Papillary Thyroid Cancer: Reasons to Seek Expert Care, Part II

The importance of experienced and proficient surgical management and how this affects further treatment, follow-up, and your quality of life.

Please make sure to check out the first installment of this two- part series concerning expert diagnosis and surgical management for papillary thyroid cancer. 

#4 Reason to Seek Expert Care for Papillary Thyroid Cancer: Further Treatment Should Rarely be Necessary

In the vast majority of cases, excellent and thorough thyroid cancer surgery is the only treatment needed for papillary thyroid cancer. Traditional chemotherapy is never used. External or beam radiation therapy is very rarely indicated for further papillary thyroid cancer treatment. Perhaps most importantly, papillary thyroid cancer diagnosis alone is not an indication for further therapy after thyroid surgery.

The most commonly used treatment after thyroid cancer surgery, however, is radioactive iodine (RAI). This treatment works better the younger the patient is. Iodine is used by normal thyroid cells to make thyroid hormone. Thyroid cancers can possess the same type of key hole on the surface of their cell called a symporter (or pump) that allows iodine to be taken into the cell. Although papillary thyroid cancer rarely produces any significant amount of thyroid hormone itself, it frequently maintains this iodine pump and ability to take up iodine. In the treatment of thyroid cancer, this can be taken advantage of by having the patient swallow an iodine pill that has been radioactively charged.

In brief, the patient swallows a radioactive iodine form of iodine called iodine- 131 (I-131) in a liquid or pill (capsule) form. The radioactive iodine (RAI) is absorbed and circulated throughout the body in bloodstream. Papillary thyroid cancer cells can pick up the radioactive iodine (if they possess the pump for iodine) wherever they are located in the body. Once taken into the thyroid cancer cells, the radioactive iodine delivers a local radiation treatment in the area where the iodine is concentrated. Importantly, the radioactive iodine works only on microscopic disease. This treatment is not used for cancer that is easily detected on imaging tests or that has been left behind by suboptimal or incorrect surgery. Read more on radioactive iodine for papillary thyroid cancer.

#5 Reason to Seek Expert Care for Papillary Thyroid Cancer: Expert follow-up is critical, but not overwhelming

After expert thyroid surgery to cure your papillary thyroid cancer, follow-up is important, but not unmanageable. At the Clayman Thyroid Center, we feel that thyroid cancer patient follow-up is best managed by an endocrinologist with defined expertise in the evaluation, management, and follow-up of thyroid cancer patients. Communication between the endocrinologist, surgeon, radiologist, and other members of the thyroid cancer team is critical. This is the absolute foundation of papillary thyroid cancer treatment at the Clayman Thyroid Center.

After thyroid cancer surgery, your thyroid hormone levels should be checked in 4-6 weeks to see if thyroid hormone medication is needed or if your dose should be adjusted. You should have a complete history and physical exam along with an expert ultrasound done 6 months after thyroid cancer surgery and yearly after that. The following blood tests are always done routinely (typically twice yearly after the first year) for surveillance and monitoring: Free T4 level (Blood level of the major hormone normally produced by the thyroid gland or provided by thyroid hormone medication), TSH (Thyroid Stimulating Hormone), Thyroglobulin (a protein made by thyroid cells and papillary thyroid cancer cells in many cases), Thyroglobulin antibody (An antibody that recognizes the normal thyroglobulin protein as being "abnormal". These are not harmful, but are a sign of an autoimmune disease where the body recognizes itself as being abnormal. The presence of Thyroglobulin antibodies makes Thyroglobulin a largely useless blood test for monitoring thyroid cancer).

Imaging tests such CT scan, PET/CT scan, and radioiodine scan are used if there is an aggressive papillary thyroid cancer with high risk of coming back (recurrence) or if there is evidence of a recurrence. In these cases, further imaging studies are done to look at the neck and other areas of the body where cancer may spread. The need for these tests should be determined and ordered by experienced thyroid cancer experts.

Read more about follow-up labs, imaging tests, and surveillance.

#6 Reason to Seek Expert Care for Papillary Thyroid Cancer: Expert Surgical Care = Better Quality of Life

Life after surgery for papillary thyroid cancer can be tough and worrisome, especially early on. If your thyroid cancer surgery is done at an expert center such as ours, the complication rates are extremely low, and almost everyone recovers quickly and without issue or permanent problems (voice change, issues swallowing, ugly scar, etc.). Your quality of life is very unlikely to be negatively affected by thyroid cancer surgery done correctly in the hands of experts.

Finally, there is a lot of misinformation causing worry about being on thyroid medication, particularly about weight gain and fatigue. Thyroid hormone medication and diligent follow-up regarding the dosage and your thyroid hormone levels is critical after your papillary thyroid cancer surgery. As long as one is compliant with the necessary medication and follow-up, then the thyroid levels should be appropriate. If your thyroid levels are where they should be, then thyroid medication or thyroid cancer surgery will NOT be the cause of weight gain, fatigue, hair loss, etc. that everyone is concerned about. The reality is, almost everyone on thyroid hormone medication will do great as long as they take the medication as directed, get their thyroid levels checked 1-2 times yearly at a minimum, and maintain a healthy lifestyle. Thyroid hormone medication after surgery for papillary thyroid cancer is very unlikely to cause symptoms, side effects, or a change in your quality of life.

As noted in Part I of this blog series, expert surgical management of papillary thyroid cancer improves outcomes and minimizes complications significantly. Not surprisingly, having an excellent, uncomplicated surgery and recovery with a great outcome will certainly maximize one’s quality of life moving forward. Therefore, you need expert, experienced care for your papillary thyroid cancer.

Summary

Papillary thyroid cancer is the most common thyroid cancer by far. Fortunately, this cancer is very curable when managed skillfully and correctly. As noted in Part I of this blog installment, expert thyroid cancer surgery done at a center like ours is the first and most important step in the cure of your papillary thyroid cancer. Additional medical treatment for papillary thyroid cancer is very often unnecessary if the correct surgery is done right the first time. An experienced and knowledgeable care team is critical throughout all phases of the pre-operative, post-operative, and surveillance periods to maximize outcomes and minimize complications. While follow-up with an expert thyroid cancer team is paramount, the surveillance is not overwhelming or difficult to manage.

Our team of thyroid cancer experts is here to help and guide you every step along the way and will be there for you after your thyroid surgery for papillary thyroid cancer. Nothing is more important than your health! To learn more and become a patient, please see our resources below.

Additional Resources

• Become our patient by filling out the form at this link. 
• Learn more about The Clayman Thyroid Center here. 
• Learn more about our sister surgeons at the Scarless Thyroid Surgery Center, Norman Parathyroid Center, and Carling Adrenal Center
• Learn more about the Hospital for Endocrine Surgery.