Thyroid Cancer Treatment

What are the treatment options for thyroid cancer?

The primary treatment options for thyroid cancer include surgery, active surveillance, radioactive iodine treatment, targeted therapies, chemotherapy and/or radiotherapy. The type of treatment you receive will depend on a number of different considerations, such as the type of thyroid cancer you have, its stage, your overall health and your treatment preferences. This page aims to give you a comprehensive overview of how thyroid cancer treatment works.

Active surveillance for thyroid cancer

For some people, thyroid cancer may be managed by active surveillance only. This involves closely monitoring your thyroid cancer for any changes over time through ultrasounds, physical examinations and blood tests rather than receiving immediate treatment. Active surveillance is only suitable for small, low-risk papillary thyroid cancers that are confined within the thyroid

Surgery for thyroid cancer

Surgical oncologists perform surgery for patients with thyroid cancer to remove cancerous tissue and reduce the risk of cancer returning. Most people with thyroid cancer will receive surgery at some point during their treatment, which usually involves removing a section of the thyroid (partial thyroidectomy) or the entire thyroid gland (total thyroidectomy).

There are a number of surgeries you may receive depending on the size and stage of your thyroid cancer and if it has spread to other areas of the body.

The three approaches for thyroid cancer surgery, performed under general anaesthesia, include:

• Standard thyroidectomy – where an incision is made through the base or middle of the neck to access the thyroid gland

• Endoscopic thyroidectomy – a minimally invasive procedure that uses a small incision to access the thyroid with a scope and camera

• Robotic-assisted thyroidectomy – uses a robotic system to perform the thyroidectomy remotely

If you have surgery to remove your thyroid (total thyroidectomy), you will no longer be able to produce the thyroxine (T4) hormone which is produced by the thyroid to help maintain the body’s metabolism. You will need to take hormone replacement therapy to replace the thyroxine (T4) hormone. This will also help reduce the risk of cancer returning after the thyroid is removed. Thyroid hormone replacement therapy continues throughout a person’s life once the thyroid is removed and involves taking a hormone tablet every day.

Radioactive iodine treatment for thyroid cancer

Radioactive iodine treatment is a radioisotope treatment which involves swallowing a pill containing the radioactive substance I131 (RAI). Since the thyroid gland absorbs the iodine from your body, the radioactive iodine concentrates within it and destroys cancer cells while leaving other cells unharmed. It is often used following surgery to treat any remaining cancer cells left behind. It is typically recommended for the treatment of papillary or follicular thyroid cancers that have spread to the lymph nodes or have a high risk of returning. Radioactive iodine treatment is commonly delivered as an adjuvant therapy following surgery to reduce the risk of thyroid cancer coming back (recurring) in high-risk patients or for thyroid cancer patients with a small amount of spread (metastases).

Typically, you will need to be assessed by nuclear medicine to determine the dose of radioactive iodine you will receive (biological dosimetry). You will need to follow certain recommendations (radiation safety procedures) after administration of the radioactive iodine and will stay at the hospital for a few days.

Chemotherapy for thyroid cancer

Chemotherapy uses drugs to destroy thyroid cancer cells or to stop them from growing and spreading. Chemotherapy is not widely used to treat thyroid cancer but may be used to treat advanced thyroid cancer that does not respond to other treatments, or in combination with radiotherapy to treat anaplastic thyroid cancer.

Targeted therapy for thyroid cancer

For people with advanced thyroid cancer, targeted therapy drugs may be given to stop the cancer’s growth and spread. These drugs are delivered orally or through the bloodstream to attack specific components of thyroid cancer cells.

Radiotherapy for thyroid cancer

Radiotherapy may be used in a number of ways to treat thyroid cancer. 

This includes:

• After surgery and radioactive iodine treatment for thyroid cancer that cannot be completely removed or has a high risk of returning

• To help control certain types of thyroid cancer such as medullary or anaplastic thyroid cancer that do not respond to other treatments

• For advanced thyroid cancer that has spread to other parts of the body to help relieve symptoms such as pain.

Types of radiotherapy commonly used for people with thyroid cancer include: External beam radiotherapy (EBRT).

Treatment by stage of thyroid cancer

When you are diagnosed with thyroid cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the type and stage of your cancer.

Common options include: