View All Pages

Thyroid Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

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 on the side of your screen. Think of that menu as a roadmap to this full guide.

Thyroid cancer begins in the thyroid gland, which is located in the front of the neck just below the larynx, which is called the voice box. Thyroid cancer starts when the cells in the thyroid begin to change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread. Thyroid tumors can also be called nodules, and 90% of all thyroid nodules are benign.

About the thyroid

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 gland has two lobes, one 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 is hard to be felt when touched. 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 due to a person not getting enough iodine. However, most Americans receive enough iodine from salt, and a goiter under these circumstances is caused by other reasons.

Types of thyroid cancer

The thyroid gland contains two types of cells: follicular cells and C cells.  Follicular cells are responsible for the production of thyroid hormone. C cells make calcitonin, a hormone that participates in calcium metabolism. There are four main types of thyroid cancer:

Papillary thyroid cancer.  Papillary thyroid cancer develops from the follicular cells and grows slowly. It is the most common type of thyroid cancer. It is usually found in one lobe; only 10% to 20% of papillary thyroid cancers appear in both lobes. Papillary thyroid cancer is a differentiated thyroid cancer, meaning that the tumor looks similar to normal thyroid tissue under a microscope.

Follicular thyroid cancer. Follicular thyroid cancer also develops from the follicular cells and usually grows slowly. Follicular thyroid cancer is also a differentiated thyroid cancer, but it is less common than papillary thyroid cancer.

These two types of cancer are very often curable, especially when found early and in people younger than 45. Together, papillary and follicular thyroid cancers make up about 90% of 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 5% of thyroid cancers.

Anaplastic thyroid cancer. This type is rare, accounting for about 2% of thyroid cancers. It is a fast-growing, poorly differentiated thyroid cancer that starts from differentiated thyroid cancer or a benign tumor of the gland. 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.

This section addresses these four main types of thyroid cancer. There are also subtypes (or variants) within these main types, such as the follicular thyroid cancer variant called Hürthle cell cancer. For lymphoma in the thyroid, please read Cancer.Net’s Guide to Lymphoma, Non-Hodgkin. For more information on sarcoma in the thyroid, review the Cancer.Net Guide to Sarcoma. For information on a tumor in the parathyroid gland, read Cancer.Net’s Guide to Parathyroid Cancer.

Looking for More of an Overview?

If you would like additional introductory information, explore this related item. Please note this link take you to another section on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a one-page fact sheet (available as a PDF) that offers an easy-to-print introduction about thyroid cancer.

To continue reading this guide, use the menu on the side of your screen to select another section.

Thyroid Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find information about how many people learn they have this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 62,980 adults (15,190 men and 47,790 women) in the United States will be diagnosed with thyroid cancer. It is estimated that 1,890 deaths (830 men and 1,060 women) from this disease will occur this year. Thyroid cancer is the fifth most common cancer in women. The incidence rates of thyroid cancer in both women and men have been increasing in recent years, and researchers are working to figure out why.

The five-year survival rate is the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases. The five-year survival rate of people with thyroid cancer is about 98%. The five-year relative survival rate for papillary, follicular, and medullary thyroid cancers that have not spread outside the thyroid is about 100%. For cancer that has spread to the regional lymph nodes, the five-year survival rate is 97%. The five-year survival rate for cancer that has spread outside the thyroid to other parts of the body is 55% (see Stages). Anaplastic thyroid cancer is associated with a much lower survival rate.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with thyroid cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2014.

To continue reading this guide to see a basic drawing of common body parts affected by this disease, use the menu on the side of your screen to select another section.

Thyroid Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find a basic drawing about the common body parts affected by this disease. To see other pages, use the menu on the side of your screen.

Thyroid Anatomy

Larger image

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

To continue reading this guide, use the menu on the side of your screen to select another section.  

Thyroid Cancer - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

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 on the side of your screen.

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 can raise a person’s risk of developing thyroid cancer:

Gender. Women are two to three times more likely to develop thyroid cancer than men.

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; read more about the 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 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 cancers.
  • A family history of goiters increases the risk of developing papillary thyroid cancer.
  • A family history of precancerous polyps in the colon (large intestines) increases the risk of developing papillary thyroid cancer.

Radiation exposure. Exposure to moderate levels of radiation may increase the risk of papillary and follicular thyroid cancers. Such sources of exposure include the following:

  • Low-dose to moderate-dose x-ray treatments used before 1950 to treat children with acne, tonsillitis, and other head and neck problems may increase the risk of papillary and follicular thyroid cancers.
     
  • People who have been treated with radiation therapy for Hodgkin lymphoma or other forms of lymphoma in the head and neck are at an increased risk for developing papillary or follicular thyroid cancer.
  • Exposure to radioactive iodine (also called I-131 or RAI), especially in childhood, may increase the risk of papillary and follicular thyroid cancers. Sources of I-131 include radioactive fallout from atomic weapons testing during the 1950s and 1960s, nuclear power plant fallout (for example, the 1986 Chernobyl nuclear power plant accident and the 2011 earthquake that damaged nuclear power plants in Japan), and environmental releases from atomic weapon production plants.

Diet low in iodine. Iodine is needed for normal thyroid functioning. 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.

To continue reading this guide, use the menu on the side of your screen to select another section.

Thyroid Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

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 on the side of your screen.

People with thyroid cancer often experience the following symptoms or signs. Sometimes, people with thyroid cancer do not show any of these symptoms. Or, these symptoms may be caused by a 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 one or more of the symptoms or signs on this list, 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 helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.

Thyroid Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person.  Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

The following tests may be used to diagnose thyroid cancer:

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 Overview, 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.
  • TSH. This blood test measures the level of thyroid-stimulating hormone (TSH), which is 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. After treatment, there should be very low levels of thyroglobulin in the blood since the goal of treatment is to remove all thyroid cells. 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 may 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 thyroid gland size and specific information about any nodules, including whether they are solid or cysts (fluid-filled sacs).

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 malignant 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 in analyzing cells and tissue to diagnose disease.

A biopsy for thyroid nodules will be done one of two ways:

  • Fine needle aspiration. This procedure is usually performed in a doctor’s office or clinic. It is an important diagnostic step to determine if a thyroid nodule is benign or malignant. 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 two or three times to obtain samples from different areas of the nodule. The report done by the pathologist. 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), negative (meaning there are no cancerous cells), or undetermined (meaning it is not clear whether cancer is there).
  • 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 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 full-body scan or a radioactive iodine (also called I-131 or RAI) scan. 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 make them appear on the scan image, allowing the doctor to see differences between thyroid 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.

Positron emission tomography (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 helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide. 

Thyroid Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

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 on the side of your screen.

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, which is the chance of recovery. There are different stage descriptions for different types of cancer.

One tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor and where is it located? (Tumor, T)
  • Has the tumor spread to the lymph nodes? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). 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. 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 one) tumors. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0: 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 bigger than 1 cm but less than 2 cm.

T2: The tumor is at least 2 cm, but it is not larger 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 stated in T4a (above).

Node. The “N” in the TNM staging system stands for lymph nodes. There are many regional lymph nodes located in the head and neck area, and 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: 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; pretracheal, paratracheal, and prelaryngeal lymph nodes.)

N1b: Cancer has spread beyond the central compartment, including unilateral cervical (lymph nodes on one 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.

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

MX: Distant metastasis cannot be evaluated.

M0: 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 cancers, it 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

Larger image

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

Larger image

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

Larger image

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

Larger image

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 (T1-3) with spread to the central compartment of lymph nodes (N1a), but no distant spread (M0).

Stage III Thyroid Cancer

Larger image

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 (T1-3), 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

Larger image

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

Larger image

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

Medullary Stage II Thyroid Cancer

Larger image

Stage III: This stage describes any localized tumor (T1-3) that has spread to the central compartment of lymph nodes (N1a) but has not metastasized (M0).

Medullary Stage III Thyroid Cancer

Larger image

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 (T1-3), 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

Larger image

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 there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

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 (2010), published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.

Thyroid Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the 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 may include a surgeon, medical oncologist, radiation oncologist, and endocrinologist, which is a doctor specializing in problems with hormones, glands, and the endocrine system.

Thyroid cancer is commonly treated by one or a combination of treatments, including surgery, hormone treatment, radioactive iodine, targeted therapy, external-beam radiation therapy, and/or chemotherapy. Descriptions of these options for thyroid cancer 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 cancer, possible side effects, and the patient’s preferences and 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 recommended by panels of expert physicians. Although most thyroid cancers are 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 surrounding tissue during an operation. Surgery may also be called a resection. It is the main treatment for most people with thyroid cancers. 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 the thyroid gland except for a small part.

Total thyroidectomy. This surgery removes the entire thyroid gland.

Surgical approaches to thyroidectomies. There are different surgical techniques that can be used for a thyroidectomy. A conventional thyroidectomy is when the surgeon makes one large incision 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. An endoscopic thyroidectomy is when the surgeon makes several small incisions and then inserts a video camera and surgical instruments to complete the surgery. In a robotic thyroidectomy, the surgeon makes an incision elsewhere, such as in an armpit or chest, then uses a robotic tool to complete the surgery. At the same time, not all surgical options are recommended for all patients. Talk with your doctor about the best approach to treat you.

Lymph node removal. 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 that can also be called a lymphadenectomy.

Surgery side effects. 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 a body’s functioning. 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 cancer surgery.

Hormone treatment

Patients who are treated with surgery for papillary, follicular, and medullary thyroid cancers require thyroid hormone therapy. In addition to replacing the hormone that is needed by the body, the thyroid hormone medication will slow down the growth of any remaining differentiated cancer cells, an important double purpose.

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, including dietary supplements such as iron or calcium, you are taking 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. The doctor will monitor the patient’s thyroid hormone levels through regular blood tests. Hyperthyroidism (too much hormone) may cause weight loss, chest pain, rapid heart rate, irregular heartbeat, cramps, and diarrhea. Patients may also feel hot and sweaty. Bone loss or osteoporosis is also possible. Hypothyroidism, or too little hormone, may cause fatigue, weight gain, and dry skin and hair. Patients may also feel cold. The amount or dose of thyroid hormone required is different for every patient and tumor type, and it can change as a person ages. 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) is given as a way to find and destroy thyroid cells not removed by surgery and those that have spread beyond the thyroid. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

This treatment is an option for most people with the papillary and follicular types. A small test dose may be given prior to full treatment to be sure the tumor cells will absorb the I-131. Patients with medullary or anaplastic thyroid cancer are not treated with I-131.

I-131 therapy is given in either liquid or pill form. Patients receiving I-131 to kill cancer cells may or may not be hospitalized for two to three 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 radioactive iodine treatment after surgery, patients are usually asked to follow a low-iodine diet for two to three weeks beforehand. In addition to the low-iodine diet, patients will be asked to either stop taking thyroid hormone replacement pills temporarily or 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 side effects due to 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 one year after radioactive iodine treatment. There is a risk of secondary cancers with the use of I-131 (see After Treatment). Occasionally, patients may require repeated radioactive 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. An external-beam radiation therapy regimen (schedule) usually consists of a specific number of treatments given oven 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, five days a week for about five to six 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 radioactive iodine 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 external-beam radiation therapy.

Chemotherapy and Targeted therapy

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 one drug at a time or combinations of different drugs at the same time.

Systemic chemotherapy is delivered through 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 (orally). 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.

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. 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. As a result, doctors can better match each patient with the most effective treatment whenever possible. 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 those targets.

In November 2013, the U.S. Food and Drug Administration (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 here. Common side effects of sorafenib include hand-foot skin reactions or other skin problems, diarrhea, fatigue, weight loss, and high blood pressure.

For MTC, two other FDA-approved targeted therapy options include:

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 is not able to be removed surgically (unresectable), the disease is worsening, or if MTC has spread to other parts of the body (metastatic). 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 serum potassium, calcium, magnesium, and TSH levels (see Diagnosis), may be done to monitor the body’s reaction to this medication on a regular basis.    

In 2012, the FDA approved another tyrosine kinase inhibitor for metastatic MTC called cabozantinib (Cometriq, 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.

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 (research study). See the Latest Research section for more information.

Learn more about chemotherapy and 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 can help a person at any stage of illness. 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, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and 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 supportive 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 is addressed as quickly as possible. Learn more about palliative care.    

Treatment options by stage

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.

Stage IV thyroid cancer

If the cancer has spread beyond the thyroid to other organs, such as the bones or lungs, this 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.

Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes 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. Supportive 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 “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious 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 the 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, including whether the cancer’s stage has changed. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above such as surgery, radioactive iodine therapy, targeted therapy, external-beam radiation therapy, hormone treatment, and chemotherapy, but 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.

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 treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this 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 six 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 helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select 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, 05/2014

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 on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with thyroid cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. 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 are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.  

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

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, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. 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.

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.

For specific topics being studied for thyroid cancer, learn more in the Latest Research section.

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. 

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.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.

Thyroid Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

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 on the side of your screen.

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.

Updated surgical methods.

  • New surgical procedures, including video-assisted thyroid surgery, are being developed that are aimed at reducing scarring on the skin and recovery periods. This includes surgery that uses special robotic tools to reach the thyroid gland through an incision (cut) in your armpit. Currently, this type of endoscopic surgery has limited availability, and not all centers have the expertise to perform these types of procedures. In addition, this type of surgery is not recommended for every patient. Talk with your surgeon about the surgical options best for you.
  • A study is underway to determine if examining a person’s sentinel lymph node is helpful in diagnosing and staging small papillary thyroid cancer. In this procedure, the surgeon finds and removes the sentinel (first) lymph node closest to the tumor for examination.

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.

  • Radio-labeled antibodies (an antibody made in the laboratory attached to a radioactive substance) are being tested for MTC.
  • Also for MTC, researchers continue to study the drugs vandetanib and cabozantinib (see Treatment Options), including targeted therapy 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 and/or I-131 treatment, or stops responding, clinical trials are studying several targeted therapies called vascular endothelial growth factor (VEGF) inhibitors, which may block the formation of new blood vessels that are necessary for tumor growth. One is called lenvatinib (E7080) and more details can be found in a 2014 study. Other VEGF inhibitors being studied include axitinib and pazopanib. Another VEGF inhibitor, AMG 706 or motesanib diphosphate, was shown in a phase II clinical trial to shrink tumors or delay the growth of them in some people with advanced thyroid cancer. Also, in patients whose tumors showed a genetic mutation known as BRAF V600E, the tumors responded better to the investigational drug. Dabrafenib is also being researched for those tumors with the BRAF genetic mutation.
  • New approaches 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 and sorafenib.
  • Investigations are underway to fine-tune diagnosis and predict treatment outcomes based on the molecular biology (the study of the structure and function of cells at the molecular level) of the tumor.
  • Researchers continue to investigate the best use of I-131, including different dosages, in treating thyroid cancer. In one 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 that will improve selection of treatment and give more precise prognosis.

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

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

To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.

Thyroid Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for thyroid cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with thyroid cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

Thyroid Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

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

After treatment for thyroid cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include physical examinations and/or medical tests on a regular basis to monitor your recovery in the coming months and years. Anyone treated for thyroid cancer is encouraged to receive routine follow-up care over the course of his/her lifetime. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

People treated for thyroid cancer are typically asked to return to the doctor’s office every six 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 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 radioactive iodine (I-131), patients may have to stop taking their thyroid medication up to six weeks and/or may be asked to follow a low-iodine diet for up to two weeks before having the test.

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 cancers. This is particularly important for people who have received I-131 treatment, who may be at higher risk of leukemia and urinary bladder cancer. And, young women who are treated for papillary or follicular thyroid cancer have a higher risk of developing breast cancer in the future and should talk with their doctor about appropriate breast cancer screening recommendations.

People recovering from thyroid cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs.

Moderate exercise can help you rebuild your strength and energy level. Talk with your doctor about helping you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select 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, 05/2014

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 on the side of your screen.

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.

  • What type of thyroid cancer do I have?
  • What experience do you have in treating this type of thyroid cancer?
  • What is the stage of the cancer? What does this mean?
  • What are my treatment options?
  • What clinical trials are open to 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?
  • Where can I get a second opinion?
  • Do I need to make a treatment decision right away?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?
  • 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 long will I be in the hospital for the surgery?
  • What can I expect during my recovery from this surgery?
  • Will I need to take thyroid hormone pills before and/or after this surgery? If so, for how long?
  • Is radioactive iodine treatment recommended? Why or why not? If so, can you describe this procedure to me?
  • Will I need to follow a low-iodine diet? If so, when and for how long?
  • Will any of these treatments cause hypothyroidism? If so, what can I expect during this time?
  • What are the short-term and long-term side effects of my treatment?
  • 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 related to my cancer care, who can help me with these concerns?
  • If MTC is diagnosed, do I need a genetic test? Why or why not? Should family members be tested?
  • What are the chances the cancer will recur?
  • If I need to take thyroid hormone replacement, how often do I need my dose checked through blood tests?
  • What other 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?
  • What support services are available to me? To my family?
  • Whom should I call for questions or problems? 

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.

Thyroid Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

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 on the side of your screen.

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. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

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