Types of treatment for thyroid cancer

Your doctors plans your treatment taking into account

• The type of thyroid cancer you have
• 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 radiotherapy afterwards 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 to diagnose the condition. If the thyroid does contain cancer, you may need to have a second operation (total thyroidectomy) depending on the size and type of the thyroid cancer.  

Lymph nodes

Your surgeon will 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 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 to control symptoms
• Help to 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 cancer, internal or external radiotherapy may be used 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

• After surgery 
• For cancer that has spread or come back

This targeted treatment is a type of internal radiotherapy that uses a form of radioactive iodine called iodine 131 or I-131.

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 of CancerHelp UK. 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. You may have external radiotherapy in the following situations

• 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)

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 need to take thyroid hormones to replace the hormones that your thyroid would normally make. This hormone replacement won't make any difference to the chance of the cancer coming back. But 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 of CancerHelp UK.