Thyroid Cancer 
TREATMENT


What is 'Thyroid Cancer'? It is a cancer the affects the thyroid organ in the neck. There are four main types of Thyroid Cancer: Papillary, Follicular, Anaplastic and Medullary. If this is not the cancer type you're looking for, please explore the information about other types of Head and Neck Cancers.


 
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1. Treatment options for Thyroid Cancer

Following a diagnosis of Thyroid Cancer, your cancer care team will discuss the treatment options including the possibility of participating in a clinical trial that is suitable for you. This is also a good time to consider if you would like a second opinion.

The most suitable treatment for Thyroid Cancer depends on many things including:

  • size and location of the cancer

  • whether the cancer has spread

  • personal factors (e.g. age, general health and treatment history)

  • treatments available

  • your preferences for treatment.

Surgery is the main treatment for people with thyroid cancer. The aim of treatment is to surgically remove all thyroid cancer cells. Many people with thyroid cancer also receive radioactive iodine and thyroid hormone replacement. Some people will need other treatments such as radiation. Adding another form of treatment is known as adjuvant therapy.

Radioactive iodine treatment is a form of internal radiation therapy, typically taken in a gel tablet form (with 1 to 3 days in hospital), to destroy any residual thyroid tissue and thyroid cancer cells left behind after surgery.

Thyroid hormone replacement therapy is needed in patients who have had all of their thyroid removed. This is to replace the thyroid hormone in the body and to help slow the growth of any cancer cells to reduce the risk of the cancer coming back.

The treatments listed apply to most thyroid cancers.

 

2. Surgery for Thyroid Cancer 

The main treatment for Thyroid Cancer is surgery. There are a number of operations that can be used to remove Thyroid Cancer . The type of operation used will depend on the size and location of the cancer. 

The different surgical options for Thyroid Cancer are: 

THYROIDECTOMY

This is the removal of the thyroid gland from the neck. If the entire thyroid gland is removed, it is called a total thyroidectomy. If only some of the thyroid gland is removed, it is called a partial or hemi-thyroidectomy. 
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NECK DISSECTION

This involves removal of lymph nodes from the neck. This is important even when there is no sign of cancer in the lymph nodes on your scan, because there is a risk of microscopic cancer in the lymph glands of the neck.
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guide to Thyroid hormone replacement therapy

Thyroid hormone replacement therapy replaces thyroid in the body, after the thyroid gland is removed by surgery. The thyroid hormone, called thyroxine, is needed by the body to maintain health.

Thyroid hormone replacement helps to keep your body’s metabolism at a normal healthy rate. If you do not have enough thyroid hormone (hypothyroidism) you may have symptoms such as weight gain, constipation, brittle and dry hair, sluggishness and fatigue. Heart problems can occur in severe cases.  Too much thyroid hormone (hyperthyroidism) may cause symptoms such as weight loss, chest pain, rapid or irregular heartbeat and feeling hot.

For thyroid hormone replacement, your doctor will prescribe a tablet (every day for the rest of your life). You should take the tablet at the same time every day. Speak to your doctor about all other medications that you take, including dietary supplements such as iron and calcium.

  • Your doctor will suggest blood tests to monitor your thyroid hormone levels, to help them adjust the dose. Don’t stop taking the thyroxine medication without discussing it first with the doctor.
  • Tell your doctor if you are pregnant as a higher dose may be needed.
  • The dose of thyroid hormone needed is different for every person and may change as a person ages. Talk to your doctor about any signs to look out for.

Taking thyroxine also helps to reduce the risk of cancer coming back, or recurring, by lowering the thyroid stimulating hormone made by your body which can stimulate thyroid tissue growth. Lowering the thyroid stimulating hormone (TSH) by taking thyroxine is called ‘TSH suppression’. A higher dose of thyroxine will be used for TSH suppression, if there is a higher risk of the cancer coming back (recurring). Your doctor will monitor the level of your TSH. Sometimes the dose will need to be adjusted, but it is important you do not increase your dose of thyroxine without speaking to your specialist.

 

3. Radioactive Iodine Treatment 

Radioactive iodine can be used as a radiation treatment for Thyroid Cancer since the thyroid gland in particular takes up iodine in the body.

The cancer cells take up radioactive iodine (called iodine–131) which causes the cancer cells to die. It is usually given to destroy remaining thyroid cells, not removed by surgery and any that may have spread.

Radioactive iodine treatment is an option only for some people with the papillary and follicular types of thyroid cancer and often starts at least 4-5 weeks after surgery.

For women who are pregnant and those who are breastfeeding, radioactive iodine treatment is not suitable. Your doctor will recommend stopping radioactive iodine treatment, before starting treatment.

Guide to radioactive iodine treatment 

How to prepare for radioactive iodine treatment

  • For about 2 weeks before treatment, you will need to avoid foods high in iodine such as seafood, iodised salt, some dairy food and any food coloured pink with the additive E127. You need to have a low iodine diet because too much iodine in your body can stop the treatment working well. Your cancer care team will provide you with advice on foods to avoid.
  • You will need to either stop taking thyroid hormone replacement pills temporarily, or have injections of thyroid stimulating hormone (Thyrogen) while taking the hormone replacement. This is to increase the thyroid stimulating hormone in your body, and your cancer care team will discuss the best option available for you.
  • If you have the option of stopping thyroid hormone replacement during the preparation, there may be some side effects due to hypothyroidism such as tiredness.

​After radioactive iodine treatment

  • After the radioactive iodine treatment, you will have a full body radio-isotope scan, using a small amount of radioactive liquid. The scan can help detect if any cancer cells are left or if the cancer has spread. The scan is painless and causes few side effects, and you will not be radioactive after the scan.
  • ​At home you may need to continue safety measures such as sleeping alone, washing your clothes separately and preparing your own food. You may be advised to sit to pass urine, shut the lid and flush the toilet several times.
  • You may be advised to take precautions to avoid pregnancy for a while after treatment, If you or your partner want to have a baby after radioactive iodine treatment, you should talk to your doctor for advice about suitable timing.
4. Radiation Therapy for Thyroid Cancer 

Sometimes external beam radiation therapy (X-rays applied from outside the body) may be used after surgery (adjuvant radiation therapy). Radiation therapy can be used in the following ways:
 

  • Adjuvant: This is when radiation therapy is given after the surgical removal of thyroid cancer to kill cancer cells that may not have been taken out during surgery. When used, it usually starts about 4 weeks after surgery to allow recovery from surgery. Radiation therapy treatment usually lasts for about 6 weeks.
  • Palliative: In cases where a cure is not possible, radiation therapy is used to relieve symptoms of advanced thyroid cancer. Symptoms that may require palliative radiation therapy include pain, bleeding, airway obstruction and swelling.

Side effects of radiation therapy

The side effects of radiation therapy start around two weeks into treatment and progress through treatment to peak in the last week just after treatment ends. The side effects start to improve 2–3 weeks after the end of treatment.
 
Side effects associated with radiation therapy depend on:
  • the dose of radiation therapy
  • the area being treated
  • whether or not chemotherapy is added to the radiation therapy.

5. Systemic Treatment - treatment that help the whole body 

Systemic treatments are usually only required when thyroid cancer spreads or is very aggressive. Systemic therapies used for the treatment of thyroid cancer most commonly refer to targeted therapy, and uncommonly chemotherapy.

targeted therapy

When thyroid cancer spreads or if it becomes resistant to radioactive iodine, there are a number of targeted therapies available in the form of a tablet, that “target” and stop key growth pathways that thyroid cancers use to grow and spread.  For example, these targets often refer to known genetic mutations (abnormalities) that occur in thyroid cancer that are responsible for driving cancer growth and spread. Targeted therapy, often called “tyrosine kinase inhibitors” or “TKIs” for short, can be effective to control cancer growth for some time. However, like all tablets side effects can occur so the timing of starting the tablet will be an important decision that your doctor will discuss with you. Your doctor may need to organize the genetic testing of your cancer .

Chemotherapy

Chemotherapy works by destroying or damaging cancer cells. Chemotherapy is not commonly used for the treatment of most thyroid cancers. However, occasionally it is considered for people with advanced thyroid cancer who are no longer responding to other treatments or if you have anaplastic thyroid cancer.

6. Clinical Trials and other treatment including Immunotherapy

Fortunately, advances in the treatment of cancer are part of routine cancer care. You may be offered participation in a clinical trial if available and relevant for your cancer type, which aim to discover or establish new treatment options for people with your type of cancer. The advantages and disadvantages of trial participation will be discussed with you before you are able to consider participation. Clinical trials are vital to help establish the best treatment for different types of cancer and can be a means of accessing new therapies that have proven value. If a treatment hasn’t been tested in enough patients to know it is safe or effective, then these treatments need to be tested in a clinical trial to prove whether they are truly beneficial for the treatment of your cancer.

 
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FURTHER INFORMATION
  1. Head and Neck Cancer Australia Resources 
  2. External Links to other Head and Neck Cancer Resources