Treatment for thyroid cancer
Treatment for thyroid cancer varies according to the type of thyroid cancer, its stage and your general health. Most types of thyroid cancer can usually be treated successfully and many people are cured.
Papillary and follicular thyroid cancers are classed by doctors as being either low- or high-risk. The risk helps doctors decide which treatments will be the most appropriate. For example, someone with a low-risk cancer may need less treatment.
The first treatment for papillary, follicular and medullary thyroid cancer is usually surgery. The surgeon will try to remove all of the cancer. Either part of the thyroid gland (a partial thyroidectomy or lobectomy) or, more commonly, all of the thyroid gland (total thyroidectomy) will be removed. Sometimes it’s also necessary to remove lymph nodes and tissue around the thyroid gland.
Thyroid hormone therapy is usually given after thyroid surgery. This is to replace the hormones that are normally made by the thyroid gland. Thyroid hormone replacement is also used in some people with papillary or follicular thyroid cancer to reduce the risk of the cancer coming back.
Radiotherapy is often given to treat thyroid cancer and can be given as radioactive iodine, or occasionally as external beam radiotherapy. Radioactive iodine is the most common way of giving radiotherapy in people with papillary or follicular thyroid cancer. It’s not used in medullary thyroid cancer. It may be used after surgery to reduce the risk of the cancer coming back, or to destroy any remaining cancer cells if surgery can’t remove it all.
Chemotherapy isn’t a common treatment for thyroid cancer. It’s sometimes used to treat anaplastic thyroid cancer, or it may be given as part of a clinical trial for other types of thyroid cancer if the cancer comes back after treatment.
Newer treatments known as targeted therapies may occasionally be used.
How treatment is planned
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In most hospitals, a team of specialists will decide the best treatment for you. This multidisciplinary team (MDT) includes:
a surgeon who specialises in thyroid cancers
an oncologist (a cancer specialist)
a radiologist (a doctor who advises on x-rays and scans)
a nuclear medicine specialist (who analyses tests and scans using radioactive substances, such as a thyroid scan)
a pathologist (a doctor who specialises in how disease affects the body)
an endocrinologist (a doctor who specialises in glands).
There may also be a number of other healthcare professionals, such as a:
speech and language therapist
psychologist or counsellor.
Together they can advise you on the best course of action and plan your treatment, taking into account a number of factors including your general health, the cancer type and stage.
If more than one treatment is equally effective for your type and stage of cancer - for example, surgery or radiotherapy - your doctors may offer you a choice of treatments. Sometimes people find it very hard to make a decision. If you’re asked to make a decision, make sure that you have enough information about the different treatment options, what they involve and the possible side effects. This is so you can decide the right treatment for you.
Remember to ask questions about anything you don’t understand or that you feel worried about. It may help to discuss the benefits and disadvantages of each option with your cancer specialist, nurse specialist or with our cancer support specialists.
Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you.
Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion.
Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.
Getting a second opinion
In our video Dr David Plume explains the possible benefits and disadvantages of getting a second opinion about treatment.
Before you have any treatment, your doctor will explain its aims. They will ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:
the type and extent of the treatment
its benefits and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away so they can explain again. Some cancer treatments are complex, so it’s not unusual for people to need repeated explanations.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
The benefits and disadvantages of treatment
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Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur. However, these can usually be controlled with medicines.
Treatment can be given for different reasons and the potential benefits will vary depending on your individual situation.
Most people with papillary or follicular thryoid cancer will be cured. Many people with medullary thyroid cancer are also cured. Anaplastic thyroid cancer is more difficult to treat.
Your doctor will be able to discuss the benefits and disadvantages of treatment for your situation with you. However, it can help to ask about the aims of treatment, the chances of a complete cure and the possible side effects of treatment.
Rarely, treatment may have no effect on the cancer and you may get the side effects without any of the benefits.
If you have been offered treatment that aims to cure your type of thyroid cancer, it may be easy to decide whether to accept the treatment.
However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead. Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, with medicines to control any symptoms.
It’s important that you ask your doctors and nurses any questions you have about your treatment. The more you understand about your treatment, the easier it will be for you and them.