Overview of Thyroid Cancer Treatment
Thyroid cancer is treated in nearly the same way every time. But these treatments are changed according to the type of thyroid cancer being treated. Some will require larger operations than others, while some thyroid cancers will require radioactive iodine treatments that others do not. The treatment of specific thyroid cancer types are discussed within the pages discussing each type (ie, papillary thyroid cancer). However, as a generic overview, thyroid cancer is treated in the following way. Written by Gary L. Clayman, DMD, MD, FACS. Dr. Clayman has also written extensively about thyroid cancer and thyroid surgery on the EndocrineWeb site here and in multiple highly reviewed medical publications. See his publications here. Last updated October 21, 2018.
04/26/2022
- Usually diagnosed by sticking a needle into a thyroid nodule (preferred) or removal of a worrisome thyroid nodule by a surgeon.
- The removed thyroid nodule is looked at under a microscope by an expert thyroid pathologist who will then decide if the nodule is benign (about 90% of all nodules that are biopsied) or malignant (less than 1% of all nodules, and about 10 % of nodules that are biopsied).
- The pathologist decides which type of thyroid cancer it is: papillary, follicular, Hurthle cell, medullary, or anaplastic.
- The entire thyroid is removed by a surgeon (sometimes this is done during the same operation where the biopsy takes place). He/she will assess the lymph nodes in the neck to see if they need to be removed also. The outcomes and survival rates for thyroid cancer are directly related to the expertise of the surgeon. Surgeons who specialize in thyroid cancer have better outcomes than surgeons who do lots of other types of surgery. The highest cure rates are achieved by surgeons who perform ONLY thyroid surgery.
- After the operation, the staging of the cancer is performed to determine its size (under the microscope), whether it was invading muscle or blood vessels, whether it has spread to lymph nodes of the neck and where those lymph nodes were located, among other things. The staging of the cancer helps your doctor determine what the next steps should be, whether or not radioactive iodine or chemotherapy is needed, and how often you need to be seen in follow up for long-term testing.
- In patients with differentiated thyroid cancers (papillary cell carcinoma and its variants, follicular carcinoma, and hurthle cell carcinoma), about 4-6 weeks after the thyroid has been removed, the patient will undergo radioactive iodine treatment if it is indicated (not all cases require it). This is very simple and consists of taking a single pill. The pill will contain the radioactive iodine in the dose that has been calculated for that individual. The patient goes home, avoids contact with other people for a couple of days (so they are not exposed to the radioactive materials), and that's it.
- At some point, nearly all patients with thyroid cancer will be put on thyroid hormone pills for post surgical hypothyroidism or to suppress the potential for cancer regrowth (termed thyroid suppressive therapy). Some will start the day after the surgery following the removal of their thyroid, while others will wait till after the radioactive iodine treatment to start the thyroid hormone pill. You can't live without thyroid hormone and since you don't have a thyroid anymore, the patient will take one pill per day for the rest of their life. This is very simple and a very common medication (example of drug names are: Synthroid, Levoxyl, levothyroxine, Armour Thyroid, etc).
- Every 6 - 12 months the patient returns to their endocrinologist for blood tests to determine if the dose of daily thyroid hormone is correct and to make sure that the thyroid tumor is not coming back. The frequency of these follow up tests and which tests to get will vary greatly from patient to patient depending on the stage of the cancer, your age, and of course, the type of thyroid cancer you have. Endocrinologists are typically quite good at this and will typically be the type of doctor that follows this patient long-term.