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Thyroid Cancer - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Thyroid Cancer. To see other pages, use the menu. Think of that menu as a roadmap to this full guide.

About the thyroid

Thyroid cancer begins in the thyroid gland. This gland is located in the front of the neck just below the larynx, which is called the voice box. The thyroid gland is part of the endocrine system, which regulates hormones in the body. The thyroid gland absorbs iodine from the bloodstream to produce thyroid hormones, which regulate a person’s metabolism.

A normal thyroid gland has 2 lobes, 1 on each side of the windpipe, joined by a narrow strip of tissue called the isthmus. A healthy thyroid gland is barely palpable, which means it is hard to find by touch. If a tumor develops in the thyroid, it is felt as a lump in the neck. A swollen or enlarged thyroid gland is called a goiter, which may be caused when a person does not get enough iodine. However, most Americans receive enough iodine from salt, and a goiter under these circumstances is caused by other reasons.

About thyroid tumors

Thyroid cancer starts when healthy cells in the thyroid change and grow out of control, forming a mass called a tumor. The thyroid gland contains 2 types of cells:

  • Follicular cells. These cells are responsible for the production of thyroid hormone. Thyroid hormone is needed to live. The hormone controls the basic metabolism of the body. It controls how quickly calories are burned. This can affect weight loss and weight gain, slow down or speed up the heartbeat, raise or lower body temperature, influence how quickly food moves through the digestive tract, control the way muscles contract, and control how quickly dying cells are replaced.

  • C cells. These cells make calcitonin, a hormone that participates in calcium metabolism.

A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. Thyroid tumors can also be called nodules, and 90% of all thyroid nodules are benign.

Types of thyroid cancer

There are 5 main types of thyroid cancer:

  • Papillary thyroid cancer. Papillary thyroid cancer develops from follicular cells and usually grows slowly. It is the most common type of thyroid cancer. It is usually found in 1 lobe. Only 10% to 20% of papillary thyroid cancer appears in both lobes. It is a differentiated thyroid cancer, meaning that the tumor looks similar to normal thyroid tissue under a microscope. Papillary thyroid cancer can often spread to lymph nodes.

  • Follicular thyroid cancer. Follicular thyroid cancer also develops from follicular cells and usually grows slowly. Follicular thyroid cancer is also a differentiated thyroid cancer, but it is less common than papillary thyroid cancer. Follicular thyroid cancers rarely spread to lymph nodes.

    Follicular thyroid cancer and papillary thyroid cancer are the most common differentiated thyroid cancers. They are very often curable, especially when found early and in people younger than 50. Together, follicular and papillary thyroid cancers make up about 95% of all thyroid cancer.

  • Hurthle cell cancer. Hurthle cell cancer, also called Hurthle cell carcinoma, is cancer that is arises from a certain type of follicular cell. Hurthle cell cancers are much more likely to spread to lymph nodes than other follicular thyroid cancers.

  • Medullary thyroid cancer (MTC). MTC develops in the C cells and is sometimes the result of a genetic syndrome called multiple endocrine neoplasia type 2 (MEN2). This tumor has very little, if any, similarity to normal thyroid tissue. MTC can often be controlled if it is diagnosed and treated before it spreads to other parts of the body. MTC accounts for about 3% of thyroid cancer. About 25% of all MTC is familial. This means that all family members will have a possibility of a similar diagnosis. The RET proto-oncogene test can confirm if family members also have familial MTC (FMTC).

  • Anaplastic thyroid cancer. This type is rare, accounting for about 1% of thyroid cancer. It is a fast-growing, poorly differentiated thyroid cancer that starts from differentiated thyroid cancer or a benign thyroid tumor. Anaplastic thyroid cancer can be subtyped into giant cell classifications. Because this type of cancer grows so quickly, it is more difficult to treat successfully.

In addition, other types of cancer may start in or around the thyroid gland. For lymphoma in the thyroid, read Cancer.Net’s Guide to Lymphoma, Non-Hodgkin. For more information on sarcoma in the thyroid, read the Cancer.Net Guide to Sarcoma. For information on a tumor in the nearby parathyroid gland, read Cancer.Net’s Guide to Parathyroid Cancer.

Looking for More of an Introduction?

If you would like more of an introduction, explore this related item. Please note that this link will take you to another section on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to thyroid cancer. This fact sheet is available as a PDF, so it is easy to print out.

The next section in this guide is Statistics. It helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu to choose another section to continue reading this guide. 

Thyroid Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find information about the number of people who are diagnosed with thyroid cancer each year. You will read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

This year, an estimated 56,870 adults (14,400 men and 42,470 women) in the United States will be diagnosed with thyroid cancer. Thyroid cancer is the fifth most common cancer in women. It is the most common cancer in women 20 to 34. About 2% of cases occur in children and teens.

The incidence rates of thyroid cancer in both women and men have been increasing in recent years, at a rate of about 5% more a year. In fact, it is the most rapidly increasing cancer diagnosis in the United States. Researchers believe that part of the reason for the increase is that new, highly sensitive diagnostic tests are leading to increased detection of smaller cancers.

It is estimated that 2,010 deaths (920 men and 1,090 women) from this disease will occur this year. Women are 3 times more likely to have thyroid cancer than men, but women and men die at similar rates. This suggests that men have a worse prognosis than women when there is a diagnosis of thyroid cancer. Prognosis is the chance of recovery.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. Overall, the 5-year survival rate for people with thyroid cancer is 98%.

However, survival rates are based on many factors, including the specific type of thyroid cancer, and stage of disease. If the cancer is located only in the thyroid, the 5-year survival rate is greater than 99%. If thyroid cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 98%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 55%.

It is important to remember that statistics on the survival rates for people with thyroid cancer are an estimate. The estimate comes from annual data based on the number of people with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. People should talk with their doctor if they have questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2017, and the ACS website.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. Or, use the menu to choose another section to continue reading this guide. 

Thyroid Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find a basic drawing of the main body parts affected by this disease. To see other pages, use the menu.

The image is a drawing showing the location of the thyroid gland in the human body and the thyroid’s anatomy. The thyroid is located in the front of the neck. It has 2 lobes, 1 on each side of the neck, joined by a narrow strip of tissue called the isthmus, with a small pyramidal lobe above the isthmus. The right and left lobes each have 2 small parathyroid glands located at the back of the lobe, a superior (upper) and inferior (lower) gland, for a total of 4 parathyroid glands. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

For medical illustrations showing the different stages of thyroid cancer, please visit the Stages section.

The next section in this guide is Risk Factors. It explains what factors may increase the chance of developing this disease. Or, use the menu to choose another section to continue reading this guide. 

Thyroid Cancer - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing thyroid cancer:

  • Gender. Women are diagnosed with 3 of every 4 thyroid cancers.

  • Age. Thyroid cancer can occur at any age, but about two-thirds of all cases are found in people between the ages of 20 and 55. Anaplastic thyroid cancer is usually diagnosed after age 60. Older infants (10 months and older) and adolescents can develop MTC, especially if they carry the RET proto-oncogene mutation (see below).

  • Genetics. Some types of thyroid cancer are associated with genetics. Below are some key facts about this disease, genes, and family history. If you are interested in learning more about your personal genetic risk, read this separate article about getting genetic testing.

    • An abnormal RET oncogene, which can be passed from parent to child, may cause MTC. Not everyone with an altered RET oncogene will develop cancer. Blood tests and genetic tests can detect the gene. Once the altered RET oncogene is identified, a doctor may recommend surgery to remove the thyroid gland before cancer develops. People with MTC are encouraged to have genetic testing to determine if a mutation of the RET proto-oncogene is present. If so, genetic testing of parents, siblings and children will be recommended.
    • A family history of MTC increases a person’s risk. People with MEN2 syndrome are also at risk for developing other types of cancers.

    • A family history of goiters increases the risk of developing papillary thyroid cancer.

    • A family history of precancerous polyps in the colon, also called the large intestines, increases the risk of developing papillary thyroid cancer.

  • Radiation exposure.Exposure to moderate levels of radiation to the head and neck may increase the risk of papillary and follicular thyroid cancer. Such sources of exposure include:

    • Low-dose to moderate-dose x-ray treatments used before 1950 to treat children with acne, tonsillitis, and other head and neck problems.

    • Radiation therapy for Hodgkin lymphoma or other forms of lymphoma in the head and neck.

    • Exposure to radioactive iodine, also called I-131 or RAI, especially in childhood.

    • Exposure to ionizing radiation, including radioactive fallout from atomic weapons testing during the 1950s and 1960s and nuclear power plant fallout. Examples include the 1986 Chernobyl nuclear power plant accident and the 2011 earthquake that damaged nuclear power plants in Fukushima, Japan. Another source of I-131 is environmental releases from atomic weapon production plants.

    • Diet low in iodine. Iodine is needed for normal thyroid function. In the United States, iodine is added to salt to help prevent thyroid problems.

    • Race. White people and Asian people are more likely to develop thyroid cancer, but this disease can affect a person of any race or ethnicity.

    • Breast cancer. A recent study showed that breast cancer survivors may have a higher risk of thyroid cancer, particularly in the first 5 years after diagnosis and for those diagnosed with breast cancer at a younger age. This finding continues to be examined by researchers.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. Or, use the menu to choose another section to continue reading this guide. 

Thyroid Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu.

It is common for people with thyroid cancer to have few or no symptoms. Thyroid cancers are often diagnosed by routine examination of the neck or are unintentionally found by x-rays or other imaging scans that were performed for other reasons. People with thyroid cancer may experience the following symptoms or signs. Sometimes, people with thyroid cancer do not have any of these changes. Or, the cause of a symptom may be another medical condition that is not cancer.

  • A lump in the front of the neck, near the Adam's apple

  • Hoarseness

  • Swollen glands in the neck

  • Difficulty swallowing

  • Difficulty breathing

  • Pain in the throat or neck

  • A cough that persists and is not caused by a cold

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

These symptoms may be caused by thyroid cancer; other thyroid problems, such as a goiter; or a condition not related to the thyroid, such as an infection.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide. 

Thyroid Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

The list below describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person.

  • Physical examination. The doctor will feel the neck, thyroid, throat, and lymph nodes (the tiny, bean-shaped organs that help fight infection) in the neck for unusual growths or swelling. If surgery is recommended, the larynx may be examined at the same time with a laryngoscope, which is a thin, flexible tube with a light.

  • Blood tests. There are several types of blood tests that may be done during diagnosis and to monitor the patient during and after treatment. This includes tests called tumor marker tests. Tumor markers are substances found at higher-than-normal levels in the blood, urine, or body tissues of some people with cancer.

    • Thyroid hormone levels. As explained in the Introduction, thyroid hormones regulate a person’s metabolism. The doctor will use this test to find out the current levels of the thyroid hormones triiodothyronine (T3) and thyroxine (T4) in the body.

    • Thyroid-stimulating hormone (TSH). This blood test measures the level of TSH, a hormone produced by the pituitary gland near the brain. If the body is in need of thyroid hormone, the pituitary gland releases TSH to stimulate production.

    • Tg and TgAb. Thyroglobulin (Tg) is a protein made naturally by the thyroid as well as by differentiated thyroid cancer. After treatment, there should be very low levels of thyroglobulin in the blood since the goal of treatment is to remove all thyroid cells. If Tg is rising after surgery and/or radioactive iodine, it may be a sign of more cancer. A tumor marker test may be done to measure the body’s Tg level before, during, and/or after treatment. There is also a test for thyroglobulin antibodies (TgAb), which are proteins produced by the body to attack thyroglobulin that occur in some patients. If TgAb is found, it is known to interfere with the results of the Tg level test.

    • Medullary type-specific tests. If MTC is a possibility, the doctor will order tumor marker tests to check for high calcitonin and carcinoembryonic antigen (CEA) levels. The doctor should also recommend a blood test to detect the presence of RET proto-oncogenes (see Risk Factors), particularly if there is a family history of MTC.

  • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. An ultrasound wand or probe is guided over the skin of the neck area. High-frequency sound waves create a pattern of echoes that show the doctor the size of the thyroid gland and specific information about any nodules, including whether a nodule is solid or a fluid-filled sac called a cyst.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The way to determine whether a nodule is cancerous or benign is through a biopsy. During this procedure, the doctor removes cells from the nodule that are then examined by a cytopathologist. A cytopathologist is a doctor who specializes in analyzing cells and tissue to diagnose disease. This test is often done with the help of ultrasound.

    A biopsy for thyroid nodules will be done in 1 of 2 ways:

    • Fine needle aspiration. This procedure is usually performed in a doctor’s office or clinic. It is an important diagnostic step to find out if a thyroid nodule is benign or cancerous. A local anesthetic may be injected into the skin to numb the area before the biopsy. The doctor inserts a thin needle into the nodule and removes cells and some fluid. The procedure may be repeated 2 or 3 times to get samples from different areas of the nodule. The report is created by the cytopathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The test can be positive, meaning there are cancerous cells, or negative, meaning there are no cancerous cells. The test can also be undetermined, meaning it is not clear whether cancer is there. Unfortunately, it can be possible to miss the targeted area.
    • Surgical biopsy. If the needle aspiration biopsy is not clear, the doctor may suggest a biopsy in which the nodule and possibly the affected lobe of the thyroid will be removed. This procedure is usually done under general anesthesia. It may also require a hospital stay.

  • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy (see Treatment Options).

  • Radionuclide scanning. This test may also be called a whole-body scan. This scan will either be done using I-131 or I-123. It is used most often to learn more about a thyroid nodule. In this test, the patient swallows a very small, harmless amount of radioactive iodine, which is absorbed by thyroid cells. This makes the thyroid cells appear on the scan image, allowing the doctor to see differences between those cells and other body structures.

  • X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

    CT scans are often used in patients with thyroid cancer to examine parts of the neck that cannot be seen with ultrasound (see above). Also, CT scans of the chest may be needed to look to see if thyroid cancer has spread. CT scans of the abdomen may be used to see if thyroid cancer has spread to the liver or other sites. Patients with the hereditary form (see Risk Factors) of medullary thyroid cancers may be at risk for developing other types of endocrine tumors in the abdomen; these patients may also have a CT scan of the abdomen.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is thyroid cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide. 

Thyroid Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis. There are different stage descriptions for different types of cancer.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many? 

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. For thyroid cancer, there are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

In addition to the TNM system, papillary and follicular thyroid cancers are also staged by the age of the patient.

Here are more details on each part of the TNM system for thyroid cancer:

Tumor (T)

Using the TNM system, the letter “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. When describing “T” in thyroid cancer, doctors may subdivide the general categories by adding the letter “s” to indicate a solitary (single) tumor or “m” to indicate multifocal (more than 1) tumors. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no evidence of a tumor.

T1: The tumor is 2 centimeters (cm) or smaller and limited to the thyroid.

T1a: The tumor is 1 cm or smaller.

T1b: The tumor is larger than 1 cm but less than 2 cm.

T2: The tumor is larger than 2 cm but smaller than 4 cm and is limited to the thyroid.

T3: The tumor is larger than 4 cm, but the tumor does not extend beyond the thyroid gland.

T4: The tumor is any size and has extended beyond the thyroid.

T4a: The tumor has spread beyond the thyroid to nearby soft tissues, the larynx, trachea, esophagus, or recurrent laryngeal nerve.

T4b: The tumor has spread beyond the regions in T4a (above).

Node (N)

The “N” in the TNM staging system stands for lymph nodes. There are many regional lymph nodes located in the head and neck area. Careful assessment of lymph nodes is an important part of staging thyroid cancer. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no evidence of cancer in the regional lymph nodes.

N1: Cancer has spread to the lymph nodes.

N1a: Cancer has spread to the lymph nodes around the thyroid (called the central compartment; the pretracheal, paratracheal, and prelaryngeal lymph nodes).

N1b: Cancer has spread beyond the central compartment, including unilateral cervical (lymph nodes on 1 side of the neck), bilateral cervical (lymph nodes on both sides of the neck), contralateral cervical (the opposite side of the tumor), or mediastinal (the chest) lymph nodes.

Metastasis (M)

The “M” in the TNM system indicates whether cancer has spread to other parts of the body, called distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): Cancer has not spread to other parts of the body.

M1: Cancer has spread to other parts of the body.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications. For thyroid cancer, this staging system differs by tumor type. For papillary or follicular thyroid cancer, staging also depends on the age of the patient.

Papillary or follicular thyroid tumors in a person younger than 45

Stage I: This stage describes a tumor (any T) with or without spread to lymph nodes (any N) and no distant metastasis (M0).

Stage I Thyroid Cancer

Stage II: This stage describes a tumor (any T) with any metastasis (M1) regardless of whether it has spread to the lymph nodes (any N).

Stage II Thyroid Cancer

Papillary or follicular thyroid tumors, in a person 45 and older

Stage I: This stage describes any small tumor (T1) with no spread to lymph nodes (N0) and no metastasis (M0).

Stage I Thyroid Cancer

Stage II: This stage describes a larger, noninvasive tumor (T2) with no spread to lymph nodes (N0) and no metastasis (M0).

Stage II Thyroid Cancer

Stage III: This stage describes a tumor larger than 4 cm but contained in the thyroid (T3) with no spread to lymph nodes (N0) and no metastasis (M0). Or, any localized tumor (T1, 2 or 3) with spread to the central compartment of lymph nodes (N1a), but no distant spread (M0). 

Stage III Thyroid Cancer

Stage IVA: This stage describes a tumor that has spread to nearby structures (T4a), regardless of whether it has spread to the lymph nodes (any N), but it has not spread to distant places (M0). Or, this describes a localized tumor (T1, T2 or T3), with lymph node spread beyond the central compartment (N1b), but no distant spread (M0).

Stage IVB: This stage describes a tumor that has spread beyond nearby structures (T4b), regardless of spread to lymph nodes (any N), but no distant spread (M0).

Stage IVC: This stage describes all tumors (any T, any N) when there is evidence of metastasis (M1). 

Stage IV Thyroid Cancer

Medullary thyroid tumors

Stage I: This stage describes a small tumor (T1) with no spread to lymph nodes (N0) and no distant metastasis (M0).

Medullary Stage I Thyroid Cancer

Stage II: This stage describes a larger localized tumor (T2 or T3) with no spread to lymph nodes (N0) and no metastasis (M0).

Medullary Stage II Thyroid Cancer

Stage III: This stage describes any localized tumor (T1, T2, or T3) that has spread to the central compartment of lymph nodes (N1a) but has not metastasized (M0).

Medullary Stage III Thyroid Cancer

Stage IVA: This stage describes a tumor that has spread to nearby structures (T4a), regardless of whether it has spread to the lymph nodes (any N), but it has not spread to distant places (M0). Or, this describes a localized tumor (T1, T2 or T3), with lymph node spread beyond the central compartment (N1b), but no distant spread (M0).

Stage IVB: This stage describes a tumor that has spread beyond nearby structures (T4b), regardless of spread to lymph nodes (any N), but no distant spread (M0).

Stage IVC: This stage is used when there is evidence of metastasis (any T, any N, M1). 

Medullary Stage IV Thyroid Cancer

Anaplastic thyroid tumors

Stage IV: All anaplastic thyroid tumors are classified as stage IV, regardless of tumor size, location, or metastasis.

Stage IVA: This stage describes an anaplastic tumor that has spread to nearby structures (T4a), regardless of whether it has spread to the lymph nodes (any N), but it has not spread to distant places (M0).

Stage IVB: This stage describes an anaplastic tumor that has spread beyond nearby structures (T4b), regardless of spread to lymph nodes (any N), but no distant spread (M0).

Stage IVC: This stage is used when there is evidence of metastasis (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, http://www.cancerstaging.org.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide. 

Thyroid Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will learn about the different ways doctors use to treat people with thyroid cancer. To see other pages, use the menu.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For thyroid cancer, this team may   include a surgeon, medical oncologist, radiation oncologist, and endocrinologist, which is a doctor specializing in treating problems with hormones, glands, and the endocrine system. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Thyroid cancer is commonly treated by 1 or a combination of treatments. Descriptions of these treatment options are listed below, followed by an outline of common cancer treatments given by stage of disease (see Stages).

Treatment options and recommendations depend on several factors, including:

  • The type and stage of thyroid cancer

  • Possible side effects

  • The patient’s preferences

  • The patient’s overall health

Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment.

Cancer treatment is often selected based on guidelines that have been recommended by panels of expert physicians. Although most thyroid cancer is curable, there can be different opinions in how to treat thyroid cancer, particularly regarding which combination of treatments to use and the timing when treatments are done. Patients are encouraged to seek a second opinion before starting treatment because they should be comfortable with the treatment plan they choose and should ask about clinical trials.

Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Surgery may also be called a resection. It is the main treatment for most people with thyroid cancer. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Depending on the size of the nodule, common surgical options include:

  • Lobectomy. This surgery removes the gland’s lobe with the cancerous nodule.

  • Near-total thyroidectomy. Also called subtotal thyroidectomy, this is surgery to remove all but a small part of the thyroid gland.

  • Total thyroidectomy. This surgery removes the entire thyroid gland.

There are different surgical techniques that can be used for a thyroidectomy:

  • Standard thyroidectomy. This is when the surgeon makes a small incision (or cut) near the base or middle of the neck. This gives the surgeon direct access to the patient’s thyroid gland for the operation. At some cancer centers, newer surgical techniques are being offered to reduce or avoid neck scarring.

  • Endoscopic thyroidectomy. During this procedure, the surgeon makes a single small incision. The surgery is similar to a standard thyroidectomy except that a scope, a flexible lighted tube, and video monitor are used to guide the procedure rather than surgical loupe magnification.

  • Robotic thyroidectomy. The surgeon makes an incision elsewhere, such as in an armpit, the hairline of the neck, or the chest, and then uses a robotic tool to perform the thyroidectomy. Robotic thyroidectomy is not a recommended surgery. 

Not all surgical options are recommended for all patients. Talk with your doctor about the best approach to treat you.

If there is evidence or risk of spread of cancer to the lymph nodes in the neck, the surgeon may also perform a neck dissection. This is surgery to remove the lymph nodes in the neck. Neck dissection is also called lymphadenectomy.

In general, complications of thyroid surgery may include damage to the nearby parathyroid glands, which help regulate blood calcium levels; excessive bleeding; or wound infections. If the nerves to the larynx are damaged during surgery, this may cause temporary or permanent hoarseness or a “breathy” voice.

Without the thyroid gland, the body stops producing thyroid hormone, which is essential to the body’s function. Hormone replacement (see below), usually given by a daily pill, is the best solution. The patient may also have to take vitamin D and calcium supplements if the parathyroid gland function is impaired after surgery.

If a tumor cannot be removed using surgery, it is called unresectable. The doctor will then recommend other treatment options.

Learn more about the basics of cancer surgery.

Hormone treatment

Patients who are treated with surgery usually require thyroid hormone therapy. In addition to replacing the hormone that is needed by the body, the thyroid hormone medication may slow down the growth of any remaining differentiated cancer cells.

Thyroid hormone replacement is levothyroxine (Levothroid, Levoxyl, Synthroid, Tirosint, Unithroid, and other brand names.) Levothyroxine typically comes as a pill that should be taken daily, at the same time each day, so that the body receives a consistent supply. Also, be sure to talk with your doctor about all other medications you take, including dietary supplements such as iron or calcium, to avoid interactions with your thyroid hormone replacement. Read more about tips to take your medication correctly.  

Thyroid pills may have a few side effects. Occasionally, some patients develop a rash or lose some hair during the first months of treatment.

Hyperthyroidism is a condition in which there is too much thyroid hormone. It may cause weight loss, chest pain, rapid heart rate, irregular heartbeat, cramps, diarrhea, a feeling of being hot, sweats, and bone loss or osteoporosis.

Hypothyroidism is a condition in where there is too little thyroid hormone. It may cause fatigue, weight gain, dry skin and hair, and a feeling of being cold.

The required amount or dose of thyroid hormone is different for every patient and tumor type, and it can change as a person ages or as a person’s weight changes. The doctor will monitor your thyroid hormone levels through regular blood tests. Talk with your doctor about what signs to watch for that may mean it is time to adjust your dose, or amount, of hormone supplement.

Radioactive iodine (radioiodine) therapy

The thyroid absorbs almost all iodine that enters a body. Therefore, a type of radiation therapy called radioactive iodine (also called I-131 or RAI) can find and destroy thyroid cells not removed by surgery and those that have spread beyond the thyroid. Doctors who prescribe radioactive iodine therapy are usually endocrinologists or nuclear medicine specialists.

Radioactive iodine treatment is an option for some people with papillary and follicular thyroid cancer. Radioactive iodine is used to treat people with differentiated thyroid cancers that have spread to lymph nodes or to distant sites. A small test dose may be given before full treatment to be sure that the tumor cells will absorb the I-131. Patients with MTC or anaplastic thyroid cancer should not be treated with I-131.

I-131 therapy is given in either liquid or pill form. Patients who receive I-131 to destroy cancer cells may be hospitalized for 2 to 3 days, depending on several factors, including the dose given. Patients are encouraged to drink fluids to help the I-131 pass quickly through the body. Within a few days, most of the radiation is gone. Talk with your doctor about ways to limit radiation exposure to other people, including children, who may be around you during this treatment and the days following it.

In preparation for I-131 therapy after surgery, patients are usually asked to follow a low-iodine diet for 2 to 3 weeks beforehand. In addition to the low-iodine diet, patients will be asked to either stop taking thyroid hormone replacement pills temporarily or to receive injections of recombinant TSH (Thyrogen) while taking the hormone replacement. If the hormone therapy is stopped during the preparation period, the patient will likely experience the side effects of hypothyroidism (see above).

It is important to discuss the possible short-term and long-term effects of I-131 therapy with your doctor. On the first day of treatment, patients may experience nausea and vomiting. In certain circumstances, pain and swelling can occur in the areas where the radioactive iodine is collected. Because iodine is concentrated in salivary gland tissue, patients may experience swelling of the salivary glands. This may result in xerostomia, sometimes called dry mouth.

Large or cumulative doses of radioactive iodine may cause infertility, which is the inability to produce a child, especially in men. It is recommended that women avoid pregnancy for at least 1 year after I-131 treatment. There is a risk of secondary cancer with the use of I-131 (see Follow-up Care). Occasionally, patients may require repeated treatments over time. However, there is a maximum total dose of radioactive iodine allowed over time, and once reached, this may prevent further use of this treatment.

External-beam radiation therapy

External-beam radiation is another type of radiation therapy in which high-energy x-rays are given from a machine outside the body to destroy cancer cells. Doctors who specialize in external-beam radiation therapy are called radiation oncologists. An external-beam radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. When used to treat thyroid cancer, radiation therapy is usually given as outpatient therapy, either in a hospital or clinic, 5 days a week for about 5 to 6 weeks.

For thyroid cancer, external-beam radiation therapy is used only in certain circumstances, typically when later-stage thyroid cancer has not responded to I-131 therapy (see above). Radiation therapy is usually given after surgery, and treatment is concentrated on a specific area, only affecting cancer cells at that site.

Side effects depend on the treatment dosage and area and may include redness of the skin, odynophagia (painful swallowing), cough, occasional hoarseness, nausea, and fatigue. Most side effects go away soon after treatment is finished.

Learn more about the basics of external-beam radiation therapy.

Chemotherapy and targeted therapy

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells and is sometimes used to treat thyroid cancer. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs at the same time.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor’s growth, or reduce symptoms.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Learn more about the basics of chemotherapy.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells. Learn more about the basics of targeted therapy.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets in the different types of thyroid cancer and new treatments directed at them.

For papillary and follicular thyroid cancer, the U.S. Food and Drug Administration (FDA) has approved 2 targeted therapies:

  • In 2013, the FDA approved a targeted therapy called sorafenib (Nexavar) for later-stage or recurrent differentiated thyroid cancer when I-131 therapy (see above) has not worked. Learn more in a 2013 summary from the ASCO Annual Meeting. Common side effects of sorafenib include hand-foot skin reactions or other skin problems, diarrhea, fatigue, weight loss, and high blood pressure.

  • In 2015, the FDA approved a targeted therapy called lenvatinib (Lenvima, E7080) for later-stage differentiated thyroid cancer that does not respond to surgery, I-131 treatment, or both. The side effects of lenvatinib include high blood pressure, diarrhea, decreased appetite, decreased weight, and nausea. More details about this drug can be found in a 2014 summary from the ASCO Annual Meeting.

For MTC, there are 2 other FDA-approved targeted therapy options:

  • In 2011, the FDA approved vandetanib tablets (Caprelsa, zd6474), which is a type of targeted therapy known as a tyrosine kinase inhibitor. Specifically, vandetanib is now a standard treatment for adults when MTC cannot be removed surgically, if the disease is worsening, or if MTC has spread to other parts of the body.

    The medication is given as a daily pill. The typical daily dose of vandetanib is 300 mg. Common side effects include diarrhea and colon inflammation, skin rash, nausea, high blood pressure, headache, fatigue, loss of appetite, and stomach pain. Additionally, more serious side effects such as respiratory and heart problems can occur. Blood tests, including measurement of serum potassium, calcium, magnesium, and TSH levels (see Diagnosis), may be done regularly to monitor the body’s reaction to this medication.   

  • In 2012, the FDA approved another tyrosine kinase inhibitor for metastatic MTC called cabozantinib (Cometriq, Cabometyx, XL184). The recommended dose is 140 mg, taken in pill form once daily. Side effects may include constipation, stomach pain, high blood pressure, hair color changes, fatigue, nausea, and swelling, in addition to serious colon problems.

Before any targeted treatment begins, talk with your doctor about possible side effects for each specific medication and how they can be managed.

Chemotherapy or targeted therapy as part of your treatment plan

At this time, the use of other systemic chemotherapy and targeted therapy for the treatment of thyroid cancer is determined on an individual basis and is most often given as part of a clinical trial. See the Latest Research section for more information.

Learn more about the basics of preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.

People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about the basics of palliative care.

Treatment options by stage

Almost all thyroid cancers are treated with surgery. The treatment plan focuses on controlling the thyroid cancer in the thyroid gland and in the neck.

If the thyroid cancer is only within the tissues of the neck, both in the thyroid gland and in the lymph nodes, surgery will typically be the first treatment. Patients with later-stage disease may be treated with surgery as well, but other treatments may be done first. Clinical trials may be recommended at any stage as a treatment option.

Stage I: Surgery, hormone therapy, possible radioactive iodine therapy after surgery

Stage II: Surgery, hormone therapy, possible radioactive iodine therapy after surgery

Stage III: Surgery, hormone therapy, possible radioactive iodine therapy or external-beam radiation therapy after surgery

Stage IV: Surgery, hormone therapy, radioactive iodine therapy, external-beam radiation therapy, targeted therapy, and chemotherapy. Radiation therapy may also be used to reduce pain and other problems. See below for more information.

Stage IV (metastatic) thyroid cancer

If the cancer has spread beyond the thyroid to other organs, such as the bones or lungs, it is called metastatic or stage IV thyroid cancer. Also, all anaplastic thyroid tumors are classified as stage IV at the time of diagnosis, regardless of tumor size, location, or spread.

If the diagnosis is stage IV thyroid cancer, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of surgery, hormone therapy, radioactive iodine therapy, external-beam radiation therapy, targeted therapy, and chemotherapy. Clinical trials on new treatment approaches may also be recommended. Palliative care will also be important to help relieve symptoms and side effects

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options.

Often the treatment plan will include the treatments described above, such as surgery, radioactive iodine therapy, targeted therapy, external-beam radiation therapy, hormone treatment, and chemotherapy. However, they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from thyroid cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life.

You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu to choose another section to continue reading this guide.

Thyroid Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with thyroid cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the FDA was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result.

Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating thyroid cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with thyroid cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects.

Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for thyroid cancer, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. Or, use the menu to choose another section to continue reading this guide. 

Thyroid Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu.

Doctors are working to learn more about thyroid cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

New treatments

Clinical trials for thyroid cancer include testing new medications, including drugs known as targeted therapy. As explained in Treatment Options, targeted therapy is a treatment that targets specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. In addition, researchers are looking at new combinations of chemotherapy and other treatments.

  • Radiolabeled antibodies are being tested for MTC. They are antibodies made in a laboratory that are attached to a radioactive substance.

  • Researchers continue to study the drugs vandetanib and cabozantinib (see Treatment Options) for MTC, including for use with children who have advanced hereditary MTC.

  • For anaplastic thyroid cancer, clinical trials are studying combination chemotherapy. One study is comparing the results of either carboplatin (Paraplatin) and paclitaxel (Taxol) alone or with an experimental drug, combretastatin A4 phosphate (CA4P, fosbretabulin, Zybrestat).

  • For later-stage differentiated thyroid cancer that does not respond to surgery or to I-131 treatment or stops responding, clinical trials are studying several targeted therapies called vascular endothelial growth factor (VEGF) inhibitors, which may block the creation of new blood vessels that are necessary for tumor growth. VEGF inhibitors being studied include axitinib (Inlyta), nintedanib (Ofev, Vargatef), and pazopanib (Votrient).

    Also, in patients whose tumors showed a genetic mutation known as BRAF V600E, the tumors responded better to the study drug. Dabrafenib (Tafinlar) and trametinib (Mekinist) are also being studied for those tumors with the BRAF genetic mutation.

  • New approaches are being tested for thyroid cancer that doesn’t respond to I-131. One drug being studied is called selumetinib (AZD6244), which is being tested to see if it helps boost I-131 absorption in treating advanced thyroid cancer. Other drugs being looked at include the combination of temsirolimus (Torisel) and sorafenib (Nexavar).

  • For follicular and anaplastic thyroid cancers, valproic acid is being researched as a possible treatment.

  • Investigations are underway to fine-tune diagnosis and predict treatment outcomes based on the molecular biology of the tumor. Molecular biology is the study of the structure and function of cells at the molecular level.

  • Researchers continue to investigate the best use of I-131, including different dosages, in treating thyroid cancer. In 1 study, researchers are looking at whether taking a drug called sunitinib (Sutent) after I-131 is helpful to those with advanced disease.

  • The genetic testing and the refinement of RET oncogenes (see Risk Factors) is an ongoing area of active research. Further knowledge in this area will improve how treatment options are chosen and give more precise prognosis.

Data collection

There is an effort to create a volunteer registry of people with a history of thyroid cancer. This can help doctors research this disease in the future. Participants are asked to provide information, tissue samples, or blood and urine samples.

Palliative care

Clinical trials are underway to find better ways of reducing symptoms and side effects of current thyroid cancer treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding thyroid cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu to choose another section to continue reading this guide.

Thyroid Cancer - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for thyroid cancer are described in the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with thyroid cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. Or, use the menu to choose another section to continue reading this guide.

Thyroid Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu.

Care for people diagnosed with thyroid cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care and may include:

  • Physical exams and medical tests. Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. People treated for thyroid cancer are typically asked to return to the doctor’s office every 6 months to a year. At a follow-up care visit, the doctor will conduct a physical examination and blood tests to watch the level of TSH suppression and to test for Tg (see Diagnosis). If the thyroid gland has been removed, there should be little or no Tg in the blood. An elevated level may indicate the cancer has returned.

    Other blood tests may be done depending on the specific type of thyroid cancer treated. Blood tests also help the doctor determine the correct dosage of the patient’s thyroid replacement medication (if needed), which may be adjusted over time as the patient gets older.

  • Other follow-up tests. Other follow-up tests may include a chest x-ray, an ultrasound of the neck, a full-body scan, or other imaging tests. If the doctor recommends a procedure that uses I-131, patients may have to stop taking their thyroid medication for up to 6 weeks or they may be asked to follow a low-iodine diet for up to 2 weeks before having the test.

  • Tests for long-term side effects. Based on the type of treatment received, the doctor will determine what examinations and tests are needed to check for long-term side effects, including the possibility of secondary cancer. This is particularly important for people who have received I-131 treatment, who may be at higher risk of leukemia and urinary bladder cancer.

  • Breast cancer screening. Young women who are treated for papillary or follicular thyroid cancer have a higher risk of developing breast cancer in the future. They should talk with their doctor about appropriate breast cancer screening recommendations.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu to choose another section to continue reading this guide.

Thyroid Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from thyroid cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. If thyroid replacement is prescribed, it is important to take your medication on schedule, usually daily. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu to choose another section to continue reading this guide. 

Thyroid Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of thyroid cancer do I have?

  • Can you explain my pathology report (laboratory test results) to me?

  • What is the stage of the cancer? What does this mean?

  • If MTC is diagnosed, do I need a genetic test? Why or why not? Should family members be tested?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What experience do you have in treating this type of thyroid cancer?

  • Where can I get a second opinion?

  • Do I need to make a treatment decision right away?

  • What are the possible side effects of each treatment, both in the short term and the long term?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • Will any of these treatments cause hypothyroidism? If so, what can I expect during this time?

  • How will this treatment affect my daily life? Will I be able to work, exercise, or perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • Whom should I call with questions or problems?

Questions to ask about surgery

  • Is surgery recommended? If so, how much of my thyroid gland will be removed? Will lymph nodes be removed as well? What type of scar can I expect?

  • Do I need other tests, such as an ultrasound, before surgery to determine the extent of the cancer?

  • How experienced is the surgeon in this type of surgery?

  • How many thyroid surgeries does the surgeon do per week?

  • How many years has the surgeon been performing thyroid surgery?

  • What complications and outcomes have other patients had after being treated by this surgeon?

  • How long will the operation take?

  • How long will I be in the hospital for the surgery?

  • Can you describe what my recovery from surgery will be like?

  • Will I need to take thyroid hormone pills before and/or after this surgery? If so, for how long?

Questions to ask about radioactive iodine treatment (I-131)

  • Is radioactive iodine treatment recommended? Why or why not? If so, can you describe this procedure to me?

  • Are there precautions I should take after having this treatment?

  • Will I need to follow a low-iodine diet? If so, when and for how long?

Questions to ask about having other treatments, such as targeted therapy, chemotherapy, or radiation therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will I have this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • If I need to take thyroid hormone replacement, how often do I need my dose checked through blood tests?

  • What follow-up tests will I need, and how often will I need them?

  • Will I need to stop taking thyroid hormone replacement for these tests? If so, for how long and what can I expect during this time?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records? Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide. 

Thyroid Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 09/2016

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Thyroid Cancer. To go back and review other pages, use the menu.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Thyroid Cancer. Use the menu to select another section to continue reading this guide.