Head & Neck

Your treatment plan will be based on the type and stage of the thyroid cancer as well as your age, overall health, symptoms, previous treatments and preferences for quality of life. One or more of the following therapies may be recommended.

Surgery is the most common treatment for thyroid cancer, and various procedures and techniques may be available.

Lobectomy, also called hemithyroidectomy, may be used in some low-risk cases when only half of the thyroid needs to be removed.

Near-total thyroidectomy is used to remove all but a very small part of the thyroid. Some lymph nodes may also be removed.

Total thyroidectomy removes the entire thyroid gland. As a result, thyroid hormone therapy must be taken because thyroid hormones can no longer be produced in the body. This hormone replacement medication can be taken as a pill. Taking calcium and vitamin D supplements may be necessary if the parathyroid gland function is affected by surgery. Your surgeon may also remove lymph nodes in the neck to see if the cancer has spread.

Radioactive iodine treatment can be used to destroy remaining thyroid cells that were not removed by surgery or that have spread beyond what can be removed with surgery. This involves giving radioactive iodine (I-131) in liquid or pill form. The thyroid absorbs almost all iodine that enters the body. The radioactive iodine will concentrate in any remaining thyroid tissue, and the radiation will kill the cancer cells.

This treatment is standard of care for papillary or follicular thyroid cancer that has spread to lymph nodes in the neck or other parts of the body. Radioactive iodine treatment does not work in medullary thyroid cancer or anaplastic thyroid cancer because the cancer cells do not absorb iodine.

Radiation therapy is usually given after surgery as adjuvant therapy and concentrates on targeted cancer cells in a specific area. It is more often used as part of treatment for medullary and anaplastic thyroid cancer. External-beam radiation therapy is used typically for later stage thyroid cancer that has spread to critical areas of the neck, such as the trachea, voice box or esophagus.

Drug therapy is systemic therapy that travels throughout the body and may include chemotherapy, hormone therapy or targeted therapy.

Chemotherapy uses drugs to destroy cancer cells by preventing them from growing and dividing. It may consist of a single drug or multiple drugs given in combination. It may also be combined with other types of treatment.

Hormone therapy is used after surgery that removes part of or the whole thyroid. It replaces the hormone needed by the body. It may also slow the growth of remaining differentiated cancer cells.

Targeted therapy drugs are used to slow or stop the progression of disease in certain types of thyroid cancer. Two types of targeted therapy approved for thyroid cancer include tyrosine kinase inhibitors, which block signals needed for tumors to grow, and protein kinase inhibitors, which block proteins needed for cell growth and may kill cancer cells. They may be an option if specific molecular (genetic) abnormalities are found in the tumor. Some of these abnormalities include a neurotrophic tyrosine receptor kinase (NTRK) genetic fusion, a BRAF V600E gene mutation and RET mutation-positive cancers. In some cases, targeted therapy may be used to treat certain types of metastatic thyroid cancer.

Watchful waiting is a strategy of postponing treatment to avoid potential treatment side effects as long as possible. It may be recommended for tumors that appear to be growing very slowly. Your doctor will closely monitor you for signs the cancer has progressed or returned before starting treatment.

Once the cancer is classified, an overall stage is assigned. Thyroid cancer may be Stage I through Stage IV. Stages I and II are generally confined to the local area where the cancer is found, and Stage III has spread to the regional lymph nodes in the neck. Stage IV is further divided into Stages IVA, IVB and IVC. Stages IVA and IVB are locally or regionally advanced disease, and Stage IVC has spread to distant sites, such as the liver, lungs or bone.

These basic stages are designed to group patients who have a similar prognosis (outlook). This grouping allows doctors to more accurately predict outcomes for patients depending on the type of treatment they receive. In certain cancers, the stage is also determined by other factors. For thyroid cancer, the subtype of cancer and age of the patient may influence the stage.

Sometimes your doctor may reassess your stage after treatment or if cancer recurs. This is known as restaging. It is rarely done but typically involves the same diagnostic tests used for the original staging. If a new stage is assigned, it’s often preceded by an “r” to denote that it’s been restaged and different from the original stage given at diagnosis.

Look carefully at the table headlines and sections to ensure you view the information that applies to your diagnosis as each has unique staging characteristics.