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Thyroid Cancer

Understanding treatment for thyroid cancer and how it is delivered

Last modified: February 4, 2022

What are the treatment options for thyroid cancer? Treatment options

The primary treatment options for thyroid cancer include surgery, active surveillance, radioactive iodine treatment, targeted therapies, chemotherapy and/or radiation therapy. 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 in the private health system.

Types of thyroid cancer treatmentTypes of treatment

Active surveillance

Surgery

Chemotherapy

Radioactive iodine treatment

Radiation therapy

Targeted therapy

Clinical trials

Active surveillance for thyroid cancerActive surveillance

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 cancerSurgery

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.

Partial thyroidectomy

A partial thyroidectomy is also known as hemithyroidectomy or lobectomy. During this procedure, the lobe or section of the thyroid which contains cancer is removed. This may be recommended for slow-growing thyroid cancers that are contained within one area of the thyroid.

Total thyroidectomy

This is the most common surgery for thyroid cancer. It involves the removal of the entire thyroid gland (including the lobes and isthmus).

Lymphadenectomy

In a lymphadenectomy, any nearby lymph nodes that have been affected by cancer are removed.

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

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 cancerChemotherapy

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 radiation therapy to treat anaplastic thyroid cancer.

Common chemotherapy medicines

Common chemotherapy drugs used to treat thyroid cancer include:

Dacarbazine and cyclophosphamide

These chemotherapy drugs work by damaging the DNA of the thyroid cancer cells, so they are unable to replicate. They are usually given in combination with other chemotherapy drugs through intravenous infusion.

Vincristine

This drug works by preventing thyroid cancer cells from being able to divide and grow. It is given by intravenous infusion, usually in combination with other chemotherapy drugs.

Doxorubicin

This drug stops the process of DNA replication within cancer cells so that they are unable to grow and spread. It is usually given by intravenous infusion every three to four weeks.

Targeted therapy for thyroid cancerTargeted therapy

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.

Common targeted therapy medicines

Common targeted therapy drugs used to treat thyroid cancer include:

Lenvatinib

This is a targeted therapy drug that blocks the action of several different receptors on the surface of thyroid cancer cells, including VEGF (vascular endothelial growth factor) and TKI (tyrosine kinase). Blocking these receptors prevents the growth of blood vessels that supplies nutrients to the thyroid cancer cells and stops them from being able to divide and grow. Lenvatinib is used to treat locally advanced or advanced (metastatic) thyroid cancer. It is taken orally as a tablet once daily.

Radiation therapy for thyroid cancerRadiation therapy

Radiation therapy 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 radiation therapy commonly used for people with thyroid cancer include:

Clinical trials for thyroid cancer

Icon offers a wide range of clinical trials providing patients with access to new and evolving treatments. Clinical trials offer hope and opportunity and contribute to breakthroughs in treatment for future cancer patients.

See current thyroid cancer clinical trials delivered by Icon Cancer Centre.

Treatment by stage of thyroid cancerTreatment by stage

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:

Stage I thyroid cancers

Surgery (either partial or full thyroidectomy) is the most common type of treatment for stage I thyroid cancers. In some cases, this may be followed with radioactive iodine treatment.
Stage II thyroid cancers

Surgery (either partial or full thyroidectomy) is also the most common type of treatment for stage II thyroid cancers, which may be followed with radioactive iodine treatment.
Stage III thyroid cancers

Surgery (either partial or full thyroidectomy) is the primary treatment for stage III thyroid cancers, and may be followed by treatment with radioactive iodine to destroy any remaining cancer cells. Depending on how extensive the cancer is, this may be followed by treatment with chemotherapy, radiation therapy or targeted therapies.
Stage IV (advanced) thyroid cancers

For advanced thyroid cancer that has spread to other parts of the body, surgery may be followed by treatment with radioactive iodine, targeted therapy or radiation therapy, depending on the type of thyroid cancer you have. Treatment for advanced thyroid cancer primarily focuses on palliative care. You may be treated with targeted therapies, while radiation therapy can help to prevent the cancer from spreading and growing as well as offering symptom and pain management.

ReferencesReferences

For a full list of references, click here.

American Cancer Society. (2019). Treating thyroid cancer. Retrieved on 9 December 2021 from https://www.cancer.org/cancer/thyroid-cancer/treating.html
American Society of Clinical Oncology. (2021). Thyroid Cancer: Treating Thyroid Cancer: Chemotherapy for Thyroid Cancer. Retrieved 9 December 2021 from https://www.cancer.org/cancer/thyroid-cancer/treating/chemotherapy.html
Cancer Council NSW. (2021). Active surveillance for thyroid cancer. Retrieved on 9 December 2021 from https://www.cancercouncil.com.au/thyroid-cancer/treatment/active-surveillance/
Cancer Council NSW. (2020). Chemotherapy for thyroid cancer. Retrieved on 14 April 2021 from https://www.cancercouncil.com.au/thyroid-cancer/treatment/chemotherapy/
Cancer Council NSW. (2020). External beam radiation therapy for thyroid cancer. Retrieved on 9 December 2021 from https://www.cancercouncil.com.au/thyroid-cancer/treatment/external-beam-radiation-therapy/
Cancer Council NSW. (2020). Radioactive iodine treatment. Retrieved on 9 December 2021 from https://www.cancercouncil.com.au/thyroid-cancer/treatment/radioactive-iodine-treatment/
Cancer Council NSW. (2021). Surgery for thyroid cancer. Retrieved on 9 December 2021 from https://www.cancercouncil.com.au/thyroid-cancer/treatment/surgery/
Cancer Council NSW. (2020). Targeted therapy for thyroid cancer. Retrieved on 9 December 2021 from https://www.cancercouncil.com.au/thyroid-cancer/treatment/targeted-therapies/
Cancer Council NSW. (2020). Thyroid hormone replacement therapy. Retrieved on 9 December 2021 from https://www.cancercouncil.com.au/thyroid-cancer/treatment/thyroid-hormone-replacement-therapy/
(2020) Medical Oncology. Head and Neck. Thyroid locally advances or metastatic lenvatinib. Retrieved 9 December 2021 from https://www.eviq.org.au/medical-oncology/head-and-neck/thyroid/1919-thyroid-locally-advanced-or-metastatic-lenvat
Filetti,C. Durante,D. Hartl,S. Leboulleux,L.D. Locati,K. Newboldm,M.G. Papotti,A. Berruti. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up. Annals of Clinical Oncology. Volume 30, Issue 12, P1856-1883, December 01, 2019. DOI: https://doi.org/10.1093/annonc/mdz400
Lohia, S., Hanson, M., Tuttle, R. M., & Morris, L. (2020). Active surveillance for patients with very low-risk thyroid cancer. Laryngoscope investigative otolaryngology, 5(1), 175–182. https://doi.org/10.1002/lio2.356

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