Thyroid Cancer: Understanding Your Treatment Options
- Treatment for thyroid cancer may involve a combination of surgery, radioactive iodine, TSH (thyroid stimulating hormone) suppression, radiation, and other targeted therapies.
- In a case-by-case approach, the doctors will decide the best treatment for you. Patients in different disease stages might need different approaches.
- Surgery is often part of the treatment plan and there are different types of surgery your doctor may recommend depending on your specific case, including removing only a part of your thyroid (a partial thyroidectomy) and removing the entire thyroid (total thyroidectomy).
- After surgery, many patients, especially those with more advanced diseases, may receive radioactive iodine (RAI) therapy.
For anaplastic thyroid cancer, the most aggressive and fast-growing form, treatment typically involves a comprehensive multi-method approach. Unlike other thyroid cancer types, anaplastic cases often need an intensive combination of surgery, radiation therapy, chemotherapy, and targeted therapy used together or in a carefully planned order.
Read MoreSurgery: Understanding the Different Types
There are a few different types of thyroid cancer surgery your doctor may recommend depending on your specific case, including removing only a part of your thyroid (a partial thyroidectomy) and removing the entire thyroid (total thyroidectomy).
“There has been a general trend toward trying to preserve as much thyroid function as possible in the process of treating cancer. And that has gone hand in hand with trying to minimize complications from thyroid surgery,” Dr. Lisa Orloff, an endocrine/head and neck surgeon at Stanford Medicine, tells SurvivorNet.
“A few decades ago, the standard operation for somebody who was diagnosed with thyroid cancer would be just to take the whole thyroid gland out, nowadays, we can achieve a cure by removing only part of the thyroid gland so that it minimizes the risk to surrounding structures and it maximizes preservation of hormone production,” she explains.
Radioactive Iodine (RAI) Therapy
After surgery, many patients, especially those with more advanced cancers, may receive radioactive iodine.
The thyroid gland tissue absorbs and uses iodine to produce its hormones. Researchers discovered that using a particular radioactive form of iodine (RAI or “I-131″) can help find and destroy any leftover cancerous thyroid cells that may have spread, with little to no harm to the rest of the body. Therefore, RAI became part of the treatment arsenal in most many thyroid cancer subtypes.
Dr. Orloff states that this therapeutic modality “is used in a variety of settings. It’s used for some benign thyroid conditions, such as when there’s overactivity of the thyroid gland, and we want to slow down the thyroid and destroy some of the function that’s overactive … it’s also used in a subset of thyroid cancer patients who are at risk of having the cancer spread.”
TSH Suppression Therapy
Thyroid stimulating hormone (TSH), as discussed above, acts on the thyroid cells to stimulate its growth and hormone production. In the context of cancer cells, the aim is precisely to avoid their growth or multiplication.
Thus, one potential treatment option is to suppress the serum levels of TSH. This is achieved by administering thyroid hormone medication in slightly higher doses. This helps keep TSH levels low and reduces the chance of stimulating any remaining cancer cells.
External Beam Radiation Therapy
External beam radiation therapy is also available to treat thyroid cancer. This treatment modality uses high-energy X-rays or proton beams to target and destroy cancer cells (radiation therapy). Unlike radioactive iodine (RAI) therapy, which is commonly used for thyroid cancer and works internally by being absorbed by thyroid tissue, EBRT is delivered externally from a machine that directs radiation precisely at the tumor site.
“Radiation therapy in the more traditional form — X-ray therapy, external beam radiation — can be used to treat specific areas that have cancer spread, whether it’s in the neck or sometimes … bone metastasis can be targeted with external beam radiation,” Dr. Orloff explains.
Sometimes, it is used in more advanced or aggressive thyroid cancers that either don’t respond well to surgery or radioactive iodine or cannot be treated entirely with surgery.
Systemic Therapies & Immunotherapy
In cases where thyroid cancer is advanced, has come back, or spread, newer medications known as targeted therapies (e.g., tyrosine kinase inhibitors) may be recommended. They specifically target the processes that help cancer cells grow.
Doctors will evaluate whether or the patient’s anaplastic thyroid cancer has a particular type of gene mutation within the cancer, which would open the door to various types of targeted therapies.
BRAF is the most common gene mutation found in thyroid cancers, with RAS mutation ranking as the second most common.
Anaplastic thyroid cancer patients may also utilize immunotherapy in their treatment. Dr. Forner explains, “You can think of (immunotherapy) somewhat like a chemotherapy, but instead of killing the cells directly, it actually helps your immune system fight the cancer better.”
With anaplastic thyroid cancers, doctors commonly use both systemic therapies and immunotherapy as part of the treatment approach to fight the cancer.
Questions To Ask Your Doctor
- What are the potential benefits, risks, and success rates of each treatment?
- Do I have any gene mutations?
- Which treatment(s) do you recommend, and why?
- Are there any newer or experimental treatments I should consider?
- How should I prepare before treatment?
- Will I need to make any lifestyle changes (diet, exercise) prior to treatment?
- What is the typical recovery time after treatment, and what kind of support or rehabilitation services are available?
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