Types of treatment for thyroid cancer
This page tells you about the main treatments for thyroid cancer and how doctors choose the right treatment for you. You can find the following information
Types of treatment for thyroid cancer
The main treatments for thyroid cancer are surgery and radiotherapy. You will usually also need to take thyroid hormones. Some people have radiotherapy and chemotherapy. Your doctors will plan your treatment taking into account the type of thyroid cancer you have, how far the cancer has grown or spread (the stage), and your age, general health and level of fitness.
Surgery to treat thyroid cancer
You may have surgery to remove the whole thyroid gland or part of the thyroid. During the operation, your surgeon may also remove any lymph nodes in the neck that are enlarged or contain cancer cells. Even if your cancer cannot be totally removed, surgery will help to control your symptoms and can control the cancer when combined with radiotherapy treatment.
Radiotherapy and chemotherapy
You may have radiotherapy to treat thyroid cancer. A type of targeted radiotherapy that uses a radioactive form of iodine called Iodine 131 (I-131) may be used for papillary or follicular thyroid cancer. External beam radiotherapy may be used for medullary or anaplastic thyroid cancers, and occasionally for papillary and follicular thyroid cancers. Chemotherapy is sometimes used to treat advanced thyroid cancers or cancer that has come back after it was first treated.
You can view and print the quick guides for all the pages in the treating thyroid cancer section.
When your doctors plan your treatment for thyroid cancer, the most important factor they consider is the type of thyroid cancer you have. They will also take into account
- How far your cancer has grown or spread (the stage)
- Your general health
- Your age and level of fitness
Treatment has a very high chance of curing papillary thyroid cancer and follicular thyroid cancer. It can also cure many people with medullary thyroid cancer. Anaplastic thyroid cancer is more difficult to treat. There is information about the outlook for different types of thyroid cancer on our page about thyroid cancer statistics and outlook.
Surgery is usually the first treatment for follicular, papillary and medullary thyroid cancer. You may have
- Your whole thyroid removed – a total thyroidectomy
- Part of your thyroid removed – called a lobectomy or partial thyroidectomy
If tests have shown that you have a papillary or follicular thyroid cancer that is less than a centimetre across (T1 stage) your surgeon will probably remove part of the thyroid gland (partial thyroidectomy). These small cancers have a very low risk of coming back. If you have a low risk type of cancer, surgery may be the only treatment you need.
For larger papillary or follicular tumours and for medullary thyroid cancers, the surgeon usually removes the whole thyroid. You may also need further treatment afterwards, such as radioactive iodine ablation or radiotherapy, or a combination of both. This is to reduce the risk of the cancer coming back.
Surgery is not usually possible for anaplastic thyroid cancers because they have often spread too far into surrounding tissues when they are diagnosed.
For many people, tests have not confirmed that they have a thyroid cancer before their operation. In this situation your surgeon may just remove half of the thyroid gland (a hemithyroidectomy) to diagnose the condition. If the thyroid does contain cancer, you may need to have a second operation (a completion thyroidectomy) depending on the size and type of the thyroid cancer.
Lymph nodes form a network of glands throughout your body. Cancer can spread to the lymph nodes making them get bigger (enlarge). Your surgeon may remove any enlarged lymph nodes they can feel in your neck, or any lymph nodes that are found to contain cancer cells during your operation. It is most common to have some of the lymph nodes removed from the front or side areas of the neck close to the thyroid (a selective neck dissection). In some situations, your surgeon may remove all the lymph nodes on one side or both sides of your neck if there is a risk that they may contain cancer cells. This is called a radical neck dissection. Removing the lymph nodes helps to stop the cancer from coming back in the future.
Thyroid cancer that has spread
If your cancer has already spread to another part of your body, your doctor may not recommend surgery. This is because surgery alone will not cure the cancer. But you may have surgery to remove your thyroid gland to help
- Control symptoms
- Control the cancer when combined with radiotherapy
Surgery to prevent medullary thyroid cancer
If medullary thyroid cancer is known to run in your family, you can have a test to see if you carry an abnormal RET gene. This is the gene that is also known to cause the MEN syndrome that increases the risk of medullary thyroid cancer. MEN stands for multiple endocrine neoplasia. Children in such families are usually tested at a young age. If they have the gene, specialists advise removing the whole of the thyroid gland to stop the cancer starting in the first place. They prefer to do this before the child is about 5 years old, sometimes as young as 6 months. But this decision is made individually, depending on the needs of the child.
Once you have had your thyroid removed, you have to take thyroid hormone tablets for the rest of your life to replace the thyroid hormones your thyroid would normally make.
Radiotherapy is commonly used to treat thyroid cancer. Depending on the type and stage of your cancer, you may have radioactive iodine treatment or external radiotherapy or a combination of both.
Radioactive iodine treatment
If you have a papillary or follicular thyroid cancer you may have a type of targeted radiotherapy. You have this
Radioactive iodine therapy after thyroid surgery aims to reduce the risk of the cancer coming back. Papillary and follicular thyroid cancer cells absorb iodine from the bloodstream. When you have radioactive iodine, it gets into the bloodstream and circulates throughout the body. The thyroid cancer cells take in the iodine and the radiation kills them. This treatment only affects the cancer cells. There are very few side effects and the radiotherapy reaches cancer cells anywhere in the body. There is more information about I-131 treatment in this section. Some people have external radiotherapy after I-131 treatment.
If you have cancer that has spread or come back, you can have an iodine 131 scan to see if the cancer picks up iodine well enough to have radioactive iodine treatment. If not, your doctor may suggest external radiotherapy.
External beam radiotherapy
Medullary and anaplastic thyroid cancers do not pick up iodine well, so external beam radiotherapy is usually used. And doctors occasionally use it for papillary or follicular thyroid cancers. You may have external radiotherapy in the following situations
- To treat papillary or follicular cancer if the surgeon cannot completely remove the cancer from the neck with surgery
- To treat medullary thyroid cancer if the surgeon may not have completely removed the cancer from the neck with surgery
- To treat medullary and anaplastic thyroid cancers if they come back after treatment
- To treat anaplastic thyroid cancer after surgery – this is rare because anaplastic thyroid cancers are usually too advanced for surgery
- To shrink an anaplastic thyroid cancer and control symptoms if you cannot have the cancer removed (palliative radiotherapy)
- To treat papillary or follicular cancers if they come back after treatment and do no take up radioactive iodine treatment.
You may have thyroid hormone therapy to treat your cancer or after surgery to replace the thyroid hormones your thyroid gland would normally make.
If you have a papillary or a follicular thyroid cancer, your treatment may include the thyroid hormones thyroxine (T4) and tri iodothyronine (T3). Taking these hormones as tablets stops your body from making another hormone called thyroid stimulating hormone (TSH). TSH may encourage the cancer to grow. So stopping TSH from being made can help to reduce the risk of the cancer coming back, or slow it down if it has already spread.
If you have had your thyroid gland removed you will need to take thyroid hormones to replace the hormones that your thyroid would normally make. It stops you from getting the symptoms of an underactive thyroid gland such as weight gain, tiredness, constipation and dry skin. It will make you feel much better if you take thyroxine.
It is important to take the dose of thyroid hormones that your cancer doctor prescribes. GPs are used to giving much lower doses of thyroid hormones for other thyroid conditions and sometimes think that the dose is too high. If your GP suggests changing the dose you can ask them to check with your cancer specialist.
Chemotherapy is sometimes used to treat advanced thyroid cancers or cancer that has come back after it was first treated. This is still an experimental treatment, but there have been reports that it has kept thyroid cancer under control for long periods for some people. It can be used to treat all types of thyroid cancer. There is more about chemotherapy for thyroid cancer in this section.
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