After treatment – follow-up for thyroid cancer
After your treatment is completed, you’ll have regular check-ups and possibly scans. You may continue to have these for several years, frequently at first and then less often.
Many people find they get very anxious for a while before the appointments. This is natural and it may help to get support from family or friends during this time.
Thyroglobulin is a protein that is normally only made by the healthy thyroid gland, but it can also be produced by papillary or follicular thyroid cancer cells. Levels of thyroglobulin can be detected in the blood.
When the thyroid gland has been removed and radioactive iodine has been given to destroy any remaining cancer cells, thyroglobulin should no longer be produced unless there are still cancer cells left in your body. This makes the thyroglobulin blood test a useful way of detecting any remaining papillary or follicular cancer cells. The blood test is often repeated every 6-12 months.
Sometimes before the test, people will be given recombinant human thyroid-stimulating hormone (rhTSH) to increase the level of TSH in the blood. This will stimulate any thyroid cells or thyroid cancer cells that are left in the body to produce thyroglobulin.
If you have rhTSH, you won’t need to stop taking your thyroid hormone replacement tablets.
Radioactive iodine scan
Some people may have a radioactive iodine scan a few months after treatment to check whether there are any thyroid cancer cells in their body. Your doctors will tell you if you’ll need to have a scan.
This test uses radioactive iodine, which is injected into a vein in your arm. After about 20 minutes, you’ll be asked to lie on a couch and a machine called a gamma camera will be positioned over your neck. The scan itself is painless.
If you have been given rhTSH to test the thyroglobulin level in your blood, you may be able to have the radioactive iodine scan 48–72 hours later. The thyroglobulin blood test is done 72 hours after your second injection of rhTSH. In this way, you won’t have to stop your thyroid hormone replacement tablets before the radioactive iodine scan.
If you’re not taking rhTSH, you’ll need to stop taking thyroid hormone replacement tablets. If you’re taking thyroxine (T4), you’ll need to stop taking it 4–6 weeks before the scan. Triiodothyronine (T3) tablets will need to be stopped two weeks before. This is done so that the body will produce enough thyroid-stimulating hormone (TSH) to make the tests as accurate as possible. TSH makes any thyroid cells, or thyroid cancer cells that may be left in your body, produce thyroglobulin and absorb radioactive iodine.
Stopping the hormone replacement tablets will mean that your levels of thyroid hormones will get lower. As a result, you’ll begin to develop the symptoms of hypothyroidism, such as depression, weight gain, forgetfulness, decreased concentration and tiredness. This may affect your ability to operate machinery or drive. You can start taking your tablets again once the tests are finished. The symptoms should begin to reduce as the levels of thyroid hormones in your bloodstream increase.
If thyroglobulin has been detected, there may still be some cancer cells present. However, thyroid cancer cells may not be found when a radioactive iodine scan is done.
In this situation, you may have an ultrasound or CT scan to help detect any cells that may be there. Sometimes a PET-CT scan may be used. A small amount of a radioactive substance is injected in the same way as a standard PET scan, and then the CT scan takes a series of x-rays. A computer combines the information from the two scans and allows your doctor to measure any changes in the activity of cells and to know exactly where in the body the changes are.
Many people survive thyroid cancer. However, the treatment can be very hard on the body, and it may be some time before you’re feeling fit and well again. Some people experience treatment side effects that gradually improve over time, while others may have ongoing side effects. You may have a range of other effects such as trouble sleeping or feeling weaker and more tired than usual, rather than specific treatment side effects.
Lifestyle - positive choices, helping yourself
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Some people want to make changes to their lifestyle after cancer. You might choose to make just a few changes or completely change the way you live. Adopting a healthy lifestyle doesn’t have to be very difficult or expensive.
Living a healthy lifestyle can sometimes appear to be a lot of hard work, and as if you will be denying yourself all of the pleasures in life. However, it’s about making small, achievable changes to the way you live that will improve your health and well-being. Your healthy lifestyle will be individual to you, and what is right for you may not be right for someone else. A healthy lifestyle can include having a well-balanced diet, getting some exercise, reducing stress and being involved in your healthcare. You’ll need to think about any side effects of treatment when planning changes to your diet and exercise. Don’t try to do too much too soon.
A well-balanced diet should include:
plenty of fresh fruit and vegetables (at least five portions a day)
foods high in fibre, such as beans and cereals
plenty of water or other non-alcoholic fluids.
Try to reduce your intake of:
red meat and animal fats
salted, pickled and smoked foods.
Before making major changes to your diet, it’s a good idea to discuss your plans with your specialist or with a dietitian at the hospital.
We have a section on healthy eating and cancer, which has more information.
If you are a smoker, you may want to stop smoking. This has many health benefits and reduces your risk of other diseases such as heart disease and stroke.
Our section on giving up smoking can give you information and guidelines on how to do this.
Exercise doesn’t have to be particularly strenuous. You can start gently and build up the amount of physical activity you do. Whatever your age or physical health, there will be some kind of exercise you could try, such as walking, hiking, cycling or swimming. Activities like gardening, dancing and playing sport are also good to try.
We have sections on physical activity and weight management with information and practical advice on how to increase your activity and control your weight.