How is thyroid cancer treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society’s Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don’t hesitate to ask him or her questions about your treatment options.

Making treatment decisions

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.

After thyroid cancer is found and staged, your cancer care team will discuss your treatment options with you. It is important to take the time to consider each of your options. In choosing a treatment plan, factors to consider include the type and stage of the cancer and your general health. The treatment options for thyroid cancer might include:

• Surgery
• Radioactive iodine treatment
• Thyroid hormone therapy
• External beam radiation therapy
• Chemotherapy
• Targeted therapy

The best treatment approaches often use 2 or more of these methods.

Most thyroid cancers can be cured, especially if they have not spread to distant parts of the body. If the cancer can’t be cured, the goal of treatment may be to remove or destroy as much of the cancer as possible and to keep it from growing, spreading, or returning for as long as possible. Sometimes treatment is aimed at palliating (relieving) symptoms such as pain or problems with breathing and swallowing.

If you have any concerns about your treatment plan, if time permits it is often a good idea to get a second opinion. In fact, many doctors encourage this. A second opinion can provide more information and help you feel confident about the treatment plan you choose.

Some treatments for thyroid cancer might affect your ability to have children later in life. If this might be a concern for you, talk to your doctor about it before you decide on treatment. For more information, see our document Fertility and Cancer: What Are My Options?

The next few sections describe the types of treatment used for thyroid cancers. This is followed by a description of the most common approaches based on the type and stage of the cancer.

Surgery for thyroid cancer

Surgery is the main treatment in nearly every case of thyroid cancer, except for some anaplastic thyroid cancers. If thyroid cancer is diagnosed by a fine needle aspiration (FNA) biopsy, surgery to remove the tumor and all or part of the remaining thyroid gland is usually recommended.

Lobectomy

This operation is sometimes used to treat differentiated (papillary or follicular) thyroid cancers that are small and show no signs of spread beyond the thyroid gland. It is also sometimes used to diagnose thyroid cancer if an FNA biopsy result doesn’t provide a clear diagnosis (see “How is thyroid cancer diagnosed?”).

First, the surgeon makes an incision (cut) a few inches long across the front of the neck and exposes the thyroid. The lobe containing the cancer is then removed, usually along with the isthmus (the small piece of the gland that acts as a bridge between the left and right lobes).

An advantage of this surgery, if it can be done, is that some patients might not need to take thyroid hormone pills afterward because it leaves part of the gland behind. But having some thyroid left can interfere with some tests that look for cancer recurrence after treatment, such as radioiodine scans and thyroglobulin blood tests.

Thyroidectomy

Thyroidectomy is surgery to remove the thyroid gland. As with lobectomy, this is typically done through an incision a few inches long across the front of the neck.

This is the most common surgery for thyroid cancer. If the entire thyroid gland is removed, it is called a total thyroidectomy. Sometimes the surgeon may not be able to remove the entire thyroid. If nearly all of the gland is removed, it is called a near-total thyroidectomy. If most of the gland is removed, it is called a subtotal thyroidectomy.

After a thyroidectomy (and possibly radioactive iodine [radioiodine] therapy), you will need to take daily thyroid hormone (levothyroxine) pills. But one advantage of this surgery over lobectomy is that your doctor can most often watch you for disease recurrence afterward using radioiodine scans and thyroglobulin blood tests.

Lymph node removal

If cancer has spread to nearby lymph nodes in the neck, these will be removed at the same time surgery is done on the thyroid. This is especially important for treatment of medullary thyroid cancer and for anaplastic cancer (when surgery is an option).

For papillary or follicular cancer where only 1 or 2 enlarged lymph nodes are thought to contain cancer, the enlarged nodes may be removed and any small deposits of cancer cells that may be left are then treated with radioactive iodine (see “Radioactive iodine [radioiodine] therapy”). More often, several lymph nodes near the thyroid are removed in an operation called a central compartment neck dissection. Removal of even more lymph nodes, including those on the side of the neck, is called a modified radical neck dissection.

Risks and side effects of surgery

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 (voice box) or windpipe is irritated by the breathing tube that was used during surgery. It may also occur if the nerves to the larynx (or vocal cords) are damaged during surgery. The doctor should examine your vocal cords before surgery to assess their mobility (see “How is thyroid cancer diagnosed?”).
• Damage to the parathyroid glands (small glands near the thyroid that help regulate blood calcium levels). This can lead to low blood calcium levels, causing muscle spasms and numbness and tingling sensations
• Excessive bleeding or formation of a major blood clot in the neck (called a hematoma)
• Wound infection

You will have a small scar across the front of your neck after surgery. This should become less noticeable over time as it heals.

If most or all of your thyroid gland is removed, you will need to take daily thyroid hormone replacement pills. All patients who have had near-total or total thyroidectomy will need to do this.

For more information about cancer surgery in general, see the American Cancer Society document, Understanding Cancer Surgery: A Guide for Patients and Families.