Thursday, February 29, 2024

Thyroid Cancer Treatment Side Effects

Treatment Of Advanced Disease

Thyroid Cancer: Q & A on Treatments, Side Effects, New Therapies. Drs. Sherman & Tuttle

A study by Heilo et al determined that ultrasonography-guided percutaneous ethanol injections were an excellent alternative to surgery in patients with a limited number of neck metastases from papillary thyroid carcinoma. The authors suggest that this strategy could replace berry picking surgery.

In patients with stage T4 disease, external beam radiation therapy may be performed to control local tumor growth in areas such as the neck, lungs, mediastinum, bone, and central nervous system.

Chemotherapy with cisplatin or doxorubicin has limited efficacy, producing occasional objective responses , and high toxicity. Chemotherapy may be considered in symptomatic patients with recurrent or advancing disease, and it may improve the quality of life in patients with bone metastases. However, a standard protocol for chemotherapeutic management has not been developed for these patients.

Novel agents are under active investigation as options for systemic therapy. Agents that have been studied in patients with metastatic thyroid carcinoma include multitargeted kinase inhibitors and BRAF V600E mutation inhibitors . Preliminary data suggest that anaplastic lymphoma kinase inhibitors such as crizotinib may be useful in PTC with fusion of the striatin and the ALK genes.

A discussion of recently available targeted therapies for use in advanced differentiated thyroid cancer no longer responsive to radioablation may be found in the Chemotherapy section of Follicular Thyroid Carcinoma.

Immunotherapy Carries Minimal Side

Immune checkpoint inhibitor therapy is the best immunotherapy method available.

The human bodys immune cellsT cellscan distinguish between pathogens or cancer cells and remove them.

In this process, immune screening allows T cells to distinguish between the good guys and bad guys in the body. If immune cells attack all cells indiscriminately, people will fall sick.

Cancer cells can trick T cells into thinking that they are normal cells and thus avoid being attacked.

Immunotherapy is moving toward precision treatment: scientists have designed a drug that allows T cells to re-identify and remove cancer cells.

Immunotherapy is appropriate if a lung cancer patients cancer cells contain a high percentage of PD-L1 molecular expression.

For example, a 72-year-old male with stage IV lung adenocarcinoma found no gene-targeted therapy suitable for him after genetic tests. However, a PD-L1 test revealed that his cancer cells had up to 85 percent of PD-L1 expression, making him a good candidate for immunotherapy.

After long-term treatment, his lung cancer was effectively brought under control and has not recurred.

Currently, all lung cancer patients can find suitable immunotherapy treatments with different combinations of drugs.

People associate conventional chemotherapy with side effects like nausea, vomiting, hair loss, and lower white blood cell count. But immunotherapy is not the case.

What Are The Symptoms Of Papillary Thyroid Cancer

The main sign of papillary thyroid cancer is a painless lump or nodule on your thyroid gland. PTC usually doesnt cause any other symptoms.

In rare cases, you may experience pain in your neck, jaw or ear from PTC. If the nodule is large enough to compress your windpipe or esophagus, it may cause difficulty with breathing or swallowing.

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Will I Be Cared For Mainly By One Provider Or Will There Be Multiple Ones

Thyroid cancer care is a team sport. Dr. Lieb says you can expect to be cared for by many people during your cancer treatment, including your primary care physician, your endocrinologist, and your surgeon. There will also be pathologists and social workers. Depending on the type of thyroid cancer, you may also see a nuclear medicine team, vascular surgeon, voice specialist, and imaging professionals.

What Is A Late Effect

CYTOMEL: Side effects, ratings, and patient comments

A late effect is a side effect that is caused by treatment that happens months to years after the cancer treatment has finished. Some side effects that you develop during treatment can last for months to years after treatment is completed . These are often called long-term side effects.

Late effects can be health issues or psychological, emotional, and practical challenges.

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Thyroid Nodules May Be Found During A Routine Medical Exam And Are Usually Not Cancer

Your childs doctor may find a lump in the thyroid during a routine medical exam, or a nodule may be seen on an imaging test or during surgery for another condition. A thyroid nodule is an abnormal growth of thyroid cells in the thyroid. Nodules may be solid or fluid-filled.

When a thyroid nodule is found, an ultrasound of the thyroid and lymph nodes in the neck is done. A fine-needle aspiration biopsy may be done to check for signs of cancer. Blood tests to check thyroid hormone levels and for anti-thyroid antibodies in the blood may also be done. This is to check for other types of thyroid disease.

Thyroid nodules usually don’t cause symptoms or need treatment. Sometimes the thyroid nodules become large enough that it is hard to swallow or breathe and more tests and treatment are needed. Only one in five thyroid nodules become cancer.

Signs Of Thyroid Cancer Include A Swelling Or Lump In The Neck

Thyroid cancer may not cause early signs or symptoms. It is sometimes found during a routine physical exam. Signs or symptoms may occur as the tumor gets bigger. Other conditions may cause the same signs or symptoms. Check with your doctor if you have any of the following:

  • A lump in the neck.
  • Trouble breathing.

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Remission And The Chance Of Recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place , nearby , or in another place .

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options.

Often the treatment plan will include the treatments described above, such as surgery, radioactive iodine therapy, targeted therapy, external-beam radiation therapy, hormone therapy, and chemotherapy. However, they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

What Is The Prognosis Of Papillary Thyroid Cancer

Thyroid Cancer: Managing Side Effects from RAI and New Treatments. Dr. Busaidy. ThyCa Conference

Overall, the prognosis of papillary thyroid cancer is excellent, especially if youre younger than 40 at diagnosis and have a small tumor. PTC can often be treated successfully and is rarely fatal, even if it has spread to lymph nodes in your neck.

Factors that may lead to a worse prognosis include:

  • Being older than 55 years at diagnosis.
  • Having a large tumor.
  • If the cancer has spread to distant parts of your body.
  • If you have a rare subtype of PTC, which are typically more aggressive, including the tall cell variant, diffuse sclerosis variant or solid variant.

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What Is Papillary Thyroid Cancer

Papillary thyroid cancer begins in the follicular cells in your thyroid that produce thyroglobulin . Its the most common type of thyroid cancer.

Your thyroid is a small, butterfly-shaped gland located at the front of your neck under your skin. Its a part of your endocrine system and controls many of your bodys important functions by producing and releasing certain hormones.

PTC tends to grow very slowly and usually develops in only one lobe of your thyroid gland.

There are several subtypes of papillary thyroid cancers. Of these, the follicular subtype is the most common. Other subtypes of papillary cancer arent as common and tend to grow and spread more quickly. They include:

Papillary thyroid cancer is also called papillary thyroid carcinoma.

There Are Different Types Of Thyroid Cancer

Thyroid cancer can be described as either:

Well-differentiated tumors can be treated and can usually be cured.

Poorly differentiated and undifferentiated tumors are less common. These tumors grow and spread quickly and have a poorer chance of recovery. Patients with anaplastic thyroid cancer should have molecular testing for a mutation in the BRAFgene.

Medullary thyroid cancer is a neuroendocrine tumor that develops in C cells of the thyroid. The C cells make a hormone that helps maintain a healthy level of calcium in the blood.

See the PDQ summary on Childhood Thyroid Cancer Treatment for information about childhood thyroid cancer.

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Side Effects Of Rai Treatment

Usually, being temporarily radioactive is the only major side effect of RAI treatment. Drinking lots of water helps the RAI treatment pass out of your body faster and also reduces the bladders exposure to radiation.

Because the salivary glands may absorb some iodine, you might have a dry mouth as well as taste and smell changes for a few weeks after treatment. Some people will have ongoing problems with swelling and pain in their salivary glands. Ask your treatment team for medicines to relieve swelling and pain. Other side effects, such as tiredness, are often caused by thyroid hormone withdrawal, but will improve when your thyroid hormone levels return to normal.

Side Effects Of Thyroid Surgery

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The risks of thyroid surgery include:

  • 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.

  • 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.

  • 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.

  • 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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What Is Dual Immunotherapy

Immune checkpoint inhibitors are effective immunotherapeutic drugs available, mainly consisting of two types of inhibitors.

Most lung cancer patients need only one type of inhibitor while a limited number of patients need both, i.e., dual immunotherapy, to achieve beneficial outcomes.

That is because, if we compare T cells that remove cancer cells in the body to a car charging forward, the situation of some patients is the same as using both the foot and hand brakes, thus making the vehicle unable to run forward with full power. However, dual immunotherapy is meant to release the two brakes as in the T cells at the same time, allowing them to attack and eliminate cancer cells in full play.

There are also some patients who have to use both immune checkpoint inhibitors and chemotherapeutic drugs to achieve desirable results.

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.

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Medical Groups Recommend Covid

People with cancer have a higher risk of severe complications from COVID-19. Approved vaccines against SARS-CoV-2 have been shown to reduce the risk of hospitalization and death from COVID-19 among people with cancer.

The Centers for Disease Control and Prevention and other medical groups generally recommend that people with cancer receive an mRNA COVID-19 vaccine.

But some people with cancer have been reluctant to be vaccinated while being treated with immune checkpoint inhibitors out of concerns that the additional stimulation of the immune system could contribute to side effects.

Some clinicians and patients at Memorial Sloan Kettering had concerns that the COVID-19 vaccine might interfere with immunotherapy and might spur immune-related adverse events, which can be serious, said Dr. Widman.

Fortunately, we found no evidence to support those concerns, he added.

Providing Reassurance About The Safety Of Covid

Sorafenib Side Effect Management in Thyroid Cancer

People with cancer were not included in the initial studies of the mRNA COVID-19 vaccines. As a result, when the vaccines became available there were no studies of these vaccines in patients receiving immune checkpoint inhibitors.

Studies of other vaccines have suggested that patients undergoing treatments for cancer that involve suppressing the immune system, such as stem cell therapy, should hold off on vaccination for several months because the response to the vaccine may be temporarily lessened.

In terms of side effects, a 2019 study found that the flu vaccine did not contribute to increased immune-related side effects in patients being treated with immune checkpoint inhibitors. The flu vaccine study was led by Mini Kamboj, M.D., the chief medical epidemiologist at MSKCC, who also led the new COVID-19 study.

Two studies published in 2021 also found no signs that COVID-19 vaccines contribute to immune-related side effects. One study was conducted in Israel, and the other in the United States. The MSKCC study was larger and followed patients for longer after vaccination than the earlier studies did.

The new findings should provide additional reassurance to doctors and patients about the safety of COVID-19 vaccines, noted Ido Wolf, M.D., of Tel Aviv University, who led the Israeli study.

These vaccines can save lives, particularly for patients with cancer who may be older and have weakened immune systems and other health conditions, said Dr. Wolf.

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How Does Radioactive Iodine Treat Hyperthyroidism

Your thyroid, a butterfly-shaped gland located in the lower front of your neck, produces hormones that regulate your bodys metabolism and other functions. Hyperthyroidism speeds up the bodys processes causing nervousness and anxiety, rapid heartbeat, missed or light menstrual periods, sleep problems, hand tremors and other problems.

The thyroid gland needs iodine to make these hormones. The thyroid is the most efficient organ at concentrating iodine. RAI treats hyperthyroidism by damaging or destroying thyroid cells through radiation.

RAI is taken in an oral capsule form. You dont need to be hospitalized unless the dose is very high, which is rarely needed. You will be prompted to drink lots of water after taking the pill to flush the remaining radioactive iodine out of your system.

Most patients need only one dose before their hyperthyroidism is resolved, which may take a few weeks to several months. If your symptoms are still there after six months, you may have to receive a second dose.

Braf And Mek Inhibitors

Some anaplastic thyroid cancers have changes in the BRAF gene, which causes them to make certain proteins that can help them grow.

Dabrafenib and trametinib are drugs that target some of these proteins. These drugs can be used together to treat anaplastic thyroid cancers that have a certain type of BRAF gene change and that cant be removed completely with surgery.

These drugs are taken as pills or capsules each day.

Common side effects can include skin changes, rash, itching, sensitivity to the sun, headache, fever, chills, joint or muscle pain, fatigue, cough, hair loss, nausea, diarrhea, and high blood pressure.

Less common but serious side effects can include bleeding, heart rhythm problems, liver or kidney problems, lung problems, severe allergic reactions, severe skin or eye problems, and increased blood sugar levels.

Some people treated with these drugs develop skin cancers, especially squamous cell skin cancers. Your doctor will want to check your skin often during treatment. You should also let your doctor know right away if you notice any new growths or abnormal areas on your skin.

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Targeted Therapy And Immunotherapy Thriving In Lung Cancer Care

If lung cancer is detected early, surgery is the best solution. If a tumor mass is large or has spread to lymph nodes, chemotherapy or radiotherapy will be needed as an auxiliary means. In the case of cancer metastasis making surgery impossible, systemic treatment will be the main choice left, such as chemotherapy, targeted therapy, and immunotherapy.

There have been many advances in the treatment of non-small cell lung cancer over the years, featuring targeted therapy and immunotherapy.

However, the strategy for the treatment of small cell lung cancer is different because patients have little chance of surgical removal due to possible metastasis, even if the tumor is small in size.

The primary cure for small cell lung cancer is chemotherapy, together with radiotherapy when necessary. Latest studies show that the combination of immunotherapy and standard chemotherapy is effective in extending the lives of patients.

Historically, lung cancers, regardless of their types, were treated the same way in the early stages because the treatments available were quite limited.

Findings show that even for the same type of lung cancer, the condition varies from patient to patient, especially in the event of gene mutation. So, corresponding targeted therapy can be created based on individual mutations. In other words, a patient with mutation A is a candidate for type A targeted therapy while another patient with mutation B is a candidate for type B targeted therapy.

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