘The Bachelor’ Star Ali Fedotowsky-Manno, 41, Says Her Husband, Who Previously Beat Thyroid Cancer, Is Facing the Chance of Recurrence After Another Spot Was Found During a Check-Up

Ali Fedotowsky‑Mano, 41, from “The Bachelor,”  is once again navigating an unsettling yet familiar situation as she supports her husband, Kevin Manno, through a new cancer scare. Kevin, who previously underwent surgery for thyroid cancer and reached remission, recently returned for routine monitoring — but an ultrasound revealed a new area of concern.

 

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“He had a follow-up ultrasound recently because only half his thyroid was taken out when he had the cancer removed,” Fedotowsky‑Mano explained in an Instagram story.

The scan “did find a spot that we need to watch,” she added, noting how unsettling it felt since a similar finding led to Kevin’s original diagnosis.

WATCH: Understanding Thyroid Cancer Types & Treatment Options

Thyroid cancer develops when abnormal cells grow in the thyroid gland, a small, butterfly‑shaped organ at the base of the neck that produces hormones essential for regulating heart rate, blood pressure, body temperature, and metabolism.

A noticeable lump or swelling in the neck is a common early sign. As a physician assistant, Stephanie Giparas of Moffitt Cancer Center explains, thyroid hormone influences nearly every organ system.

 

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“The thyroid hormone not only regulates our metabolism, but almost every organ system in our body uses thyroid hormone. It supports our heart, it supports our brain. So you cannot live without thyroid hormone,” Giparas said.

Monitoring for Signs of Thyroid Cancer Coming Back After Initial Treatment

After treatment, thyroid cancer patients may face the risk of recurrence depending on various factors, including the risk level of the disease and the type of thyroid cancer the patient has.

In the first year after completing treatment, it’s common to see your doctor every three to six months.

WATCH: Recurrence In Thyroid Cancer

“Anybody who has a diagnosis of thyroid cancer, who’s been treated for thyroid cancer, we do less frequent surveillance for low-risk disease, a little bit more frequent for intermediate risk, and much more frequent for high risk,” Dr. Kristen Otto, a head and neck/endocrine surgeon at Moffitt Cancer Center in Florida, tells SurvivorNet.

Lower-risk patients are usually those whose tumors could be completely removed by surgery, and who did not present with any characteristics that might increase the risk that some cancer was left behind, Dr. Samantha Kass Newman, an endocrinologist at Memorial Sloan Kettering Cancer Center, tells SurvivorNet.

“Recurrence usually is detected in one of two ways. Either they have a new finding on imaging, so we’re likely doing surveillance ultrasounds of their neck or CT scans, and something pops up that wasn’t there before. Alternatively, sometimes we detect a recurrence through the blood work,” Dr. Newman adds.

Certain factors that may increase the risk of thyroid cancer returning include:

• Age over 55 at the time of initial diagnosis.
• More aggressive or advanced stage tumor (for example, a tumor that has spread beyond the thyroid or has invaded blood vessels).
• Being male (though women are more likely to get thyroid cancer in general, men who do get it sometimes face a higher risk of recurrence).
• Specific genetic changes, such as mutations in the BRAFV600E gene.
• An incomplete surgical removal of the original cancer occurs if the tumor was too large or in a location that was difficult to remove entirely.

Papillary thyroid cancer (PTC) has been shown to recur in around 1.6% of low-risk patients, 7.4% of intermediate-risk patients, and 22.7% of high-risk patients, while follicular thyroid cancer recurs in about 13.6% of cases.

Medullary thyroid cancer (MTC) can return in up to 50% of individuals, and Hürthle cell cancer can recur in about 12-33% of cases. Though these figures may appear intimidating, close monitoring and an array of available therapies still provide a favorable outlook for many patients, including those in higher-risk groups.

Some of the more common signs and symptoms of a return include:

• A lingering cough that doesn’t go away
• A lump or swelling in the neck that you can feel or see
• Difficulty swallowing (dysphagia)
• Neck pain that isn’t explained by muscle strain or other causes
• Hoarseness or voice changes

Understanding Thyroid Cancer and How It Is Treated

Thyroid cancer is generally grouped based on the specific cells it develops from.

• The most common type is differentiated thyroid cancer, such as papillary thyroid cancer. Under the microscope, these cancer cells still look somewhat like normal thyroid tissue. They typically start in follicular cells, the part of the thyroid responsible for making hormones.
• Non-differentiated cancers can come from the thyroid’s calcium-controlling cells, the immune cells that fight infections within the thyroid, or from follicular cells that are so mutated that they no longer look like thyroid cells under a microscope.

“Although papillary thyroid cancer is the most common, the other types of cancers tend to be more aggressive and tend to spread more widely, at least in advanced cases,” Dr. Lisa Orloff, a head and neck surgeon at Stanford Medicine, explained to SurvivorNet.

Differentiated Thyroid Cancers

“Differentiated” thyroid cancers are those in which the cancer cells still resemble normal thyroid tissue under a microscope. These cancers usually begin in the follicular cells—the cells responsible for producing thyroid hormones.

• Papillary Thyroid Cancer (PTC):
  • The most common form of thyroid cancer accounts for the majority of cases. It typically grows slowly and is considered highly treatable. PTC often develops in one lobe of the thyroid, and even when it spreads to nearby lymph nodes, treatment outcomes are generally very positive.
• Follicular Thyroid Cancer:
  • The second most common type. It can sometimes spread through the bloodstream to areas such as the lungs or bones, but it also tends to grow slowly and often responds well to treatment. When found early, long‑term outcomes are usually excellent.
• Oncocytic (Hürthle Cell) Thyroid Cancer:
  • A less common subtype that was once grouped with follicular cancers. It can be more challenging to treat, but early detection is associated with more favorable outcomes.

WATCH: Diagnosing Thyroid Cancer.

When being diagnosed, patients may receive the following tests:

Thyroid-stimulating hormone (TSH) Test. This blood test mainly checks levels of a hormone called TSH (thyroid-stimulating hormone), which is made by a small gland in the brain (the pituitary) to regulate thyroid function.
While the test can’t tell if a thyroid issue is cancerous, it helps doctors see if a thyroid nodule is producing hormones. In many cases, hormone-producing nodules are not cancerous.

• Ultrasound. An ultrasound can detect subtle thyroid changes, ranging from small nodules to extensive changes. However, not all nodules detected are necessarily harmful.
• Biopsy. The biopsy may follow an ultrasound, which detected a nodule. In this procedure, a radiologist visualizes the nodule on a screen and directs the needle precisely into the targeted area to collect a tissue sample for further testing for signs of cancer.
• Depending on the size of the tumor and if it has spread into nearby lymph nodes or tissues, doctors determine the stage or how advanced the thyroid cancer is.

Preparing for Surgery

“Thyroid surgery tends to be a relatively low-pain operation,” Dr. Ofloff explains. “Many thyroid operations are done as outpatient surgery. Sometimes patients are kept in the hospital overnight, but in general, people are able to resume eating and drinking and walking around, getting out of bed pretty much right away once they have recovered from the anesthesia.”

Thyroid cancer patients may be faced with surgery to help treat the cancer. There are varying surgery options, including a total thyroidectomy, which involves completely removing the thyroid. In other cases, a partial thyroidectomy may be necessary, which means only a portion of the thyroid gland is removed.

A partial thyroidectomy may be optimal if the nodule is confined to one side or has smaller growths affecting a smaller portion of the thyroid.

“The benefits to partial thyroidectomy over total thyroidectomy are that many patients maintain normal thyroid function and don’t have to be on lifelong thyroid hormone medication after a partial thyroidectomy, whereas with a total thyroidectomy, you need the lifelong medication,” Dr. Otto explains.

“Additionally, it’s a shorter surgery and less invasive, so we do prefer partial thyroidectomy. There are some patients who are well suited to that, and then there are others who are not, and we can go over those details.”

Dr. Otto explains that tumors that are small and on one side of the gland are well-suited for a partial thyroidectomy.

WATCH: Understanding what goes into thyroid cancer surgery.

After the surgery, soreness at the incision site and in the throat (due to the breathing tube) is common but typically mild. Over-the-counter medications or prescribed pain relievers help manage discomfort. In some cases, a small tube may be placed in your neck to drain fluid. This is usually removed in a day or two.

Many patients leave the hospital the same day, especially if it’s a lobectomy.

“After partial thyroidectomy, most patients can go home from the hospital the same day. They actually don’t have to stay overnight. The distinction with a total thyroidectomy is that we watch patients overnight, and the main reason is actually that we have to monitor calcium levels after total thyroidectomy,” Dr. Otto explains.

Patients can usually resume light activities the next day, but avoid strenuous exercise or heavy lifting for about two weeks to let their incision heal.

For thyroid cancer patients whose cancer is at an advanced stage, in addition to possible surgery, treatment may also involve chemotherapy, thyroid-stimulating hormone therapy (stimulates hormone production), and/or radiation therapy. In some cases, when thyroid cancer is very aggressive, surgery may no longer be effective, so relying on other treatment methods may be more optimal.

Thyroid cancer has reasonable treatment success rates. However, there is a chance of recurrence, meaning the cancer can return after treatment (also called recurrence). Recurrence may happen a few months after remission or sometimes even decades later. Patients should ask their doctor after treatment what their risk of recurrence is.

Some advanced patients also have an aggressive type of disease, such as anaplastic thyroid cancer. Patients should know that there are still powerful treatment options in these settings that can yield an optimal quality of life and control disease progression.

WATCH: The Role of Targeted Therapy in Advanced Thyroid Cancer

“When patients present with more aggressive disease or high-risk disease, our focus is really on identifying how we can best treat these patients and decrease their risk for recurrence without causing unnecessarily aggressive harm from the treatments that we’re offering,” Dr. Mara Roth, an endocrinologist and associate professor at the University of Washington in the Fred Hutch Cancer Center, tells SurvivorNet.

Turning to Radiotherapy

In many cases, thyroid cancer can be treated with surgery and a treatment approach known as radioactive iodine (RAI) therapy. However, in some advanced cases of thyroid cancer, standard radiation therapy.

When people hear the word “radiation” in relation to thyroid cancer, they often think of radioactive iodine (RAI)—a treatment that works well for certain thyroid cancers that still act like normal thyroid cells. But RAI is very different from external beam radiation.

• Radioactive Iodine (RAI): Taken as a pill or liquid, it travels through the bloodstream and targets any remaining thyroid tissue.
• External Beam Radiation: Uses high-energy beams from a machine outside the body to precisely target tumors.

For advanced or more aggressive thyroid cancers, external beam radiation may be used to ease symptoms, slow tumor growth, or help control a specific problem area. It’s often most effective when used in very targeted situations or alongside other treatments.

Dr. Jessica Geiger, a medical oncologist at Cleveland Clinic, describes this approach as “spot welding.” If a patient has one particularly troublesome tumor—such as a painful lesion in a weight-bearing bone—radiation can be directed at that single area to “zap” the problem spot while the rest of the disease remains under surveillance or systemic treatment.

WATCH: Thyroid cancer surveillance.

If a doctor finds your recurrence at an early stage, your chance of quickly regaining remission is often higher. This is why regular follow-ups, blood tests, and neck ultrasounds are essential.

Some of the more common signs and symptoms of a return include:

• A lingering cough that doesn’t go away
• A lump or swelling in the neck that you can feel or see
• Difficulty swallowing (dysphagia)
• Neck pain that isn’t explained by muscle strain or other causes
• Hoarseness or voice changes

Questions For Your Doctor

If you or someone you love has been diagnosed with thyroid cancer, you may have questions regarding treatments and what your next steps should be, so you can prepare. Here are some questions to help you begin your conversation with your care team.

• What type of thyroid cancer do I have, and how does that affect my treatment options?
• What are the recommended treatments for my specific cancer subtype, and what are the potential side effects?
• Will I need surgery, radioactive iodine, or external beam radiation—and how do these treatments differ?
• How will treatment affect my thyroid function long‑term, and will I need to take hormone replacement medication?
• What lifestyle changes or precautions should I take during and after treatment to support recovery and reduce recurrence risk?

Learn more about SurvivorNet's rigorous medical review process.

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