Cancer treatment team
All hospitals within the NHS have multidisciplinary teams (MDTs) who treat thyroid cancer.
An MDT is made up of a number of different specialists (see the box, right, for more details). If you have thyroid cancer, you may see some or all of these people as part of your treatment.
It can be difficult to decide which treatment is best for you. Your cancer team will make recommendations that are based on reviewing your individual case, but the final decision will be yours.
Before going to hospital to discuss your treatment options, you may want to write a list of questions to ask the specialist. For example, you may want to find out what the advantages and disadvantages are of particular treatments.
Your treatment plan
Your recommended treatment plan will depend on the type and grade of your cancer, and whether your care team thinks that a complete cure is realistically achievable.
Most cases of differentiated thyroid cancers (DTCs - papillary carcinomas and follicular carcinomas) and some cases of medullary thyroid carcinomas are thought to have a good prospect of achieving a cure.
Differentiated thyroid cancers are treated using a combination of:
- surgically removing your thyroid gland (thyroidectomy)
- a type of radiotherapy known as radioactive iodine treatment, which is designed to destroy any remaining cancer cells and prevent the thyroid cancer from returning
Medullary thyroid carcinomas tend to spread faster than DTCs, so it may be necessary to remove any nearby lymph nodes as well as your thyroid gland. Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. Radiotherapy iodine treatment is not used as it is ineffective in treating this type of thyroid cancer.
Stage 4 medullary thyroid carcinomas are not usually curable, although it should be possible to slow the progression of the cancer and control any associated symptoms.
In most cases of anaplastic thyroid carcinoma a cure is not usually achievable. This is because by the time the condition has been diagnosed, it has usually spread to other parts of your body, such as the windpipe and lungs. Radiotherapy and chemotherapy can be used to slow the progression of anaplastic thyroid carcinoma and can help control any symptoms
Some cases of differentiated thyroid cancer, medullary thyroid carcinoma and anaplastic thyroid carcinoma may benefit from a new type of treatment known as targeted therapies. However these treatments are currently undergoing clinical trials and are not offered as routine treatments.
More information about each of the treatment options is provided below.
Thyroidectomy
In almost all cases of thyroid cancer it is necessary to remove some of your thyroid gland (a hemithyroidectomy) or all of your thyroid gland (a total thyroidectomy).
The decision whether to remove some or all of your thyroid gland will be influenced by a number of factors, including:
- the type of thyroid cancer that you have
- the size of the tumour
- whether the cancer has spread beyond your thyroid gland
Your surgeon will explain to you what type of surgery is required, as well as why it is required, so that you can make an informed decision about undergoing surgery.
A thyroidectomy is carried out under a general anaesthetic (painkilling medication that makes you unconscious). The operation usually takes around two hours and will leave a small scar on your neck, but this will not be very noticeable.
For the first 24-48 hours after having thyroid surgery, you will be connected to a series of drips to provide fluids and help accelerate the healing process.
Following surgery, your neck will feel sore, so you will be given painkillers to help ease any discomfort. Your voice may sound hoarse, but this usually passes within a few weeks. In a small number of cases, the hoarseness can be permanent.
After a thyroidectomy, swallowing food may feel painful for a number of weeks. It may therefore be necessary to switch to a diet of soft food until your throat recovers from the surgery. A nurse or dietitian will be able to provide you with advice about a suitable diet plan.
Most people are well enough to leave hospital within three to five days of thyroid surgery. However, you will need to rest at home for two to three weeks and avoid any activities that could put a strain on your neck, such as heavy lifting. A member of your MDT will be able to advise you when you will be healthy and fit enough to resume normal activities and return to work.
Replacement hormone therapy
If some or all of your thyroid gland is removed, it will no longer be able to produce the hormones that regulate your metabolic system. This means you will experience the symptoms of an underactive thyroid (hypothyroidism) including:
- fatigue (extreme tiredness)
- weight gain
- dry skin
To compensate for the removal of your thyroid gland, you will need to take replacement hormone tablets for the rest of your life.
If your surgery is to be followed by radioactive iodine treatment, it is likely that initially you will be given a hormone tablet known as triiodothyronine. Once radioactive iodine treatment is completed, you will be prescribed an alternative hormone tablet called thyroxine, which most people only need to take once a day.
You will require regular blood tests to check that you are receiving the right amount of hormones, or determine whether your dose needs to be adjusted.
It can take some time to achieve the optimum dose. Until that time you may experience symptoms of tiredness or weight gain if your hormone levels are too low. Alternatively, if your hormone levels are too high, you may experience symptoms of:
- weight loss
- hyperactivity
- diarrhoea
Once the right dose has been determined, you should not experience any more side effects.
Calcium levels
Occasionally, the parathryoid glands can be affected during surgery. The parathryoid glands are located close to the thyroid gland, and help regulate the levels of calcium in your blood.
If your parathryoid glands are affected during surgery, you may experience a drop in calcium levels, which can cause a tingling sensation in your hands, fingers, lips and around your nose.
If you experience any of these symptoms, report them to your MDT or to your GP. You will probably be required to take calcium supplement tablets. Most people only need to take a short course of calcium supplements, as over time, the parathryoid glands will resume their normal function.
Radioactive iodine treatment
Following thyroid surgery, a course of radioactive iodine treatment is recommended. This can help destroy remaining cancer cells in your body and prevent the cancer from returning.
If you are currently taking thyroid hormone replacement tablets, you will be required to stop taking them for two to four weeks before treatment. They can interfere with the effectiveness of the iodine treatment.
After you have stopped taking your thyroid hormone replacement tablets, you may feel very tired and weak, but these symptoms will pass once you begin taking the tablets again.
If it is thought that withdrawing your hormone replacement treatment could be particularly problematic, you may be given a medicine called recombinant human thyroid stimulating hormone (rhTSH). This is an injection that is given on two consecutive days. Its main advantage is that you will not need to interrupt your thyroid hormone replacement treatment.
However, rhTSH may not be suitable for you for a number of reasons. Your MDT will be able to advise you about whether or not rhTSH is suitable for you.
The procedure
During radioactive iodine treatment, you will swallow radioactive iodine in either liquid or capsule form. The radiation that is contained in the iodine will travel up into your neck through your blood supply and destroy any cancerous cells.
Side effects of radioactive iodine treatment are uncommon, but a small number of people may experience tightness, pain or swelling in their throat and may feel flushed (warm). These side effects usually pass within 24 hours.
You may notice a change in your taste and dryness of your mouth. These symptoms usually disappear after a few weeks or months, but some people have permanent altered taste and dry mouth.
Following radioactive iodine treatment, you will need to stay in hospital for three to five days because the iodine will make your body slightly radioactive. As a precaution, you will need to stay in a single room, protected by lead sheets, so that hospital staff are protected against exposure to radiation.
Visitors will usually not be able to enter your room during this time, and pregnant women and children will not be allowed to visit because they are more vulnerable to the effects of radiation. Hospital staff members will keep their contact with you to a minimum during this time.
Your bodily fluids, such as urine, will also be slightly radioactive for three to five days, so it is important that you flush the toilet every time you use it. Your sweat will also be radioactive so you should have a bath or shower every day.
Once the radioactive levels in your body have subsided you will be allowed to return home.
Dietary recommendations
If you are receiving radioactive iodine treatment, you will be asked to eat a diet that is low in iodine because a high iodine diet can reduce the effectiveness of your treatment. It is recommended that you:
- avoid all seafood
- limit your consumption of dairy products
- do not take cough medicines or use sea salt (sea salt is a coarser type of salt than table salt) as both contain iodine
- do not eat glace and maraschino cherries, as they contain colouring (E127) that is known to be high in iodine
Eat plenty of fresh meat, fresh fruit and vegetables, and pasta and rice. They are all low in iodine.
Pregnancy and breastfeeding
You should not have radioactive iodine treatment if you are pregnant, or if there is a good chance that you may be. This is because the treatment could damage any unborn children. You should tell your MDT if you are unsure. Any treatment will need to be delayed until your pregnancy is complete.
If you are not pregnant, you will still be required to use a reliable contraceptive for at least six months after receiving your iodine treatment. This is because there is a small risk that any child conceived during this time could develop birth defects.
A similar risk applies to men, who should use a reliable contraceptive for at least four months after receiving iodine treatment.
See the Health A-Z topic about Contraception for more information.
Your MDT will be able to advise you about when it is safe for you to attempt to conceive a child.
If you are breastfeeding, you should stop for at least four weeks (but preferably eight weeks) before iodine treatment begins, and you should not resume until after your treatment has finished. It is safe to begin breastfeeding if you have another child at a future date.
Fertility
Radioactive iodine treatment does not affect fertility in women, but there is a small risk that it could affect your fertility if you are a man, if you are required to undergo multiple sessions of treatment. Your MDT can advise you about the level of risk in your individual circumstances.
If the risk is significant, you may wish to consider having your sperm or eggs harvested and frozen, so that they can be used for fertility treatment at a later date. See the Health A-Z topic about Infertility for more information.
External radiotherapy
External radiotherapy, where radioactive waves are targeted at affected parts of the body, is usually only used to treat advanced, or anaplastic, thyroid carcinomas.
The length of time that you require radiotherapy for will depend on the particular type of thyroid cancer that you have and its progression.
Side effects of radiotherapy include:
- nausea (feeling sick)
- vomiting
- tiredness
- pain on swallowing
- dry mouth
These side effects should pass two to three weeks after your radiotherapy has finished.
See the Health A-Z topic about Radiotherapy for more information.
Chemotherapy
Chemotherapy is usually only used to treat anaplastic thyroid carcinoma that has spread to other parts of your body.
Chemotherapy involves taking medicines that kill cancerous cells. It is rarely successful at curing anaplastic cancer, but it can slow its progression and help to relieve symptoms.
Possible side effects of chemotherapy include:
- nausea
- vomiting
- tiredness
- loss of appetite
- hair loss
- mouth ulcers
If you are receiving chemotherapy, you will also be more vulnerable to infection. You should see your GP if you suddenly feel ill, or your temperature rises above 38C (100.4F).
See the Health A-Z topic about Chemotherapy for more information.
Targeted therapies
A number of targeted therapies are being tested in clinical trials (a type of research that tests one treatment against another) to treat advanced cases of medullary thyroid cancers, differentiated thyroid cancers that do not respond to radioactive iodine and anaplastic thyroid carcinomas.
Targeted therapy involves using medication that specifically targets the biological functions that cancers need to grow and spread. For example, there is a type of enzyme (a protein that causes certain chemical reactions) that helps stimulate the growth of cancerous cells. Therefore, there is a type of targeted therapy, known as a tyrosine kinase inhibitor, which is designed to block the effects of the enzyme.
Examples of tyrosine kinase inhibitors include:
None of the currently available tyrosine kinase inhibitors have been licensed for the treatment of thyroid cancer. This means that the manufacturers of the medication have not applied for a license for their medication to be used in treating thyroid cancer. In other words, the medication has not undergone clinical trials to see if it is effective and safe in the treatment of thyroid cancer.
In exceptional circumstances, your specialist may suggest an unlicensed medication if:
- they think that it is likely to be effective
- if there are no better alternatives, and
- if the benefits of treatment outweigh any associated risks
If your specialist is considering prescribing a tyrosine kinase inhibitor, they will inform you that it is unlicensed and will discuss the possible risks and benefits with you.
Tyrosine kinase inhibitors are a very powerful type of medication and can cause a wide range of side effects, such as:
- burning or painful sensations in the tongue
- upset stomach
- nausea
- vomiting
- diarrhoea
- flu-like symptoms, such as chills and muscle aches
- loss of appetite
For a complete list of side effects check the patient information leaflet that comes with the medication.
The National Institute for Health and Clinical Excellence (NICE) has not approved these types of medications for treating thyroid cancer. The decision about whether to fund treatment with these types of medication will therefore be at the discretion of your local primary care trust.
Alternatively, you may be able to access these types of treatment by agreeing to take part in a clinical trial for thyroid cancer. However, you should be aware that there is no guarantee that you will receive a treatment that is more effective than the currently available treatments.
