Thyroid Cancer Treatment Options

Treatment depends on:

• the cancer type: papillary, follicular, medullary, or anaplastic
• the size of the nodule
• your age
• whether the cancer has spread

Your doctor can explain each choice and what to expect.

Thyroid cancer treatment may include surgery, thyroid hormone replacement therapy, radioactive iodine therapy for thyroid cancer, external beam radiation for thyroid cancer, or chemotherapy. Most people get a mix of treatments. For papillary cancer, the usual plan is surgery, thyroid hormone replacement therapy, and radioactive iodine therapy. External beam radiation for thyroid cancer and chemotherapy are used less often. When needed, they may be used together.

Surgery and external beam radiation are local treatments. They work in one area. If cancer has spread, local treatment can still help control it there.

Thyroid hormone replacement therapy, radioactive iodine therapy, and chemotherapy are systemic, or whole-body, treatments. They travel through the blood and can reach cancer cells all over the body.

Thyroid Cancer Surgery

Most people with thyroid cancer have surgery. The surgeon removes all or part of the thyroid. The choice depends on the cancer type and stage, the size of the nodule, and your age.

Total thyroidectomy

A total thyroidectomy can be used for all types of thyroid cancer. The surgeon removes the whole thyroid through a cut in the neck.

If some thyroid tissue cannot be removed, radioactive iodine therapy can destroy it later. Nearby lymph nodes may also be removed. If cancer has grown into tissue in the neck, the surgeon may remove that tissue too. If cancer has spread outside the neck, surgery, radioactive iodine therapy, or external beam radiation for thyroid cancer may be used to treat those areas.

Lobectomy for thyroid cancer

Some people with follicular or papillary thyroid cancer only need part of the thyroid removed. The surgeon removes one lobe and the isthmus.

Some people later need a second surgery to remove the rest of the thyroid. Less often, the rest of the thyroid is destroyed with radioactive iodine therapy.

Healing time after surgery is different for each person. You may feel sore for the first few days. Medicine can help with pain.

Before surgery, talk with your doctor or nurse about pain relief. After surgery, your doctor can change the plan if you need more help.

Surgery removes the cells that make thyroid hormone. After surgery, almost all people need thyroid hormone replacement therapy for life. If the surgeon removes the parathyroid glands, you may also need calcium and vitamin D pills for life.

Thyroid Hormone Replacement Therapy

After surgery to remove part or all of the thyroid, almost everyone needs pills to replace natural thyroid hormone.

Thyroid hormone pills are also used for papillary or follicular thyroid cancer. They slow the growth of any cancer cells left after surgery. Side effects are rare.

Your doctor will order blood tests to find the right dose.

Too much thyroid hormone may cause weight loss, feeling hot, sweating, a fast heart rate, chest pain, cramps, and diarrhea. Too little may cause weight gain, feeling cold, tiredness, dry skin, and dry hair.

If you have side effects, your doctor can adjust your dose.

Radioactive Iodine Therapy for Thyroid Cancer

Radioactive iodine therapy for thyroid cancer, also called I-131 therapy, is used for papillary or follicular thyroid cancer. It kills thyroid cancer cells and normal thyroid cells that remain after surgery.

People with medullary or anaplastic thyroid cancer usually do not get I-131 therapy because these cancers rarely respond. Even people with iodine allergy can usually take I-131 safely. The treatment comes as a liquid or capsule that you swallow. I-131 enters the bloodstream and goes to thyroid cancer cells throughout the body. When the 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 go home the same day. Some people stay in the hospital for a day or longer. Ask your care team how to protect family members and coworkers from radiation exposure. Most radiation from I-131 is gone in about one week. After three weeks, only traces remain in the body.

During treatment, drink plenty of fluids to help protect your bladder and other healthy tissues. Fluids also help I-131 leave the body faster.

Some people have mild nausea on the first day. A few have pain and swelling in the neck where thyroid cells remain. If cancer has spread outside the neck, those areas may hurt too.

You may have a dry mouth or lose taste or smell for a short time after I-131 therapy. Sugar-free gum or sugar-free hard candy may help.

A rare side effect in men who get a high dose is sterility. In women, loss of fertility is not common, but some doctors advise avoiding pregnancy for one year after a high dose.

A very small number of patients may develop a second cancer years later.

A high dose also kills normal thyroid cells, so you will need thyroid hormone pills after treatment.

External Beam Radiation for Thyroid Cancer

External beam radiation for thyroid cancer, also called radiation, is used for any thyroid cancer that surgery or I-131 cannot treat. It may also be used when cancer comes back after treatment or to ease bone pain from cancer spread.

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

Most people go to a hospital or clinic five days a week for several weeks. Each treatment takes only a few minutes.

Chemotherapy for Anaplastic Thyroid Cancer

Chemotherapy for anaplastic thyroid cancer is used to treat that cancer. It is sometimes used to ease symptoms of medullary thyroid cancer or other thyroid cancers.

Chemotherapy uses drugs to kill cancer cells. The drugs are usually given by vein. They enter the bloodstream and can affect cancer cells all over the body.

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

Frequently Asked Questions

Question: How do doctors decide which thyroid cancer treatments to use?

Short answer: Treatment depends on the cancer type, nodule size, your age, and whether the cancer has spread. Most people get a mix of treatments. Papillary cancer is often treated with surgery, thyroid hormone pills, and radioactive iodine therapy. External beam radiation for thyroid cancer and chemotherapy are used less often, but they may be added when surgery or I-131 is not enough, when cancer comes back, or to ease symptoms.

Question: What's the difference between local and systemic therapies?

Short answer: Local treatments act in one area. For thyroid cancer, surgery and external beam radiation are local. They remove or destroy cancer in the thyroid or nearby tissue. Systemic means whole-body. Thyroid hormone replacement therapy, radioactive iodine therapy, and chemotherapy are systemic treatments because they travel through the blood and can reach cancer throughout the body.

Question: When is radioactive iodine (I-131) used, and who shouldn't expect to get it?

Short answer: I-131 is often used after surgery for papillary or follicular thyroid cancer to kill remaining thyroid cells and tiny cancer spots. It is usually not used for medullary or anaplastic thyroid cancer because these cancers rarely respond. People with iodine allergy can usually still take it safely. Most radiation clears within a week, and only traces remain after about three weeks.

Question: Will I need to take thyroid hormone pills after surgery or I-131?

Short answer: Almost everyone needs lifelong thyroid hormone pills after part or all of the thyroid is removed, and also after high-dose I-131, because the hormone-making cells are gone. The pills replace natural hormone and can also slow the growth of any remaining papillary or follicular cancer cells. Your doctor will check blood tests and adjust the dose to avoid symptoms from too much or too little hormone.

Question: What are common side effects of I-131, external radiation, and chemotherapy?

Short answer: I-131 may cause mild nausea, short-term taste or smell changes, dry mouth, or brief pain and swelling in areas with remaining thyroid cells. Rare long-term risks include sterility in men after high doses and a very small risk of second cancers years later. External radiation is given over several weeks and treats areas that surgery or I-131 cannot, including painful bone spread; side effects depend on the area treated. Chemotherapy is mainly used for anaplastic thyroid cancer and sometimes to ease symptoms in medullary or other types. It is given by vein and can affect cancer cells all over the body, with side effects based on the drug plan.