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
Most thyroid cancers are treated with surgery. Like all surgeries, thyroid cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure. There are two main types of thyroid cancer surgery:
Lobectomy/Hemithyroidectomy: In a lobectomy, only the side of the thyroid where the tumor is located is removed. This is the most common thyroid cancer surgery. Most patients with well differentiated thyroid cancer can be treated with a lobectomy unless the cancer has spread or the tumor is very large. After this procedure, some patients must take thyroid hormone replacement pills every day for the rest of their lives.
Total thyroidectomy: During this procedure, the surgeon removes the entire thyroid gland. Lymph nodes near the tumor or in the neck/chest may also be removed. This is a common surgery for thyroid cancers that are larger and/or have spread. Patients who undergo a total thyroidectomy must take thyroid hormone replacement pills daily for the rest of their lives.
Radioactive iodine for thyroid cancer
Since well differentiated thyroid cells absorb iodine, patients can be given radioactive iodine to treat their cancer. In these treatments, the patient drinks a liquid or swallows a pill that contains radioactive iodine. The iodine is absorbed by thyroid tissue and destroys cancer cells. This method can be used after a thyroidectomy to kill any remaining thyroid cells. This treatment is not effective for anaplastic or medullary thyroid cancer because those cancer cells do not absorb iodine.
If radioactive iodine is used after surgery, the patient may have to stop taking thyroid hormone pills. This helps stimulate thyroid cells to take up the radioactive iodine.
Women should not become pregnant for one year after radioactive iodine treatment.
Hormone therapy for thyroid cancer
This treatment uses thyroid hormone pills to discourage the growth of cancer cells. In 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 left unchecked. In other thyroid cancers, hormone therapy may be used to keep thyroid hormone levels normal.
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. Targeted therapy is a common treatment for advanced and/or metastatic, progressive thyroid cancer.
Chemotherapy for thyroid cancer
Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy 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.
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 is most effective for thyroid cancers that do not absorb iodine, including anaplastic thyroid cancer. It may be used against thyroid cancer cells remaining after surgery or cancers that are not responding well to other treatments.
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.
MD Anderson patients have access to clinical trials offering promising new treatments that cannot be found anywhere else.
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BY Devon Carter
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.