Thyroid Cancer Treatment
When you have thyroid cancer, it is important to be treated by doctors with a high level of expertise. MD Anderson has one of the largest thyroid cancer treatment programs in the country, making our physicians some of the most skilled and experienced in the nation.
If you are diagnosed with thyroid cancer, your doctor will discuss the best options to treat it. This depends on several factors, including:
- The type of thyroid cancer
- The size of the tumor
- The stage of cancer
- Your age and health
Thyroid cancer surgery
Surgery is the most common and effective treatment for most types of thyroid cancer. Active surveillance (watching) or ablation may be considered for some small and localized thyroid cancers, especially when the disease is diagnosed early. Outcomes are best when surgery is performed by a high-volume thyroid surgeon. The extent of surgery may include:
Lobectomy (Hemithyroidectomy)
In this procedure, only one lobe (one side) of the thyroid gland is removed. It is most often used to treat small, well-differentiated thyroid cancers (such as papillary or follicular thyroid cancer) that are limited to one part of the thyroid and have not spread to lymph nodes or other organs.
This approach offers several benefits, including fewer surgical risks and a reduced chance of developing permanent thyroid hormone dependency. However, some patients may still need to take daily thyroid hormone replacement pills if the remaining thyroid lobe cannot produce enough hormone on its own.
Total thyroidectomy
This surgery removes the entire thyroid gland and is often recommended for:
- Larger tumors
- Cancer that has spread to both lobes or nearby lymph nodes
- More aggressive or high-risk thyroid cancers
- Thyroid cancers for which radioactive iodine therapy is indicated
Patients who undergo a total thyroidectomy will need lifelong thyroid hormone replacement therapy to maintain normal body function and suppress tumor regrowth. In some cases, nearby lymph nodes are also removed if the cancer has spread.
Lymph node dissection
Certain thyroid cancers may spread to the lymph nodes of the neck. Removal of these lymph nodes may be performed at the same time as the thyroid surgery or in a separate procedure, and may include:
- A central neck dissection: Removal of lymph nodes adjacent to the thyroid gland
- A lateral neck dissection: Removal of lymph nodes along the jugular vein
Possible surgery side effects
The side effects of surgery include:
- Neck pain or stiffness
- Hoarseness or voice changes (temporary or permanent)
- Low calcium levels if parathyroid glands are affected (hypocalcemia)
- Risk of bleeding
- Lifelong need for thyroid hormone pills (especially after total thyroidectomy)
Radioactive Iodine therapy for thyroid cancer
Thyroid cancer is the only cancer treated with radioactive iodine (RAI).
RAI works because thyroid cells naturally absorb iodine, including most well-differentiated thyroid cancer cells (such as papillary and follicular types). RAI is not effective for anaplastic or medullary thyroid cancer, since those cells do not absorb iodine.
After a thyroidectomy, RAI can be used to:
- Detect any remaining thyroid or cancer cells and determine whether the disease has spread to other parts of the body
- Destroy any remaining thyroid cells to improve follow-up testing accuracy and reduce the risk of cancer recurrence
- Kill remaining microscopic cancer cells
- Treat thyroid cancer that has spread to lymph nodes or other organs
RAI is taken by mouth as a capsule or liquid. The radioactive iodine travels through the bloodstream and is taken up by thyroid cells, which are then destroyed.
Before receiving radioactive iodine (RAI) treatment, patients usually get an injection to raise thyroid-stimulating hormone levels, which is necessary for the therapy to be effective. An alternative approach is to temporarily pause thyroid hormone therapy, but this can cause symptoms of hypothyroidism (a condition in which the thyroid gland does not produce enough hormones, slowing the body’s metabolism) for several weeks. In addition, women should avoid becoming pregnant for at least 6 to 12 months after treatment.
Common side effects
RAI side effects include:
- Dry mouth or taste changes
- Nausea or upset stomach
- Neck tenderness or swelling
- Temporary changes in smell
- Fatigue
- Swelling of salivary glands (can cause pain or dry mouth)
- In rare cases, fertility issues or secondary cancers
Targeted therapy for thyroid cancer
Targeted therapy drugs are designed to stop or slow the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them. These treatments are especially helpful for:
- Advanced or metastatic thyroid cancer that no longer responds to RAI
- Aggressive types such as medullary or anaplastic thyroid cancer
Targeted therapy is usually taken as a daily oral pill and requires close monitoring for side effects.
Common side effects
Side effects of targeted therapy for thyroid cancer include:
- High blood pressure
- Diarrhea
- Fatigue
- Mouth sores
- Skin rash or hand-foot syndrome
- Loss of appetite
- Liver function changes
Learn more about targeted therapy
Immunotherapy for thyroid cancer
The immune system finds and defends the body from infection and disease. Cancer is a complex disease that can evade and outsmart the immune system. Immunotherapy improves the immune system’s ability to eliminate cancer.
Immune checkpoint inhibitors are a type of immunotherapy. They stop the immune system from turning off before cancer is completely eliminated. Patients may receive a single immunotherapy drug or multiple drugs in combination.
Thyroid cancer patients can get immune checkpoint inhibitors through intravenous (IV) infusions. Each treatment session usually takes 30 minutes to a few hours, depending on the drug. Most checkpoint inhibitors are given once every two to six weeks, and treatment can continue for several months or longer if it is working and side effects are manageable.
Side effects depend on the specific drug used. Because these medicines activate the immune system, they can sometimes cause inflammation in healthy organs. Common side effects include fatigue, skin rash or itching, diarrhea, cough, and mild flu-like symptoms.
Learn more about immunotherapy and immune checkpoint inhibitor side effects
Chemotherapy for thyroid cancer
Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. The treatment may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing. Chemotherapy is rarely used to treat thyroid cancer, as most types do not respond well to traditional drugs. However, it may be considered in certain situations:
- For anaplastic thyroid cancer, which is fast-growing and aggressive
- If the cancer has spread widely and is no longer responding to surgery, RAI or targeted therapy
Chemotherapy may be used alone or combined with radiation therapy in these cases. It is usually given through an IV.
Common side effects:
Side effects of chemotherapy include:
- Nausea and vomiting
- Hair loss
- Fatigue
- Weakened immune system (higher infection risk)
- Mouth sores
- Appetite loss
- Bruising or bleeding
Radiation therapy for thyroid cancer
Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue.
External beam radiation therapy is typically used to treat only the most aggressive thyroid cancers. It can play an important role in treating:
- Anaplastic thyroid cancer
- Medullary thyroid cancer
- Cancers that don’t absorb iodine and cannot be treated with RAI
- Recurrences in the neck or other difficult-to-reach areas
Radiation may be used after surgery if:
- The cancer could not be completely removed
- It has spread to nearby tissues
- There is a high risk of local recurrence
Radiation is often given in daily treatments over several weeks. It may also be used as the first treatment if the tumor cannot be surgically removed.
Common side effects
Thyroid cancer patients treated with radiation therapy may experience:
- Fatigue
- Skin redness or irritation in the treated area
- Sore throat or difficulty swallowing
- Hoarseness
- Loss of appetite
Learn more about radiation therapy
Thyroid cancer clinical trials
As one of the world’s premier cancer centers, MD Anderson participates in many clinical trials (research studies) for thyroid cancer. Sometimes, clinical trials are the best option for treatment. Research studies may also help researchers learn how to better treat cancer and improve the future of cancer treatment.
Learn more about clinical trials.
Survivorship care for thyroid cancer
Most people with thyroid cancer live long, healthy lives, especially those with well-differentiated types like papillary and follicular. However, ongoing care is essential to monitor for recurrence and manage life without a thyroid.
Follow-up care includes:
- Regular blood tests to check markers for cancer recurrence (including thyroglobulin for differentiated types and both calcitonin and CEA for medullary) and TSH
- Neck ultrasounds to detect any regrowth or new tumors
- Radioactive iodine scans in certain cases
- Medication management to adjust thyroid hormone levels
Health and lifestyle considerations:
- Calcium and vitamin D monitoring: This is especially important if the parathyroid glands were affected during treatment.
- Mental and emotional support: Anxiety and fatigue are common, even after treatment ends, so emotional support can be an important part of recovery.
- Fertility planning: It is important to discuss family planning with your care team, especially if you have had radioactive iodine (RAI) therapy.
- Healthy habits: Eating a balanced diet, exercising regularly and maintaining consistent sleep patterns can help support energy and overall recovery.
Hormone therapy for thyroid cancer
After surgery, many patients require thyroid hormone replacement therapy, not only to maintain normal body functions but also to prevent cancer recurrence.
- In patients with well-differentiated thyroid cancer, hormone treatment may be used to lower the level of thyroid-stimulating hormone (TSH). This hormone could promote the growth of thyroid cancer cells if levels are too high.
- In medullary and anaplastic thyroid cancer, hormone therapy may be used to keep thyroid hormone levels normal.
Regular blood tests are needed to monitor TSH levels and adjust medication.
Common side effects:
Side effects from hormone therapy are usually caused by patients taking too much or too little of the mediation. They include:
- Fast or irregular heartbeat
- Weight changes
- Nervousness or anxiety
- Insomnia
- Bone thinning (long-term over-suppression)
- Menstrual irregularities
Side effects are typically managed with proper dosing and regular bloodwork.
Learn more about thyroid cancer survivorship
Learn more about thyroid cancer:
Thyroid cancer is treated in our Endocrine Center, Head and Neck Center and the Children's Cancer Hospital
Thyroid cancer surgery: What to consider
Hearing you have a thyroid nodule can be scary, but it doesn’t always mean you have cancer. In fact, only about 10% of thyroid nodules are malignant.
But if you’ve been diagnosed with thyroid cancer, you may be feeling anxious about the next steps, which almost always include surgery.
Below, Mark Zafereo, M.D., shares what to consider before undergoing thyroid cancer surgery.
Get an accurate diagnosis
It’s important that you’re comfortable with the evaluation of your thyroid nodule before undergoing surgery. Since most nodules aren’t cancerous, many patients don’t need surgery at all.
There are four types of thyroid cancer. About 95% of thyroid cancers are either papillary thyroid cancer or follicular thyroid cancer. Patients with these cancers typically have a good prognosis.
The remaining 5% are medullary thyroid cancer and anaplastic thyroid cancer, which can be more aggressive and may require more extensive treatment.
There are different types of thyroid cancer surgery
The type of surgery your doctor recommends will be based on a risk assessment that includes the tumor pathology, size and location.
The simplest thyroid tumor surgery is a lobectomy. This procedure removes half the thyroid gland. When a thyroid tumor is more likely to spread, a total thyroidectomy (removal of the entire thyroid gland) may be performed.
If the cancer has spread beyond the thyroid gland to surrounding lymph nodes, a more extensive surgery removing these lymph nodes may be needed.
In rare cases, thyroid cancers may spread to other important structures of the neck, which may require more complex surgeries that are best performed by an expert thyroid and neck surgeon.
Ask the right questions
When you meet with your surgeon, make sure you have a clear understanding of your diagnosis, surgical plan and expected recovery. Here are some questions to ask:
- How many thyroid cancer surgeries do you perform each year? The most experienced thyroid cancer surgeons perform more than 100 thyroid/neck surgeries annually.
- What type of thyroid cancer surgery do I need? How much experience do you have performing this specific type of surgery? If the surgeon hasn’t performed many surgeries like yours, seek a second opinion from someone who has.
- How many of your newly diagnosed patients have to undergo a second thyroid/neck surgery within a year? This number should be less than 1%.
- How closely do you work with an endocrinologist, radiologist and pathologist? It’s important that your doctors collaborate and are all confident in the diagnosis and care plan. This minimizes surprises during and after surgery.
- Will the surgery affect my metabolism regulation? If part of your thyroid gland is removed, it may still produce enough of the hormone that regulates your metabolism. But if you have the whole gland removed, you’ll need to take a daily thyroid hormone pill for the rest of your life.
- What are the risks of this thyroid surgery?
- How much discomfort will I have after surgery?
Every patient’s recovery from thyroid cancer surgery is different
Every patient’s recovery is different. Most people take a week or two off work to recover, but can talk and eat a few hours after surgery. All patients will have a scar after surgery. With surgeries limited to the thyroid, the scar is usually about 2 inches long and will look like a natural crease in the neck over time. But ask your doctor what to expect after your particular surgery.
Don’t rush into surgery
With thyroid cancer, you’re not in a race to remove the tumor as soon as possible. Except for the most aggressive thyroid cancers (such as anaplastic thyroid cancer), these cancers are typically slow-growing. Even when the cancer has spread to the lymph nodes, there’s generally not an urgent need for surgery. So, take time to research your options, and find the right cancer center with the right surgeon to perform the right surgery the first time.
Since there’s more urgency with anaplastic thyroid cancer, we encourage these patients to seek proper care soon after diagnosis. At MD Anderson, our specialized clinic called Facilitating Anaplastic Specialized Treatments, or FAST, enables us to quickly finalize treatment plans for patients with suspected anaplastic thyroid cancer.
Specialized care has benefits
Receiving thyroid cancer care at a major cancer center like MD Anderson can make a significant difference in your outcome. At MD Anderson, we have care teams studying every aspect of thyroid cancer, which gives you access to the most cutting-edge care and clinical trials. In fact, MD Anderson has the most clinical trials in the world for medullary and anaplastic thyroid cancers. No matter what type of thyroid cancer you have, a specialized team can help ensure you have a well-thought-out care plan that reduces your chances of recurrence and the need for another surgery.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Can you have thyroid cancer without knowing?
The thyroid is a small, butterfly-shaped gland at the base of the neck. It’s responsible for the hormones that control your heart rate, blood pressure, temperature and metabolism.
When thyroid cells grow abnormally, they can cause thyroid cancer. But because symptoms are vague and may mimic other less-serious conditions, it’s possible you could have thyroid cancer for months or even years without knowing it.
Thyroid cancer surgeon Nancy Perrier, M.D., explains how thyroid cancer can go unnoticed – and what you can do to catch it early when it’s easiest to treat.
Thyroid cancer symptoms can go unnoticed
Unfortunately, thyroid cancer doesn’t have many obvious symptoms, and they can vary from person to person. Some signs of thyroid cancer include:
- a lump in the front of the neck
- swollen thyroid or swelling in the neck
- pain in the front of the neck that may stretch to the ears
- hoarse voice
- trouble breathing
- persistent cough
- problems swallowing
If you experience any of these symptoms for three weeks or longer, see your health care provider to have them checked out.
Accurate diagnosis is key
Because thyroid cancer symptoms may also be associated with other conditions, like enlarged lymph nodes in the neck, thyroiditis or Hashimoto’s disease, an accurate diagnosis is important. There are several tests your health care provider may use to find out if you have thyroid cancer.
The first thing they’ll likely do is perform a physical exam, to feel for any lumps or swelling in the neck. Firm nodules that don’t go away may be cause for concern. Soft, short-lasting nodules don’t usually cause problems.
After a physical exam, your care team will likely perform:
Imaging exams: Ultrasound and later a CT scan may be used to get a better look at the size, shape and location of thyroid nodules. These exams can also show if thyroid cancer has spread to lymph nodes or other areas of the body.
Biopsy: If the initial imaging shows a potential tumor, a biopsy may be used to remove a small number of cells so a pathologist can look at them under a microscope.
If the biopsy and imaging exams suggest you have thyroid cancer, it’s important to seek care from a cancer center with thyroid cancer specialists to get an accurate diagnosis. For example, you may have several nodules, but if the wrong one is biopsied and deemed benign, a cancerous nodule may get overlooked and cause problems in the future.
At MD Anderson, we have a team of pathologists who exclusively look at thyroid cancer all day, every day.
Certain types of thyroid cancer can grow slowly
Papillary thyroid cancer is the most common and least aggressive type of thyroid cancer. It can occur in one or both thyroid lobes and can grow over several years. Certain people may be at risk for papillary thyroid cancer, like those with some types of young-onset colon cancer.
Patients diagnosed with papillary thyroid cancer often have symptoms that they dismiss for years until receiving a diagnosis.
Other, less common types of thyroid cancer, like anaplastic thyroid cancer or poorly differentiated thyroid cancer, are more aggressive. They tend to present as a large lump that shows up suddenly over a few weeks or months.
Thyroid cancer doesn’t always need treatment right away
If a thyroid nodule isn’t causing problems, patients may choose to take a watch-and-wait approach, where their care team will monitor the lump for any changes before moving forward with treatment.
Most of the time, when patients go to get a lump checked out, it’s already causing trouble breathing or swallowing. In this case, the most common treatment is surgery to remove part or all of the thyroid.
Patients with genetic mutations – especially children at high risk for thyroid cancer – may live for years before needing treatment. We monitor these patients with ultrasounds and lab work.
It’s sometimes better to let the body release thyroid hormones naturally for as long as possible before moving forward with treatment. But, if we know someone is at high risk for developing thyroid cancer, we can watch them closely and, if needed, remove the thyroid quickly, before the disease has a chance to spread.
Seek treatment from thyroid cancer experts
Don’t be afraid to get a second opinion. You want the right treatment at the right time from the right place. The thyroid is such a delicate gland, and it’s in a very challenging area. So, it’s vital to seek treatment from experts who have experience treating – and removing – the tumor so you can achieve the best quality of life possible.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.