thyroid cancer treatment
People with thyroid cancer often want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, the shock and stress that people may feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some also want to have a family member or friend with them when they talk to the doctor – to take part in the discussion, to take notes, or just to listen.
The doctor may refer patients to doctors (oncologists) who specialize in treating cancer, or patients may ask for a referral. Specialists who treat thyroid cancer include surgeons, endocrinologists (some of whom are called thyroidologists because they specialize in thyroid diseases), medical oncologists, and radiation oncologists. Treatment generally begins within a few weeks after the diagnosis. There will be time for patients to talk with the doctor about treatment choices, get a second opinion, and learn more about thyroid cancer.
Preparing for treatment
The doctor can describe treatment choices and discuss the results expected with each treatment option. The doctor and patient can work together to develop a treatment plan that fits the patient's needs.
Treatment depends on a number of factors, including the type of thyroid cancer, the size of the nodule, the patient's age, and whether the cancer has spread.
These are some questions a person may want to ask the doctor before treatment begins:
Methods of treating thyroid cancer
People with thyroid cancer have many treatment options. Depending on the type and stage, thyroid cancer may be treated with surgery, radioactive iodine, hormone treatment, external radiation, or chemotherapy. Some patients receive a combination of treatments.
The doctor is the best person to describe the treatment choices and discuss the expected results.
A patient may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods. The section on "The promise of cancer research" has more information about clinical trials.
Surgery is the most common treatment for thyroid cancer. The surgeon may remove all or part of the thyroid. The type of surgery depends on the type and stage of thyroid cancer, the size of the nodule, and the patient's age.
Nearly all patients who have part or all of the thyroid removed will take thyroid hormone pills to replace the natural hormone.
After the initial surgery, the doctor may need to operate on the neck again for thyroid cancer that has spread. Patients who have this surgery also may receive I-131 therapy or external radiation therapy to treat thyroid cancer that has spread.
These are some questions a person may want to ask the doctor before having surgery:
Radioactive iodine therapy (also called radioiodine therapy) uses radioactive iodine (I-131) to destroy thyroid cancer cells anywhere in the body. The therapy usually is given by mouth (liquid or capsules) in a small dose that causes no problems for people who are allergic to iodine. The intestine absorbs the I-131, which flows through the bloodstream and collects in thyroid cells. Thyroid cancer cells remaining in the neck and those that have spread to other parts of the body are killed when they absorb I-131.
If the dose of I-131 is low enough, the patient usually receives I-131 as an outpatient. If the dose is high, the doctor may protect others from radiation exposure by isolating the patient in the hospital during the treatment. Most radiation is gone in a few days. Within 3 weeks, only traces of radioactive iodine remain in the body.
Patients with medullary thyroid cancer or anaplastic thyroid cancer generally do not receive I-131 treatment. These types of thyroid cancer rarely respond to I-131 therapy.
Hormone treatment after surgery is usually part of the treatment plan for papillary and follicular cancer. When a patient takes thyroid hormone pills, the growth of any remaining thyroid cancer cells slows down, which lowers the chance that the disease will return.
After surgery or I-131 therapy (which removes or destroys thyroid tissue), people with thyroid cancer may need to take thyroid hormone pills to replace the natural thyroid hormone.
People may want to ask these questions about radioactive iodine (I-131) therapy or hormone therapy:
External radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. A large machine directs radiation at the neck or at parts of the body where the cancer has spread.
External radiation therapy is local therapy. It affects cancer cells only in the treated area. External radiation therapy is used mainly to treat people with advanced thyroid cancer that does not respond to radioactive iodine therapy. For external radiation therapy, patients go to the hospital or clinic, usually 5 days a week for several weeks. External radiation may also be used to relieve pain or other problems.
These are some questions a person may want to ask the doctor before having external radiation therapy:
Chemotherapy, the use of drugs to kill cancer cells, is sometimes used to treat thyroid cancer. Chemotherapy is known as systemic therapy because the drugs enter the bloodstream and travel throughout the body. For some patients, chemotherapy may be combined with external radiation therapy.
Patients may want to ask these questions about chemotherapy:
Because cancer treatment may damage healthy cells and tissues, unwanted side effects sometimes occur. These side effects depend on many factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Doctors and nurses will explain the possible side effects of treatment and how they will help the patient manage them.
Patients are often uncomfortable for the first few days after surgery. However, medicine can usually control their pain. Patients should feel free to discuss pain relief with the doctor or nurse. It is also common for patients to feel tired or weak. The length of time it takes to recover from an operation varies for each patient.
After surgery to remove the thyroid and nearby tissues or organs, such as the parathyroid glands, patients may need to take medicine (thyroid hormone) or vitamin and mineral supplements (vitamin D and calcium) to replace the lost functions of these organs. In a few cases, certain nerves or muscles may be damaged or removed during surgery. If this happens, the patient may have voice problems or one shoulder may be lower than the other.
Radioactive iodine (I-131) therapy
Some patients have nausea and vomiting on the first day of I-131 therapy. Thyroid tissue remaining in the neck after surgery may become swollen and painful. If the thyroid cancer has spread to other parts of the body, the I-131 that collects there may cause pain and swelling.
Patients also may have a dry mouth or lose their sense of taste or smell for a short time after I-131 therapy. Chewing sugar-free gum or sucking on sugar-free hard candy may help.
During treatment, patients are encouraged to drink lots of water and other fluids. Because fluids help I-131 pass out of the body more quickly, the bladder's exposure to I-131 is reduced.
Because radioactive iodine therapy destroys the cells that make thyroid hormone, patients may need to take thyroid hormone pills to replace the natural hormone.
A rare side effect in men who received large doses of I-131 is loss of fertility. In women, I-131 may not cause loss of fertility, but some doctors suggest that women avoid pregnancy for one year after I-131 therapy.
Researchers have reported that a very small number of patients may develop leukemia years after treatment with high doses of I-131.
Thyroid hormone pills seldom cause side effects. However, a few patients may get a rash or lose some of their hair during the first months of treatment.
The doctor will closely monitor the level of thyroid hormone in the blood during followup visits. Too much thyroid hormone may cause patients to lose weight and to feel hot and sweaty. It also may cause chest pain, cramps, and diarrhea. (The doctor may call this condition "hyperthyroidism.") If the thyroid hormone level is too low, the patient may gain weight, feel cold, and have dry skin and hair. (The doctor may call this condition "hypothyroidism.") If necessary, the doctor will adjust the dose so that the patient takes the right amount.
External radiation therapy
External radiation therapy may cause patients to become very tired as treatment continues. Resting is important, but doctors usually advise patients to try to stay as active as they can. In addition, when patients receive external radiation therapy, it is common for their skin to become red, dry, and tender in the treated area. When the neck is treated with external radiation therapy, patients may feel hoarse or have trouble swallowing. Other side effects depend on the area of the body that is treated. If chemotherapy is given at the same time, the side effects may worsen. The doctor can suggest ways to ease these problems.
Followup care after treatment for thyroid cancer is an important part of the overall treatment plan. Regular checkups ensure that any changes in health are noted. Problems can be found and treated as soon as possible. Checkups may include a careful physical exam, X-rays and other imaging tests (such as a nuclear medicine scan), and laboratory tests (such as a blood test for calcitonin). The doctor can explain the followup plan – how often the patient must visit the doctor and which types of tests are needed.
An important test after thyroid cancer treatment measures the level of thyroglobulin in the blood. Thyroid hormone is stored in the thyroid as thyroglobulin. If the thyroid has been removed, there should be very little or no thyroglobulin in the blood. A high level of thyroglobulin may mean that thyroid cancer cells have returned.
For six weeks before the thyroglobulin test, patients must stop taking their usual thyroid hormone pill. For part of this time, some patients may take a different, shorter-lasting thyroid hormone pill. But all patients must stop taking any type of thyroid hormone pill for the last two weeks right before the test. Without adequate levels of thyroid hormone, patients are likely to feel uncomfortable. They may gain weight and feel very tired. It may be helpful to talk with the doctor or nurse about ways to cope with such problems. After the test, patients go back to their usual treatment with thyroid hormone pills.
The doctor may request an I-131 scan of the entire body. This may be called a "diagnostic I-131 whole body scan." For a short time (usually six weeks) before this scan, the patient stops taking thyroid hormone pills. Thyroid cancer cells anywhere in the body will show up on the scan. After the test, the doctor will tell the patient when to start taking thyroid hormone pills again.
Support for people with thyroid cancer
Living with a serious disease such as cancer is not easy. Some people find they need help coping with the emotional and practical aspects of their disease. Support groups can help. In these groups, patients or their family members get together to share what they have learned about coping with the disease and the effects of treatment. Patients may want to talk with a member of their health care team about finding a support group.
People living with cancer may worry about caring for their families, holding on to their jobs, or keeping up with daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team will answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for help with rehabilitation, emotional support, financial aid, transportation, or home care.
The promise of research
Doctors all over the country are conducting many types of clinical trials. These are research studies in which people take part voluntarily. Studies include new ways to treat thyroid cancer. Research already has led to advances, and researchers continue to search for more effective approaches.
Patients who join these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease. Although clinical trials may pose some risks, researchers take very careful steps to protect their patients.
Patients who are interested in being part of a clinical trial should talk with their doctor.