How Is Thyroid Cancer Treated?

Michael Hancock, MD, an Indianapolis endocrinologist with Franciscan Physician Network Diabetes & Endocrinology Specialists, discusses how thyroid cancer is treated and how thyroid cancer differs from other types of cancers.

How Is Thyroid Cancer Treated?

Thyroid cancer is typically treated with surgery first, after which the patient is evaluated as to whether radioactive iodine treatment is needed.

“The primary treatment for thyroid cancer is surgery,” Dr. Hancock said. “If you have a chance to take it out, that's always the best option.”

Thyroid surgery

“Whenever it's accessible to surgery, we always want to look at that option, and that's going to be with an experienced ear, nose and throat surgeon, or an endocrine surgeon, depending on your hospital,” Dr. Hancock said. “Most of us who deal with thyroid cancer routinely in our practice have people that we work with a lot for surgery.”

Radioactive iodine treatment

Radioactive iodine treatment may also be used to remove tiny amounts of remaining normal thyroid tissue that might be in the neck or in lymph nodes that may have metastatic thyroid cancer, Dr. Hancock said.

Radioactive iodine, or RAI, comes in the form of a pill or liquid that patients take in one dose while at the nuclear medicine department of the hospital. The medicine works in the body for six months to a year after ingestion.

“Thyroid tissue is the only tissue in our body that really uses iodine normally,” he said. “The nuclear medicine doctors order radioactive iodine and those cells will take the radioactive iodine in. Once they take it in, they can't spit it out. They can't expel it. It just delivers radiation in a very targeted way to thyroid tissue.”

Whether radioactive iodine treatment is used depends on the stage of the thyroid cancer.

“Thyroid cancer is essentially divided into low, moderate, or high risk,” Dr. Hancock said. “That risk is not necessarily risk of dying from the cancer but can also include risk of recurrence. Radioactive iodine is helpful to avoid recurrences in people who have moderate or high-risk thyroid cancer staging. For people who have a low risk for recurrence, we've not seen that they actually get benefit from being treated with radioactive iodine.”

Staging depends on the size of the tumor, whether it has left the thyroid and metastasized to other locations, and the age of the patient. For thyroid cancer, patients under age 55 can only be stage I or 2, while patients 55 and older can be stage 1 to 4.

Other cancer treatments

Traditional chemotherapy is not generally needed or effective for thyroid cancer. External radiation can sometimes be useful for very aggressive types of thyroid cancer.

“The most common reason that we've used oncologists on our team, is if someone has thyroid cancer that has spread or they have some sort of recurrence that for whatever reason is not in a spot that's amenable to surgery that can't be operated on,” Dr. Hancock said. “Our oncologists have done a great job using medications called tyrosine kinase inhibitors. And there are a few different ones that they have to choose from.”

Who Is Part Of A Thyroid Cancer Treatment Team?

“I think of thyroid cancer treatment really as a team approach because no single area of medicine is entirely responsible for the patient's care,” Dr. Hancock said. “Everybody has a different role.”

That treatment team can include:

• An endocrinologist, who helps with diagnosis and follow-up testing and care
• An ear, nose and throat surgeon, or a general surgeon trained in endocrine surgery
• A nuclear medicine specialist if radioactive iodine is needed
• A radiation oncologist if external radiation is needed
• An oncologist, if traditional chemotherapy is needed

What Happens After Thyroid Cancer Surgery?

People who have had surgery as part of thyroid cancer treatment will have life-long follow-up, Dr. Hancock said.

Your doctors will monitor:

• Your body’s response to replacement thyroid hormones
• Signs of any recurrence of the thyroid cancer
• Any abnormal lymph nodes
• Blood testing for a protein called thyroglobulin, a protein that's made exclusively by thyroid tissue

“If you've had your thyroid gland removed, then your thyroglobulin level should be really pretty low,” Dr. Hancock said. “We can use thyroglobulin as a tumor marker for long-term surveillance to detect any recurrences, should they occur.”

Are There Potential Complications From Thyroid Cancer Treatment?

Complications from thyroid cancer surgery and treatment include hoarseness and problems with calcium levels.

Hoarseness

“There are a lot of sensitive structures in our neck including the nerves that go to the voice box,” Dr. Hancock said. “Part of the reason people may sometimes show up with hoarseness with a thyroid cancer is because the tumor’s pressing on that nerve. So that's how close it lives to the thyroid normally.”

Calcium levels impacted

Glands behind the thyroid called parathyroid glands help control the calcium level in our blood.

“Those can sometimes be injured or removed during the surgery. so that's another role that we serve in is helping detect calcium problems after a thyroid surgery,” said Dr. Hancock, who said the calcium levels can be often addressed by the patients’ endocrinologist or primary care doctor.

Other health concerns after thyroid cancer treatment

“Keep in mind that if you have concerns, talk to your doctor, they can help you sort through ‘how concerned should I be?’” Dr. Hancock said. “If it comes down to an issue of ruling out or being suspicious for a thyroid tumor, probably an ultrasound's going to be the best way to evaluate that.”

Listen Now: Thyroid Cancer

Franciscan Health endocrinologist Dr. Michael Hancock discusses thyroid cancer signs, diagnosis and treatment in the Franciscan Health Doc Pod podcast.