Thyroid CancerLast Updated: October 30, 2009 This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/09 Overview
Thyroid cancer begins in the thyroid gland, which is located in the front of the neck just below the larynx (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 hormone, which regulates a person’s metabolism. Thyroid cancer begins when the cells in the thyroid begin to change, grow uncontrollably, and eventually form a tumor. There are two types of tumors: benign (noncancerous) and malignant (cancerous, meaning that it can spread to other parts of the body). Thyroid tumors can also be called nodules, and 90% of all thyroid nodules are benign. A healthy thyroid gland is barely palpable (capable of being touched or felt). A normal gland has two lobes, one on each side of the windpipe, joined by a narrow strip of tissue called the isthmus. 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 iodine deficiency. Most Americans receive enough iodine from salt, and a goiter under these circumstances is caused by other reasons. The thyroid gland contains two types of cells: follicular cells, which are responsible for the production of thyroid hormone, and C cells, which 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 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 that 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 80% to 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 5% to 10% of thyroid cancers. Anaplastic thyroid cancer. This rare and fast-growing, poorly differentiated thyroid cancer 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 can be more difficult to treat successfully. This section addresses these four main types of thyroid 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 Guide to Sarcoma. For information on a tumor in the parathyroid gland, read Cancer.Net’s Guide to Parathyroid Cancer. Statistics In 2009, an estimated 37,200 adults (10,000 men and 27,200 women) in the United States will be diagnosed with thyroid cancer. It is estimated that 1,630 deaths (690 men and 940 women) from this disease will occur this year. Thyroid cancer is the seventh most common cancer in women. The five-year relative survival rate (the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) for all stages of thyroid cancer is about 97%. The five-year relative survival rate of papillary and follicular thyroid cancers and MTC range from 97% to 100% for early-stage cancer and decrease with later-stage cancer (See Staging). 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 cases of 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. Statistics adapted from the American Cancer Society’s publication, Cancer Facts & Figures 2009. Find out more about basic cancer terms used in this section. Medical Illustrations
Risk Factors
A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can 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 communicating them to 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: Genetics. Some types of thyroid cancer are associated with genetics.
Read more about the genetics of thyroid cancer. Radiation exposure. Exposure to moderate levels of radiation therapy may increase the risk of papillary and follicular thyroid cancers. Such sources of exposure include the following:
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. Gender. Women are two to three times more likely to develop thyroid cancer than men. Age. Thyroid cancer can occur at any age. 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 above). Race. White people are more likely to develop thyroid cancer than black people. Symptoms People with thyroid cancer often experience the following symptoms. Sometimes, people with thyroid cancer do not show any of these symptoms. Or, these symptoms may be similar to those of other medical conditions. If you are concerned about a symptom on this list, please talk with your doctor.
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. Talk with your doctor if you are experiencing any of these symptoms. Symptoms
People with thyroid cancer often experience the following symptoms. Sometimes, people with thyroid cancer do not show any of these symptoms. Or, these symptoms may be similar to those of other medical conditions. If you are concerned about a symptom on this list, please talk with your doctor.
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. Talk with your doctor for more information. Diagnosis
Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). 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 metastasized. Your doctor may consider these factors when choosing a diagnostic test:
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 (thin, flexible tube with a light). Blood tests. The doctor may use a blood test to check the level of thyroid-stimulating hormone (TSH). A measurement of thyroid hormone levels and antithyroid antibodies may be done as well. If MTC is a possibility, the doctor will order a test to check for high calcitonin levels and a blood test to detect the presence of RET proto-oncogenes (see Risk Factors). The search for RET proto-oncogenes is often recommended 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. 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 doctor who specializes in analyzing cells and tissue) to determine if cancer is present. A biopsy for thyroid nodules will be done one of two ways:
Radionuclide scanning. This test, also called a full-body scan or a radioactive iodine (I-131 or RAI) scan, is used most often to learn more about a thyroid nodule. In this test, the patient swallows a small, harmless amount of radioactive iodine, which allows the doctor to see differences between thyroid cells and other body structures. 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 radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images. Learn more about what to expect when having common tests, procedures, and scans. Find out more about common terms used during a diagnosis of cancer. Staging With Illustrations
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine 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 (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. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. 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. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
In addition to the TNM system, papillary and follicular thyroid cancers are also staged by the age of the patient. 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 “a” to indicate a solitary (single) tumor or “b” 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 1 centimeter (cm) or smaller at its greatest dimension and limited to the thyroid. T2: The tumor is at least 1 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. 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 ipsilateral cervical lymph nodes (lymph nodes in the neck on the same side as the tumor). N1b: Cancer has spread to the bilateral cervical (lymph nodes on both sides of the neck), the contralateral cervical (the opposite side of the tumor), the midline cervical (the middle of the neck), or the 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 no spread to lymph nodes (N0) and no distant metastasis (M0). 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). 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 II: This stage describes any larger, noninvasive tumor (T2, T3) with no spread to lymph nodes (N0) and no metastasis (M0). Stage III: This stage describes any invasive tumor (T4) with no spread to lymph nodes (N0) and no metastasis (M0), or any tumor (any T) with spread to lymph nodes (N1). Stage IV: This stage describes all tumors (any T, any N) when there is evidence of metastasis (M1). Medullary thyroid tumors Stage I: This stage describes a small tumor (T1) with no spread to lymph nodes (N0) and no distant metastasis (M0). Stage II: This stage describes any tumor (any T) with no spread to lymph nodes (N0) and no metastasis (M0). Stage III: This stage describes any tumor (any T) that has spread to lymph nodes (N1) but has not metastasized (M0). Stage IV: This stage is used when there is evidence of metastasis (any T, any N, M1). Anaplastic thyroid tumors Stage IV: All anaplastic thyroid tumors are classified as stage IV, regardless of tumor size, location, or metastasis. Recurrent: Recurrent cancer is cancer that comes back after treatment. 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, Sixth Edition (2002) published by Springer-Verlag New York, www.cancerstaging.net Treatment
The treatment of thyroid cancer depends on the size and location of the tumor, the type of thyroid cancer, whether the cancer has spread, and the person’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan, including a surgeon, endocrinologist (a doctor specializing in problems with glands and the endocrine system), medical oncologist, and radiation oncologist. This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials as a treatment option when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section. 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 in which combination of treatments to use. 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. Thyroid cancer is treated by one or a combination of treatments, including surgery, radioactive iodine, hormone treatment, external-beam radiation therapy, and/or chemotherapy. Descriptions of the most common treatment options for thyroid cancer are listed below followed by an outline of common cancer treatments given at which stage of disease. Surgery Surgery is the main treatment for most thyroid cancers. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Depending on the size of the nodule, the surgeon will perform a total thyroidectomy (surgery to remove the entire thyroid gland), a near-total thyroidectomy (surgery to remove the thyroid gland except for a small part), or a lobectomy (surgery to remove the lobe with the cancerous nodule). Total or near-total thyroidectomies are the most common operations for thyroid cancer; lobectomies are performed on some patients with papillary or follicular thyroid cancer. 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 (surgery to remove the lymph nodes in the neck; also called a lymphadenectomy). Complications of surgery may include damage to the 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. Learn more about cancer surgery. 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. Hormone treatment Patients who are treated for papillary, follicular, and medullary thyroid cancers by surgery 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, Unithroid). 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. Thyroid pills have 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 or arrhythmias (irregular heartbeat), cramps, and diarrhea; patients may also feel hot and sweaty. Hypothyroidism (too little hormone) may cause fatigue, weight gain, and dry skin and hair; patients may also feel cold. The amount of thyroid hormone required is different for every patient and tumor type, and it can change as a person ages. Radioactive iodine (radioiodine) therapy The thyroid absorbs almost all iodine that enters a body. Therefore, 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. Not all patients require this treatment. 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 avoid an iodine-rich 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 will receive injections of recombinant TSH (Thyrogen) while taking the hormone replacement. 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 (dry mouth). Large or cumulative doses of radioactive iodine may cause infertility, especially in men. It is recommended that women avoid pregnancy for at least one year after radioactive iodine 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. Epidemiologic studies (studies that determine the cause of cancer in large groups of people) have shown that repeated high-dose radioactive treatment can cause leukemia and occasionally urinary bladder cancer. External-beam radiation therapy Radiation uses high-energy x-rays to kill cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. Radiation therapy is usually given as outpatient therapy five days a week for about five to six weeks either in a hospital or clinic. For thyroid cancer, external-beam radiation therapy is used only in certain circumstances, typically when advanced thyroid cancer has not responded to radioiodine therapy. 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. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells and is sometimes used to treat thyroid cancer. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor’s growth, or reduce symptoms. At this time, the use of systemic chemotherapy 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). With new knowledge in the molecular abnormalities of cancer cells, scientists are developing therapies that specifically target such abnormalities. In turn, the cancer therapy can be more specific. See the Current Research section for more information. The side effects of chemotherapy depend on the individual and the dose used. The side effects of chemotherapy depend on the individual and the dose used but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. 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. 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 more advanced disease may be treated with surgery as well, but other treatments may be done first. 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 (advanced): Stage IV thyroid cancer is the most advanced stage of the disease. The cancer has spread beyond the thyroid to the lymph nodes and other organs, such as the bones or lungs. Symptoms of advanced thyroid cancer are similar to those present when the disease was first diagnosed:
Treatment for advanced thyroid cancer may include a combination of surgery, hormone therapy, radioactive iodine therapy, external-beam radiation therapy, and chemotherapy. Radiation therapy may also be used to reduce pain and other problems. Patients with advanced thyroid cancer are also encouraged to consider participating in clinical trials. Recurrent thyroid cancer Recurrent thyroid cancer is cancer that comes back after treatment. Treatment for recurrent cancer will depend on the type of treatment given previously, the type of thyroid cancer, and where the cancer recurs. A combination of treatments will likely include: external-beam radiation therapy, chemotherapy, surgery, radioactive iodine treatment, hormone treatment, and clinical trials. In certain instances, a PET scan may be used to determine the extent of the cancer. Find out more about common terms used during cancer treatment. Clinical Trials Resources
Doctors and scientists are always looking for better ways to treat patients with thyroid cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. The clinical trial may be evaluating a new drug, a new combination of existing treatments, a new approach to radiation therapy or surgery, or a new method of treatment or prevention. Patients who participate in clinical trials are 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. 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 finding new drugs and other therapies is 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 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 than 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. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials. For specific topics being studied for thyroid cancer, learn more in the Current Research section.
Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person’s overall health. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing such needs, including concerns about managing the cost of your cancer care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your doctor. After Treatment
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. People treated for thyroid cancer are encouraged to receive routine follow-up care over the course of their lifetimes. 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 determine the level of thyroid-stimulating hormone (TSH) suppression and to test for thyroglobulin, the substance that stores hormones in the thyroid gland. If the thyroid gland has been removed, there should be little or no thyroglobulin in the blood. An elevated level of thyroglobulin may indicate recurrent cancer. 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. 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. As explained in the Treatment section, this is particularly important for people who have received I-131 treatment. 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 healthy living after cancer. Find out more about common terms used after cancer treatment is complete. Current Research
Research for thyroid cancer is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor.
Questions to Ask the Doctor
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
