Monday, November 28, 2022

Treating Thyroid Cancer Without Surgery

Risks And Side Effects Of Thyroid Surgery

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Complications are less likely to happen when your operation is done by an experienced thyroid surgeon. Patients who have thyroid surgery are often ready to leave the hospital within a day after the operation. Potential complications of thyroid surgery include:

  • Temporary or permanent hoarseness or loss of voice. This can happen if the larynx or windpipe is irritated by the breathing tube that was used during surgery. It may also occur if the nerves to the larynx are damaged during surgery. The doctor should examine your vocal cords before surgery to see if they move normally.
  • Damage to the parathyroid glands . This can lead to low blood calcium levels, causing muscle spasms and feelings of numbness and tingling.
  • Excessive bleeding or formation of a major blood clot in the neck

Cancer May Spread From Where It Began To Other Parts Of The Body

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if thyroid cancer spreads to the lung, the cancer cells in the lung are actually thyroid cancer cells. The disease is metastatic thyroid cancer, not lung cancer.

After Initial Treatment Are Recurrences Common

Unfortunately, yes. While most patients have a very small risk of dying from thyroid cancer, the risk of recurrence can be as high as 30% depending on the specifics of the individual tumor and patient. The good news is that most recurrences appear in lymph nodes in the neck and are usually readily treated with either additional surgery or more radioactive iodine.

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Papillary Thyroid Cancer Surgery In Sites Other Than The Neck

Papillary thyroid cancer surgery is uncommonly proposed as a treatment approach when disease has spread to distant sites. Although surgery is not commonly proposed for distant spread of papillary thyroid cancer, consideration for surgery for distant disease is based upon the expert thyroid cancer team evaluation and considers the following issues:

  • Where is the papillary thyroid cancer distant disease located?
  • What are the risks and benefits of surgery?
  • Are there other sites of distant spread?
  • What papillary thyroid cancer treatments have already been used?
  • What were the outcomes of other treatments for the papillary thyroid cancer?
  • How fast is the papillary thyroid cancer growing?
  • What are the patient’s treatment desires?
  • What are the other treatment options?
  • What is the papillary thyroid cancer pathologic type (what do the cells look like under the microscope?
  • What are the papillary thyroid cancer genetic mutations?

What Is Differentiated Thyroid Cancer

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Most thyroid cancers are differentiated, according to the American Cancer Society, which means that when the cells are looked at under a microscope they appear similar to normal thyroid cells. Papillary, follicular, and Hurthle cell thyroid cancer are all types of differentiated thyroid cancer. When the cancerous cells are not similar in appearance to normal thyroid tissue, the cancer is called poorly differentiated or undifferentiated. Medullary and anaplastic thyroid cancers fall into this category.

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Life After Thyroid Cancer Surgery

Congrats! You have finished the most important step in your thyroid cancer treatment: surgery to remove the disease. Take a few deep breaths and relax. I want to walk you through what your life after thyroid cancer surgery will look like.

Since the 1970s, the incidence of thyroid cancer has doubled. Until recently, thyroid cancer was the fastest growing cancer in the United States, mainly due to our ability to detect these cancers so well . Thyroid cancer is the 5th most common cancer in women. Overall, the 5-year survival rate for people with thyroid cancer is 98%. The 5-year survival rate is almost 100% for papillary, follicular, and medullary thyroid cancers that have not spread outside of the thyroid gland .

The 5-year survival rate for papillary thyroid cancer that has only spread to lymph nodes or tissue in the neck is 99%. For follicular thyroid cancer that only involves the neck, the survival rate is 97%. If there is distant spread to other parts of the body , it is called metastatic disease. The 5-year survival rate for metastatic papillary thyroid cancer is 76%. For metastatic follicular thyroid cancer, the rate is 64%. Medullary and anaplastic thyroid cancers are very rare, making up only 3% of the thyroid cancer cases. They are more aggressive and tend to spread around and outside of the neck more often.

Thyroid Hormone Replacement Therapy

Thyroid hormone replacement therapy is often prescribed after thyroid surgery to replace the hormones that are no longer being produced by your thyroid tissue. Depending on how much of your thyroid was taken out, you may have to take the medication most commonly levothyroxine for the rest of your life.

Thyroid hormone replacement can also help prevent the growth or recurrence of thyroid cancer. It does this by lowering your circulating level of the hormone TSH, which is secreted by your brains pituitary gland and tells your thyroid to make more thyroid hormone. High TSH levels can stimulate the growth of thyroid cancer cells. Higher doses of replacement thyroid hormone tell your body to make less TSH, slowing the growth of any thyroid cancer cells and lowering the odds of your cancer coming back.

It can take a few adjustments to find the correct dosage of thyroid hormone replacement. During this time, you may need to see the doctor every 6 to 8 weeks for a blood draw to determine if your levels are optimal.

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Who Treats Thyroid Cancer

Depending on the type and stage of your thyroid cancer, you may need more than one type of treatment. Doctors on your cancer treatment team may include:

  • A surgeon: a doctor who uses surgery to treat cancers or other problems
  • An endocrinologist: a doctor who treats diseases in glands that secrete hormones
  • A radiation oncologist: a doctor who uses radiation to treat cancer
  • A medical oncologist: a doctor who uses chemotherapy and other medicines to treat cancer

Many other specialists may be involved in your care as well, including nurse practitioners, nurses, psychologists, social workers, rehabilitation specialists, and other health professionals.

How Is Thyroid Cancer Managed Or Treated

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Treatments for thyroid cancer depend on the tumor size and whether the cancer has spread. Treatments include:

  • Surgery: Surgery is the most common treatment for thyroid cancer. Depending on the tumors size and location, your surgeon may remove part of the thyroid gland or all of the gland . Your surgeon also removes any nearby lymph nodes where cancer cells have spread.
  • Radioiodine therapy: With radioiodine therapy, you swallow a pill or liquid containing a higher dose of radioactive iodine than whats used in a diagnostic radioiodine scan. The radioiodine shrinks and destroys the diseased thyroid gland along with cancer cells. Dont be alarmed this treatment is very safe. Your thyroid gland absorbs almost all of the radioiodine. The rest of your body has minimal radiation exposure.
  • Radiation therapy: Radiation kills cancer cells and stops them from growing. External radiation therapy uses a machine to deliver strong beams of energy directly to the tumor site. Internal radiation therapy involves placing radioactive seeds in or around the tumor.
  • Chemotherapy: Intravenous or oral chemotherapy drugs kill cancer cells and stops cancer growth. Very few patients diagnosed with thyroid cancer will ever need chemotherapy.
  • Hormone therapy: This treatment blocks the release of hormones that can cause cancer to spread or come back.

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Once My Surgery Is Over Is My Cancer Gone Forever

In cases of small thyroid cancers confined to the thyroid, surgery alone has a very high cure rate. When the thyroid cancers are larger, or spread outside the thyroid gland, the risk of recurrence can vary between 5-30% depending on the specifics of the individual tumor and patient.

Sometimes thyroid cancer can come back or spread to other parts of the body even many years after surgery. That is why your doctor needs you to come in for regular checkups especially in the first 5 to 10 years after your surgery.

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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Who Might Have Thyroid Cancer

Women are three times more likely than men to get thyroid cancer. The disease is commonly diagnosed in women in their 40s and 50s, and men in their 60s and 70s. Even children can develop the disease. Risk factors include:

  • Exposure to radioactive fallout from nuclear weapons or a power plant accident.

Side Effects Of Thyroid Hormone Treatment

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Thyroid hormone pills themselves do not usually cause side effects, but it can take some time to get the dosage right, and you may experience symptoms of either or while you and your doctor work to determine the correct dose.

Symptoms of too much thyroid hormone may include:

  • Increased heart rate

Symptoms of too little thyroid hormone may include:

  • dry skin and hair

Definitely check in with your doctor if you feel you are experiencing any of the above symptoms so that your dosage can be properly adjusted.

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What Can Be Done To Make Radioactive Iodine Work Better

To maximize the effectiveness of radioactive iodine, we routinely place patients on a low iodine diet and treat only when the TSH is elevated . However, exciting work the last several years has shown the potential of using other medicines for a few weeks prior to radioactive iodine therapy that blocks specific pathways within the thyroid cancer cells and causes some of the thyroid cancers to dramatically increase the amount of radioactive iodine they absorb. Currently, these medications are being evaluated as part of clinical trials . We hope that in the near future, that one of more of these drugs can be used as part of the preparation for radioactive iodine therapy both to maximize its effectiveness in tumors that can concentrate radioactive iodine but also to restore radioactive iodine uptake in tumors that have lost that ability.

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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Where Can I Find Thyroid Cancer Support

Your biggest sources of support can be your friends and family. Consider taking a trusted friend or relative to your appointments to take notes and ask questions you might not think of right away.

Additionally, hospitals will often have information on support groups in your area both virtual and IRL . The doctor treating your cancer may also be able to suggest some of these.

The Thyroid Cancer Survivors Association has information and support for both newly diagnosed people and those who have been on their cancer journey for longer.

You can also visit and join the American Cancer Societys Cancer Survivors Network.

Thyroid Cancer Causes And Risk Factors

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Its not clear exactly what causes thyroid cancer to develop. However, there are a number of known potential risk factors, some of which can be modified and others that cant. According to the National Cancer Institute, risk factors for developing thyroid cancer include:

Other research led by Dr. Harari is looking at whether certain environmental exposures, including to pesticides and flame retardants, have a link to thyroid cancer.

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Do I Need Treatment For My Thyroid Nodule

Often, patients are not even aware that they have thyroid nodules prior to an imaging test of the neck due to other medical issues. These asymptomatic and hidden nodules are almost always benign and are often left untreated. However, regular safety check-ups and initial diagnostic are commonly conducted in order to rule out any risk of malignancy. Therefore, it is always advisable to discuss with a physician if you suspect you have a lump in the thyroid or neck area.Sometimes, nodules cause symptoms such as pressure on the trachea or gullet, or hyperthyroidism which requires therapy. In the few cases, where diagnosis reveals thyroid cancer, treatment options also have to be carefully discussed with a physician in order to keep the disease from spreading.

Why Do I Need To Take Thyroid Hormone After My Thyroid Surgery

As previously mentioned, patients that had their entire thyroid removed start taking thyroid hormone after their surgery. If only half of the thyroid was removed, thyroid blood tests are usually done 4-8 weeks after surgery to determine if the half of thyroid is producing enough thyroid hormone to make you feel normal.

Thyroid hormone pills replace the normal hormones that the thyroid gland used to make. Taking thyroid hormone prevents you from experiencing hypothyroidism, which can cause a variety of symptoms, such as depression, difficulty in concentrating, tiredness, forgetfulness, dry skin and hair, puffy face and eyes, inability to tolerate the cold, weight gain, constipation, and heavy menstrual periods in women. These symptoms of hypothyroidism vary from patient to patient.

Another reason to take thyroid hormone after thyroidectomy is that TSH may cause thyroid cancers to grow. Taking thyroid hormone tablets sends a signal to the pituitary gland to make less TSH. Your goal TSH level will be based on your initial risk assessment and your response to therapy classification. But it is very few patients that require the TSH to be completely undetectable. Most patients initially start with a TSH goal of about 0.1 to 0.5 mIU/L which then changes to 0.5 to 1.5 mIU/L once they demonstrate an excellent response to therapy

So, taking the thyroid hormone tablets helps in two ways:

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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.

How Do You Qualify For Rfa Treatment

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To be considered for this procedure, there needs to be two biopsys that come back negative for thyroid cancer, says Dr. Goldfarb. There is no evidence to support RFA as a cure for cancer currently. According to a recent press release, Dr. Goldfarb is hopeful this technology will become more prevalent, she is a staunch proponent that it will become the procedure medical experts will utilize to treat thyroid nodules.

Its so exciting to bring RFA to Saint Johns Health Center, providing our community greater access to innovative treatment options and their benefits, said Dr. Goldfarb

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