Thyroid Cancer Treatment

Overview | Types | Causes | Symptoms | Diagnosis | Treatment | Prognosis/Outcomes

What Is The Treatment For Thyroid Cancer?

There are three main parts to thyroid cancer treatment:

  1. Thyroid Surgery
  2. Thyroid Hormone Replacement
  3. Radioactive Iodine Treatment
  4. Other Treatment Options

How Is Thyroid Cancer Treated With Surgery?

Thyroid cancer surgery is the preferred treatment option for all forms of thyroid cancer except thyroid lymphoma. (Chemotherapy is the treatment of choice for most thyroid lymphomas)

The best surgical treatment for most thyroid cancers is entire thyroid removal (called a total thyroidectomy).  Removing the entire thyroid gland prevents cancer from returning or spreading.

In some cases where the cancer is small and hasn’t spread much, a thyroid lobectomy may be done instead.  In this procedure, only the half of the thyroid that contains the cancer is removed.  This is usually only an option for differentiated thyroid cancers, and even then, only for select cases.

Prior to the operation, a thyroid ultrasound exam that focuses on the lymph nodes of the neck is done to see if there are suspicious lymph nodes that may need to be removed along with the thyroid. The procedure to remove these lymph nodes is called a central neck dissection.  Sometimes lymph nodes further along the neck need to be removed as well.  This is called a modified radical neck dissection.

In follow-up appointments after surgery, a blood test for a protein called Thyroglobulin can be monitored to make sure treatment was effective.  Thyroglobulin is made in the thyroid, so after surgery levels should be low.  High thyroglobulin levels suggest that cancer cells may have returned.

Patients might need to replace thyroid hormones after surgery.

How Is Thyroid Cancer Treated With Thyroid Hormone Replacement?

After the thyroid has been removed in thyroid surgery, the body no longer has access to the thyroid hormones it produced.  As a result, people who have had their thyroids removed need to take daily thyroid hormone replacement pills.

Normally, the thyroid makes its hormones after getting a signal from the pituitary gland called TSH (Thyroid Stimulating Hormone).  When the thyroid is removed in surgery, thyroid hormone levels in the body drop.  The pituitary gland senses this, and it sends out even more TSH in an attempt to get those levels back up.  

Even though there is no longer a thyroid to act on, TSH can stimulate cancer cells that may have been left over from the surgery and cause them to grow and spread.  Thyroid hormone replacement pills help prevent this by signaling to the pituitary gland that the hormone levels are fine, and so not as much TSH is needed.  

Medullary thyroid cancer and anaplastic thyroid cancer do not come from cells that are affected by TSH, so hormone replacement does not prevent their recurrence.  The pills are still needed post-surgery, however, to replace the thyroid’s normal activity.

In order to find and maintain the right dose of thyroid hormone, blood tests for thyroid function are checked periodically after surgery. Generally, these blood tests are done every two months until a stable dose has been achieved, after which they may be done less frequently.

How Is Thyroid Cancer Treated With Radioactive Iodine Ablation (RAI)?

A normal thyroid gland needs iodine to produce its metabolism-controlling hormones.  With radioactive iodine treatment, radioactive iodine, swallowed in pill form, travels through the body until it is taken up by cells of the thyroid, just like the regular iodine found in everyday foods like salt and milk.  Unlike regular iodine, though, the radioactive iodine is toxic to thyroid cells.

Radioactive iodine treatment helps prevent thyroid cancer from returning after surgery.  It is typically used for papillary thyroid cancer and follicular thyroid cancers (and some Hurthle cell carcinomas) that have spread to lymph nodes or other body parts.  

Radioactive iodine treatment does not work for medullary thyroid cancer and anaplastic thyroid cancer or for thyroid lymphoma because these forms of cancer do not involve the types of thyroid cells that use iodine.

Because all the radioactive material gets directed to the thyroid, Radioactive iodine treatment does not harm other cells in the body.

What Other Treatments Are Used For Thyroid Cancer?

Chemotherapy is the treatment of choice for most thyroid lymphomas. Often a few doses of chemotherapy is enough to make a thyroid lymphoma shrinks in size. It is also used in many cases of anaplastic thyroid cancer and advanced cases of medullary thyroid cancer.

External beam radiation may be used to help shrink thyroid cancer that has spread to nearby areas.  This involves aiming focused beams of radiation from a large machine at the cancer.  It is an option for thyroid cancers that can not be treated with radioactive iodine treatment, like medullary thyroid cancer, anaplastic thyroid cancer, and thyroid lymphoma.  It is often used in combination with chemotherapy.

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