Treatments For Thyroid Cancer
When you have thyroid cancer, your healthcare team creates a treatment plan just for you. The plan is based on your health and specific information about the cancer. What you want is also important when planning treatment. When deciding which treatments to offer for thyroid cancer, your healthcare team will consider:
- the type of thyroid cancer
- any medical problems you have
- your lifestyle and what you prefer or want
Surgery and hormone therapy are the main treatments for thyroid cancer. Radiation therapy, targeted therapy and chemotherapy may also be used.
Considering Complementary And Alternative Methods
You may hear about alternative or complementary methods that your doctor hasnt mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.
Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctors medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.
Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known about the method, which can help you make an informed decision.
Papillary Thyroid Cancer Robotic Surgery
Robotic surgery for the thyroid was developed largely in South Korea and brought to the United States several years ago as a “tool” in thyroid surgery. Its proposed benefits were to be the following:
- Absent or less noticeable neck incisions
- Improved visualization
- Less Surgeon Fatigue
Although we have been trained and performed robotic thyroid surgery, the following is the reality of robotic thyroid surgery:
- Incisions are tremendously longer but just not located on the front of the neck
- In papillary thyroid cancer, it is a one sided surgery approach to a frequently required two-sided surgery!
- The instruments used to perform the surgery are not as refined or delicate as the instruments used to perform the minimally invasive neck surgeries.
- Multiple surgeons are required
- The surgeon has no ability to feel in the neck. The fingers are the surgeon’s third eye. Subtle changes in feel, hardness or extension of cancer can be totally unappreciated.
- It is not minimally invasive by any measure. It is maximally invasive but just at a distance from where the surgery is focusing.
- It is a much longer surgical procedure by any measure .
- It is an inferior surgical approach to manage papillary thyroid cancer
- Unanticipated findings during surgery may not be able to be adequately addressed robotically.
- It may be an acceptable surgical approach for clearly known benign thyroid surgery.
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Thyroid Stimulating Hormone Suppression
Following surgery, patients may be treated with thyroid hormone to provide physiologic hormone replacement and to sufficiently suppress pituitary gland secretion of thyroid stimulating hormone , which is a growth-promoting factor for many types of thyroid cancer. All patients treated with total thyroidectomy require thyroid hormone therapy with levothyroxine approximately 25% of patients treated with lobectomy require thyroid hormone therapy. Thyroid hormone replacement is usually provided as a daily oral pill called levothyroxine. Your endocrinologist will monitor blood tests, including a TSH level, to determine the optimal dose for managing your thyroid hormone balance and the recurrence risk of your thyroid cancer . In general, patients with more aggressive disease and higher risk of recurrence are initially managed with levothyroxine to suppress the TSH level , while patients with lower risk of recurrence and/or other health factors that would increase their risk from side effects are managed with a TSH in the lower half of the normal reference range . Levothyroxine thyroid hormone therapy and TSH suppression in thyroid cancer patients are individualized and change over time based upon the risk of disease recurrence.
Active Surveillance Of Low
While surgery is the initial management for most thyroid cancers, in an appropriately selected group of patients with low risk disease, active surveillance may be an alternative strategy to immediate surgery. Recent data suggest that management with active surveillance may allow patients with low risk disease to avoid or delay surgery for thyroid cancer without significant increases in disease spread or overall survival outcomes.
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Role Of Systemic Therapy In Atc
Response rates of chemotherapeutic agents in ATC are modest, in the range of 20% for doxorubicin, bleomycin, etoposide, cisplatin and methotrexate. In a Swedish series published in 2002, accelerated, hyperfractionated radiotherapy and 20 mg doxorubicin given daily did not lead to serious side effects . The impact of chemotherapy on survival is generally limited. One reason could be that according in-vitro-analyses, anaplastic cell lines form less mdr-1-mRNA and P-glycoprotein but more MRP which can expel cytostatic agents from cells . Chemotherapy has shown beneficial effects mostly in combination with radiation.
Papillary Thyroid Cancer Treatment For Persistent Or Recurrent Disease:
Papillary thyroid cancer treatment for recurrences or persistence depends mainly on where the cancer is, although other factors may be important as well. The recurrence may be found by either thyroglobulin blood tests or imaging studies such as ultrasounds, radioiodine scans, CAT scan or PET imaging.
If there is concern that the papillary thyroid cancer has come back in the neck, an ultrasound-guided biopsy is first done to confirm that it is really cancer. Then, if the papillary thyroid cancer appears to be resectable , surgery is often used. The extent of surgery would depend upon the location or locations of the persistent or recurrent papillary thyroid cancer and the prior surgeries and quality of surgeries that the patient has undergone. The sections of central compartment surgery and lateral neck dissection have been written for you and are appropriate for persistence or recurrent papillary thyroid cancer in either of those locations. We have examples of surgeries for just these types of circumstances for you to watch. Papillary thyroid cancer surgery very effectively manages neck disease, sparing function and cosmetic appearance but should only be performed by very high volume and experienced papillary thyroid cancer surgeons. We have publications establishing our ability to control papillary thyroid cancer recurrences or persistence in the neck approaching 98% in both of these areas of the neck lymph nodes. :15-27)
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What Are The Signs Of Thyroid Cancer In Dogs
The telltale sign of thyroid cancer in dogs is a lump in the cervical area. The lump may be fixed or movable and may or may not be painful to touch.
Other clinical signs and symptoms of thyroid cancer in dogs include:
- Difficulty breathing
- Increased thirst
- Frequent urination.
Some of these signs are specific, but others are universal and associated with various conditions. Therefore, pet owners are advised to seek immediate veterinary attention if their dogs exhibit some of them.
Papillary Thyroid Cancer Surgery For Central Compartment Lymph Nodes And Swallowing Tube
The removal of the lymph nodes of the central neck can be performed initially when the thyroid gland is removed in the treatment of papillary thyroid cancer or following the initial surgery in the less common circumstances when papillary thyroid cancer recurs or persists. The central compartment lymph node surgery spares all critical structures including the nerves to the voice box and all parathyroid glands not directly involved by cancer. Central compartment dissection extends from the carotid arteries on both sides of the neck, below to the blood vessels of the upper chest, and above to where the blood vessel of the upper portion of the thyroid gland begins off of the carotid artery .
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Radioactive Iodine Treatment For Thyroid Cancer
Radioactive Iodine therapy has been utilized for the treatment of thyroid cancer for a long time, beginning in the 1940s. Radioactive iodine can be used for the treatment of overactive thyroid and some types of thyroid cancer. Thyroidectomy is usually enough to remove thyroid cancer from an individual. However, in cases where the cancer has spread, especially to the lymph node and other parts of the body or where the tumors are not small, additional treatment is required. Read More
When To Get Medical Advice
See a GP if you have symptoms of thyroid cancer. The symptoms may be caused by less serious conditions, such as an enlarged thyroid , so its important to get them checked.
A GP will examine your neck and can organise a blood test to check how well your thyroid is working.
If they think you could have cancer or theyre not sure whats causing your symptoms, youll be referred to a hospital specialist for more tests.
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How Is Anaplastic Thyroid Cancer Treated
Anaplastic thyroid cancer is difficult to treat because it is very aggressive and can spread rapidly within the neck and metastasize to distant parts of the body. It is less predictable than other thyroid cancers however, one thing that all long-term survivors have in common is the sense of urgency in diagnosis and treatment.
It is important to work with a doctor or team of doctors who have experience with anaplastic thyroid cancer. You must be your best advocate. Take a family member or friend to appointments if possible. Take notes. Ask questions. If you are unable to travel to a major medical/ cancer facility with experience, many of the larger, more experienced institutions are happy to advise your local doctors on the best treatment options. Do not be afraid to ask your local doctors to collaborate with experts at more experienced centers on your treatment plan given the rarity of this diagnosis. It is also important to understand the risks and benefits involved with various treatment options.
Anaplastic thyroid cancer does not respond to radioactive iodine therapy or Thyroid Stimulating Hormone suppression, which are commonly used in patients with other forms of differentiated thyroid cancer.
Treatment of anaplastic thyroid cancer, is best done through a multidisciplinary team , and typically consists of combining surgery with external beam radiation and chemotherapy.
Side Effects Of Thyroid Surgery
The risks of thyroid surgery include:
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Damage to the laryngeal nerve. It can be stunned, or one vocal cord wont move the same way as the other, Dr. Harari explains. About 5% of people temporarily experience this complication, and 1% have permanent damage. There are procedures to regain vocal strength, and an ENT specialist can assist the patient in these efforts.
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Hypoparathyroidism, or, as sometimes surgeons decide to remove one or more of the parathyroid glands four tiny glands that regulate the bodys calcium levels and are located near the back of the thyroid. People whose thyroid surgery involves a central neck incision have a 10% risk of parathyroid complications.
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Vagus nerve issues. Lateral neck incisions can risk impacting the vagus nerve, Dr. Harari says. This can have effects on the voice as well as the shoulder or tongue.
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Loss of thyroid function. After surgery, you will probably need to take pills for the rest of your life to replace lost thyroid hormones. If your parathyroid glands are also removed, you may also need to take calcium and vitamin D.
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Will I Get Side
The type of side-effects you get will depend on the type of treatment, the dose, the duration and your own general health.
Your doctor or nurse will discuss any possible side-effects with you before your treatment. Some treatments may cause nausea, vomiting, diarrhoea, constipation, loss of appetite and hair loss. A lot of treatments cause fatigue. Read more about coping with the side-effects of treatment.
A Change In Calcium Levels
The parathyroid glands can be affected by thyroid surgery. These are small delicate glands that are right next to the thyroid gland. They help to control the level of calcium in your blood.
If the parathyroid glands are not working properly, your blood calcium levels can fall below normal. You will need to take calcium tablets and possibly extra vitamin D if this happens.
If you have a low calcium level in your blood, you may have twitching or jerking muscles . Contact your healthcare team if you have this. It is usually only temporary and the parathyroids normally start working again within 6 to 8 weeks of the operation. But low calcium levels can sometimes be permanent.
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Life After Thyroid Cancer Surgery #2 Thyroid Hormone Supplements
Depending of the type of thyroid cancer surgery you have, you could need thyroid hormone medication. There are numerous formulations and types, but all these medications do a great job at replacing or supplementing the natural hormone your thyroid makes. Low risk thyroid cancers in patients who only have half of their thyroid removed do not need aggressive thyroid hormone suppression . Many patients who have half of their thyroid removed do not need thyroid hormone supplementation at all. The healthy remaining half of their thyroid makes enough hormone in many instances. If half of your thyroid was removed during your thyroid cancer surgery, you will routinely get your thyroid hormone levels checked to make sure the remaining half of thyroid is making enough thyroid hormone.
Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- The age of the patient at the time of diagnosis.
- The type of thyroid cancer.
- The stage of the cancer.
- Whether the cancer was completely removed by surgery.
- Whether the patient has multiple endocrine neoplasia type 2B .
- The patient’s general health.
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
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Risk Factors For Thyroid Cancer
There are some things that can make it more likely to develop thyroid cancer. These are called risk factors and they include:
- Exposure to radiation a small number of thyroid cancers are due to having radiation therapy to the head and neck area as a child or living in an area with high levels of radiation.
- Family history only around 5% of thyroid cancer runs in families. Some inherited genetic conditions, such as familial adenomatous polyposis or Cowden syndrome, or inheriting the RET gene may also increase your risk.
- Other factors people who are overweight or obese possibly have a higher risk of developing thyroid cancer. Other thyroid conditions only slightly increase the chance of developing thyroid cancer.
Having these risk factors doesnt mean you will develop thyroid cancer. Often there is no clear reason for getting thyroid cancer. If you are worried about your risk factors, ask your doctor for advice.
Treatment Options By Stage
Almost all thyroid cancers are treated with surgery. If the thyroid cancer is only within the tissues of the neck, both in the thyroid gland and in the lymph nodes, surgery will typically be the first treatment. Patients with later-stage disease may be treated with surgery as well, but other treatments may be done first. Clinical trials may be recommended at any stage as a treatment option.
Hormone therapy and radioactive iodine therapy are only given for papillary, follicular, and Hurthle cell thyroid cancers. MTC and anaplastic thyroid cancers are not managed with radioactive iodine thyroid or thyroid hormone therapy.
Stage I: Surgery, hormone therapy, possible radioactive iodine therapy after surgery
Stage II: Surgery, hormone therapy, possible radioactive iodine therapy after surgery
Stage III: Surgery, hormone therapy, possible radioactive iodine therapy or external-beam radiation therapy after surgery
Stage IV: Surgery, hormone therapy, radioactive iodine therapy, external-beam radiation therapy, targeted therapy, and chemotherapy. Radiation therapy may also be used to reduce pain and other problems. See below for more information, for “Metastatic thyroid cancer.”
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Will I Feel Different Taking Thyroid Hormone Pills
Fortunately, a well-tolerated and safe form of thyroid hormone therapy is available, called levothyroxine . This is the recommended medication to treat hypothyroidism following thyroid surgery and to suppress TSH in patients with a history of thyroid cancer. Most patients achieve a normal thyroid balance and feel well within 6-8 weeks of starting therapy or sooner when followed by an endocrinologist. Your doctor will monitor thyroid function tests over time to ensure that your dose is optimal for both your thyroid balance and controlling your thyroid cancer. More information about thyroid hormone tests and thyroid hormone medication can be found here: Normal Thyroid Hormone Levels.
Life After Thyroid Cancer Surgery #3 Follow Up Lab Tests And Scans
The Clayman Thyroid Center believes that thyroid cancer patient follow-up is best managed by an endocrinologist with defined expertise in the evaluation, management, and follow-up of thyroid cancer patients. Communication between the endocrinologist, surgeon, radiologist, and other members of the thyroid cancer team is critical. This is the absolute foundation of thyroid cancer treatment at the Clayman Thyroid Center.
After thyroid cancer surgery, your thyroid hormone levels should be checked in 4-6 weeks to see if thyroid hormone medication is needed or if your dose should be adjusted. You should have a complete history and physical exam along with an expert ultrasound done 6 months after thyroid cancer surgery and yearly after that. The following blood tests are always done routinely for surveillance and monitoring:
1) Free T4 level: This is the blood level of the major hormone normally produced by the thyroid gland. This is also a direct measurement of the most commonly prescribed thyroid hormone pill, levothyroxine or Synthroid. The dose of thyroid hormone pill will be based upon the blood thyroid stimulating hormone level described below.
Additional blood tests that are used to monitor medullary thyroid cancer are calcitonin and CEA .
A PET/CT scan in a patient with thyroid cancer spread to the lungs is seen below.
Check out this post for more information regarding staging and imaging for thyroid cancer along with follow-up.
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