Treatment Overview

You may be shocked to find out that you have thyroid cancer. You may also feel angry, scared, depressed, or anxious. There is no normal or right way to react to or cope with having cancer. Try to remember to take care of yourself and to get help when you need it.

The goal of treatment for thyroid cancer is to get rid of the cancer cells in your body. How this is done depends on your age, the type of thyroid cancer you have, the stage of your cancer, and your general health.

Most people have surgery to remove part or all of the thyroid gland. Sometimes a suspicious lump or nodule has to be surgically removed before you will know if you have cancer or not.

After surgery, you may need treatment with radioactive iodine to destroy any remaining thyroid tissue. When you no longer have all or part of your thyroid gland, you will probably need to take thyroid hormone medicines for the rest of your life. These medicines replace necessary hormones that are normally made by the thyroid gland and prevent you from having hypothyroidism—too little thyroid hormone. For more information on hypothyroidism, see the topic Hypothyroidism.

Initial treatment

Your treatment for thyroid cancer may include:

• Surgery to remove the part of the thyroid gland that contains cancer. Removing one part (lobe) is called a lobectomy. Removing both lobes is called a thyroidectomy. Lymph nodes may also be removed during surgery.
• Radioactive iodine, which is used after surgery to destroy any remaining thyroid tissue. After you have your thyroid surgically removed, you may have to wait several weeks before having radioactive iodine treatment to destroy any remaining thyroid tissue. During the waiting period, you may have symptoms of hypothyroidism such as fatigue, weakness, weight gain, depression, memory problems, or constipation. Your doctor may also put you on a low-iodine diet before your treatment. If you are on a low-iodine diet, you cannot eat foods that contain a lot of iodine, such as seafood and baked goods. Depleting your body of iodine may make radioactive iodine treatment more effective because your cells become "hungry" for iodine.
  • Foods to avoid in a low-iodine diet include milk and other dairy products, commercial baked products (including most breads), seafood, and red food dye #3. A low-iodine diet is not the same as a low-salt diet. Most salt in the United States and Canada has iodine added, so low-iodine diets avoid iodized salt, but non-iodized salt is okay to eat.
  • For more information, talk to your doctor or a registered dietitian, or visit the National Institutes of Health's Web site at: www.cc.nih.gov/ccc/patient_education/pepubs/lowio.pdf.
• Thyroid-stimulating hormone (TSH) suppression therapy. TSH suppression therapy reduces the TSH in your body, which may help prevent the growth of any remaining cancer cells.
• If thyroid cancer is advanced when it is diagnosed, initial treatment may also include chemotherapy or radiation therapy.

Ongoing treatment

After treatment for thyroid cancer, you may need to take thyroid hormone medicine for the rest of your life to replace the hormones that your body no longer makes. You will also need follow-up visits with your doctor every 6 to 12 months. In addition to scheduling regular visits, be sure to call your doctor if you notice another lump in your neck or if you have trouble breathing or swallowing.

At your follow-up visits, your doctor may order:

• A blood test to measure your thyroid-stimulating hormone (TSH) level. This test helps your doctor know if you are taking the right amount of thyroid hormone medicine.
• A blood test to measure your thyroglobulin level. This test helps your doctor know if your cancer has come back. Before this test, you may have to stop taking your thyroid hormone medicine for several weeks. This can cause you to have symptoms of hypothyroidism such as fatigue, weakness, weight gain, depression, memory problems, or constipation.
• Serum calcitonin tests, if you had medullary thyroid cancer (MTC).
• A radioiodine scan to see if the cancer has come back or spread to other parts of your body.
• Other imaging tests to look for signs of cancer, such as ultrasounds, X-rays, CT scans and, in rare cases, MRIs or PET scans.

Treatment if the condition gets worse

Thyroid cancer may come back (recur). If thyroid cancer does recur, it may be found during a physical exam, on an ultrasound, or as a result of increasing thyroglobulin levels. Unlike other types of recurrent cancer, recurrent thyroid cancer is often cured, especially if it has spread only to the lymph nodes in the neck. Recurrent thyroid cancer or thyroid cancer that has spread (metastasized) to other parts of the body is treated with:

• Surgery to remove any remaining thyroid tissue and involved lymph nodes.
• Radioactive iodine.
• Chemotherapy. Medicines such as doxorubicin and cisplatin may be used for certain types of recurrent thyroid cancer.⁴
• Radiation therapy to the neck. This is rarely used.

Before you have a radioactive iodine scan to see if cancer cells have spread (metastasized), you will need to either stop your thyroid hormone replacement for a while or take Thyrogen.