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Thyroid Cancer

  • Posted: 05/07/2012

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Treatment

Treatment options for people with thyroid cancer are…

You'll probably receive more than one type of treatment. For example, the usual treatment for papillary thyroid cancer is surgery, thyroid hormone treatment, and radioactive iodine therapy. External radiation therapy and chemotherapy are not often used for people with papillary thyroid cancer.

The treatment that's right for you depends mainly on the type of thyroid cancer (papillary, follicular, medullary, or anaplastic). It also depends on the size of the nodule, your age, and whether the cancer has spread. You and your doctor can work together to develop a treatment plan that meets your needs.

Your doctor may refer you to a specialist who has experience treating thyroid cancer, or you may ask for a referral. You may have a team of specialists:

  • Endocrinologist: An endocrinologist is a doctor who specializes in treating people who have hormone disorders.
  • Thyroidologist: A thyroidologist is an endocrinologist who specializes in treating diseases of the thyroid.
  • Surgeon: This type of doctor can perform surgery.
  • Nuclear medicine doctor: A nuclear medicine doctor specializes in using radioactive substances to diagnose and treat cancer and other diseases.
  • Medical oncologist: A medical oncologist is a doctor who specializes in treating cancer with drugs.
  • Radiation oncologist: A radiation oncologist is a doctor who specializes in treating cancer with radiation therapy.

An oncology nurse and a registered dietitian may also be part of your team.

Your health care team can describe your treatment choices, the expected results of each treatment, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type of treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities.

At any stage of the disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. You can get information about coping on NCI's website at http://www.cancer.gov/cancertopics/coping.

Also, you can get information about supportive care from NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). Or, chat using LiveHelp, NCI's instant messaging service, at https://livehelp.cancer.gov.

You may want to talk with your doctor about taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of thyroid cancer. See the section on Taking Part in Cancer Research.

You may want to ask the doctor these questions before treatment begins:

  • What type of thyroid cancer do I have? May I have a copy of the report from the pathologist?
  • What is the stage of my disease? Has the cancer spread? If so, where?
  • What are my treatment choices? Which do you recommend for me? Will I have more than one kind  of treatment?
  • What are the expected benefits of each kind of treatment?
  • What are the risks and possible side effects of each treatment? What can we do to control the side effects?
  • What can I do to prepare for treatment?
  • Will I have to stay in the hospital? If so, for how long?
  • What is the treatment likely to cost? Will my insurance cover the cost?
  • How will treatment affect my normal activities?
  • What is my chance of a full recovery?
  • Would a research study (clinical trial) be right for me?

Surgery

Most people with thyroid cancer have surgery. The surgeon removes all or part of the thyroid.

You and your surgeon can talk about the types of surgery and which may be right for you:

  • Removing all of the thyroid: This surgery can be used for all types of thyroid cancer. The surgeon removes the thyroid through an incision in the neck. If some of the thyroid tissue can't be removed, it can be destroyed later by radioactive iodine therapy. See the Radioactive Iodine Therapy section.
    The surgeon may also remove nearby lymph nodes. If cancer has invaded tissue within the neck, the surgeon may remove as much of that tissue as possible. If cancer has spread outside the neck, treatment of those areas may involve surgery, radioactive iodine therapy, and external radiation therapy.
  • Removing a lobe: Some people with follicular or papillary thyroid cancer may have a small tumor removed from only part of the thyroid. The surgeon will remove one lobe and the isthmus. See The Thyroid for a picture of the thyroid lobes and isthmus.

    Some people who have a lobe removed have a second surgery later on to remove the rest of the thyroid. Less often, the remaining thyroid tissue is destroyed by radioactive iodine therapy.

It's common to feel tired or weak for a while after surgery for thyroid cancer. The time it takes to heal is different for each person.

You may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your health care team. After surgery, they can adjust the plan if you need more pain control.

Surgery for thyroid cancer removes the cells that make thyroid hormone. After surgery, most people need to take pills to replace the natural thyroid hormone. You'll probably need to take thyroid hormone pills for the rest of your life. See the Thyroid Hormone Treatment section.

If the surgeon removes the parathyroid glands, you may need to take calcium and vitamin D pills for the rest of your life.

In a few people, surgery may damage certain nerves or muscles. If this happens, a person may have voice problems or one shoulder may be lower than the other.

You may want to ask the doctor these questions before having surgery:

  • Which type of surgery do you suggest for me?
  • Do I need any lymph nodes removed? Will the parathyroid glands or other tissues be removed? Why?
  • What are the risks of surgery?
  • How many surgeries for thyroid cancer have you done?
  • How will I feel after surgery? If I have pain, how will it be controlled?
  • How long will I have to be in the hospital?
  • What will my scar look like?
  • Will I have any lasting side effects?
  • Will I need to take thyroid hormone pills? If so, how soon will I start taking them? Will I need to take them for the rest of my life?
  • When can I get back to my normal activities?

Thyroid Hormone Treatment

After surgery to remove part or all of the thyroid, most people need to take pills to replace the natural thyroid hormone. However, thyroid hormone pills are also used as part of the treatment for papillary or follicular thyroid cancer. Thyroid hormone slows the growth of thyroid cancer cells left in the body after surgery.

Although thyroid hormone pills seldom cause side effects, too much thyroid hormone may cause you to lose weight and to feel hot and sweaty. Too much thyroid hormone may also cause a fast heart rate, chest pain, cramps, and diarrhea. Too little thyroid hormone may cause you to gain weight, feel cold and tired, and have dry skin and hair. If you have side effects, tell your doctor. Your doctor can give you a blood test to make sure you're getting the right dose of thyroid hormone.

You may want to ask the doctor these questions before taking thyroid hormone:

  • Why do I need this treatment?
  • What will it do?
  • How long will I be on this treatment?

Radioactive Iodine Therapy

Radioactive iodine therapy with I-131 is a treatment for papillary or follicular thyroid cancer. It kills thyroid cancer cells and normal thyroid cells that remain in the body after surgery.

People with medullary or anaplastic thyroid cancer usually do not receive I-131 therapy. These types of thyroid cancer rarely respond to I-131 therapy.

For one or two weeks before treatment, you will need to be on a special diet. Avoid fish (especially shellfish), seaweed, iodized salt, milk, yogurt, ice cream, bacon, ham, and other foods with iodine. Do not take vitamin pills or drugs that have iodine.

Because some imaging tests (such as CT scans) use iodine in the contrast material, tell your doctor if you had a CT scan or other imaging test in the past 6 months.

For the treatment, you will swallow one or more capsules or a liquid that contains I-131. Even people who are allergic to iodine can take I-131 therapy safely. I-131 goes into the bloodstream and travels to thyroid cancer cells throughout the body. When thyroid cancer cells take in enough I-131, they die.

Many people get I-131 therapy in a clinic or in the outpatient area of a hospital and can go home afterward. Other people have to stay in the hospital for one day or longer.

Most radiation from I-131 is gone in about one week. Within three weeks, only traces of radiation remain in the body.

During treatment, you can help protect your bladder and other healthy tissues by drinking a lot of fluids. Drinking fluids helps I-131 pass out of the body faster.

Some people have mild nausea the first day of I-131 therapy. A few people have swelling and pain in the neck where thyroid cells remain. If thyroid cancer cells have spread outside the neck, those areas may be painful too.

You may have a dry mouth or lose your sense of taste or smell for a short time after I-131 therapy. Gum or hard candy may help.

A rare side effect in men who receive a high dose of I-131 is loss of fertility. In women, I-131 may not cause loss of fertility, but some doctors advise women to avoid getting pregnant for one year after a high dose of I-131.

Researchers have reported that a very small number of patients may develop a second cancer years after treatment with a high dose of I-131. See the Follow-up Care section for information about checkups after treatment.

Because a high dose of I-131 also kills normal thyroid cells, you'll need to take thyroid hormone pills after this treatment to replace the natural hormone.

You may want to ask the doctor these questions before having I-131 therapy:

  • Why do I need this treatment?
  • What will it do?
  • How do I prepare for this treatment? Which foods and drugs should I avoid? For how long?
  • Will I need to stay in the hospital for this treatment? If so, for how long?
  • How do I protect my family members and others from the radiation? For how many days?
  • Will I-131 therapy cause side effects? What can I do about them?
  • What is the chance that I will be given I-131 therapy again in the future?

External Radiation Therapy

External radiation therapy is a treatment for any type of thyroid cancer that can't be treated with surgery or I-131 therapy. It's also sometimes used for cancer that returns after treatment or to relieve bone pain from cancer that has spread.

External radiation therapy uses high-energy rays to kill cancer cells. A large machine directs radiation at the neck or other tissues where cancer has spread.

The treatment usually is given in a hospital or clinic. You may receive external radiation therapy 5 days a week for several weeks. Each treatment takes only a few minutes.

Although radiation therapy is painless, it may cause side effects. The side effects depend mainly on how much radiation is given and which part of your body is treated. Radiation to the neck may cause a sore throat and trouble swallowing. Also, the skin on your neck may become red, dry, and tender.

You are likely to become tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Although the side effects of radiation therapy can be upsetting, they can usually be treated or controlled. Talk with your doctor or nurse about ways to relieve discomfort. Most side effects go away when treatment ends.

You may find it helpful to read the NCI booklet Radiation Therapy and You.

You may want to ask the doctor these questions before having radiation therapy:

  • What is the goal of this treatment?
  • Will I need to stay in the hospital? If so, for how long?
  • When will the treatments begin? How often will I have them? When will they end?
  • How will I feel during treatment? What are the side effects? 
  • How will we know if the radiation therapy is working?
  • Will I be able to continue my normal activities during treatment?
  • Are there lasting side effects?

Chemotherapy

Chemotherapy is a treatment for medullary and anaplastic thyroid cancer. It's sometimes used to relieve symptoms of other thyroid cancers.

Chemotherapy uses drugs to kill cancer cells. Most drugs for thyroid cancer are given directly into a vein (intravenously) through a thin needle, but a new drug for medullary thyroid cancer can be taken by mouth.

You may receive chemotherapy in a clinic, at the doctor's office, or at home. Some people need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. For drugs given directly into a vein, the most common side effects include mouth sores, nausea, vomiting, loss of appetite, and hair loss. For the drug given by mouth, side effects include diarrhea, high blood pressure, coughing, and a rash.

Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.

You may want to read the NCI booklet Chemotherapy and You.

You may want to ask the doctor these questions before having chemotherapy:

  • What is the goal of treatment?
  • What are the risks and possible side effects of treatment? What can we do about them?
  • When will treatment start? When will it end?
  • How will treatment affect my normal activities?

This text may be reproduced or reused freely. Please credit the National Cancer Institute as the source. Any graphics may be owned by the artist or publisher who created them, and permission may be needed for their reuse.