Treatment

For most people with most types of thyroid cancer, the first treatment is surgery. Surgery for SCCA patients is performed at the UWMC main campus by UW Medicine surgeons who are very experienced in treating thyroid cancer. We use the most up-to-date information to guide surgical decisions. 

Many studies show patients have fewer complications if they have surgery at a center that does a high volume of thyroid cancer surgeries, as we do.

Which type of thyroid surgery will I need?

Your first step toward surgery will be to meet with your thyroid surgeon, who will:

• Carefully review your imaging and biopsy results.
• Evaluate your health needs, and ask about your personal preferences.
• Explain your options, the type of surgery we recommend for you, why, and what to expect. 
• Answer your questions about surgery.

Together, you’ll decide on a surgical plan.

The extent of your surgery depends on several factors, including where the cancer is located in your thyroid and if it has spread to your lymph nodes.

• If cancer is only in your thyroid, you may have half of your thyroid removed (hemithyroidectomy) or the entire thyroid removed (total thyroidectomy), depending on the size of the tumor, the appearance of the cancer on ultrasound, and other factors.  
• If cancer is in your lymph nodes as well, the surgeon will remove your entire thyroid along with the group of lymph nodes involved. 

What can I expect if I need surgery?

Your surgery team will talk with you about the benefits and risks of the procedure, how to prepare, what will happen during surgery, and how to best support your recovery.

• Operations can be as short as one hour or last multiple hours.  
• You will have general anesthesia, so you will be completely asleep during the procedure.  
• Depending on the extent of your surgery, you may go home the same day or spend one or two nights in the hospital.  
• After surgery you can eat, drink, walk, and talk, but you will be tired and sore. Your team will give you medicine for pain and an ice pack to reduce swelling in your neck. 
• If your entire thyroid is removed, you no longer produce thyroid hormone. To get the thyroid hormone your body requires, you’ll need thyroid hormone therapy. 

Radioactive iodine (RAI) therapy has been a standard part of thyroid cancer care for years, but guidelines about exactly when and how to use this treatment have changed over time. 

The thyroid cancer experts at SCCA closely follow the very latest developments on RAI and other therapies to make sure you receive the most effective treatment for your disease with the fewest possible side effects. We’re using RAI therapy less often because research shows it’s not helpful if you are at low risk for thyroid cancer coming back. World-class care at SCCA means providing the treatments you do need and sparing you from those you don’t.

What is radioactive iodine therapy?

Your thyroid gland naturally takes up and holds onto the mineral iodine, present in certain foods. No other tissue in the body does this — except breast tissue in pregnant and lactating women, which is why doctors wait several months after a woman stops nursing before treating her with iodine. 

• In radioactive iodine therapy, you take a capsule that contains a special radioactive form of iodine called I-131. 
• After you swallow the capsule, it releases I-131, which travels through your bloodstream and then collects in your thyroid cells, destroying them. 
• RAI therapy works best when your levels of thyroid-stimulating hormone (TSH) are high, so most patients receive injections of a synthetic TSH-elevating hormone, thyrotropin alfa (Thyrogen), for two days before taking the RAI capsule.

Who needs radioactive iodine therapy?

RAI therapy is commonly used to treat papillary thyroid cancer and follicular thyroid cancer. 

• Some people receive RAI therapy to destroy any microscopic normal thyroid cells that may be left behind after surgery to remove their thyroid. This is called remnant ablation. It is done to help prevent a recurrence of cancer in any thyroid cells that remain. 
• Other people need higher doses of I-131 to treat areas of thyroid cancer that surgeons cannot remove. This is called adjuvant treatment.  

Your SCCA team will decide whether or not to recommend RAI therapy for you based on the results of your surgery. Therapy typically starts about two to three months after surgery to allow time for healing first. 

Most people need to take only one capsule. Another capsule might be used in the future to treat thyroid cancer that returns or spreads.  

What about side effects?

Like many cancer treatments, RAI therapy can cause side effects. We will talk with you before treatment about side effects you might experience and do everything we can to prevent, reduce, or manage them. 

For a short period after you take the capsule, your body will give off radiation that could affect other people. 

• Your care team will make sure you understand how to avoid exposing others to radiation during this time, such as not preparing food for anyone but yourself and not sleeping in the same bed with another person. 
• Most precautions apply for only the first few days to a week after treatment; depending on the dose you received, some might apply for a few weeks. 

Your SCCA team will explain everything you need to know.

Medicines that target cancer cells specifically are an important treatment option if your thyroid cancer stops responding to RAI therapy.

SCCA scientists and cancer specialists are at the forefront of research into new options for people with RAI-refractory disease. 

What are targeted therapies?

Targeted therapies are medicines that block the growth or spread of cancer cells through a specific pathway or receptor — rather than generally attacking all fast-growing cells the way conventional chemotherapy drugs do.
 

• Thyroid cancer cells have a certain set of genetic mutations not present in healthy cells. The medicines sorafenib (Nexavar) and lenvatinib (Lenvima) target the mutated cells.
• Both drugs are approved by the U.S. Food and Drug Administration to treat thyroid cancer that is no longer responding to RAI therapy. They have been tested in large clinical trials.

Who needs targeted therapies?

The decision to receive targeted therapies is complex and requires the expertise of medical oncologists and endocrinologists who specialize in thyroid cancer, like those at SCCA.

• While targeted therapies can be helpful, they can also cause side effects.
• In most cases, RAI-refractory thyroid cancer is indolent — it progresses slowly. So most people with this type of disease can stay relatively healthy without additional treatment but with regular doctor visits to monitor their condition.
• Your SCCA doctors can talk with you about the benefits and risks of all your options and recommend a treatment plan for you based on the best available scientific evidence.
• If you received thyroid cancer treatment somewhere else and now have RAI-refractory disease, our experts can provide a second opinion about whether to try targeted therapies in your particular situation.

Tissues throughout your body use thyroid hormone for important functions, such as keeping your brain, heart, and other vital organs working the way they should. 

If you have surgery to remove your entire thyroid:, you will need thyroid hormone therapy.

What is thyroid hormone therapy?

Thyroid hormone therapy means:

• You will need to take the pill levothyroxine every day to provide the thyroid hormone your body requires (thyroid replacement therapy). 
• You might also need to take thyroid hormone because it helps prevent thyroid cancer from coming back (suppressive therapy).

If only half of your thyroid was removed, you may or may not need thyroid hormone therapy. Your SCCA team will explain what they recommend for you and why.

What do I need to know about taking thyroid hormone?

Your SCCA endocrinologist will carefully calculate a starting dose for you based on your weight, and then they will monitor your thyroid hormone level over time with regular blood tests. 

• It’s common to need adjustments to your dose for a variety of reasons, like stopping or starting other medicines or supplements or becoming pregnant.
• Having too much or too little thyroid hormone can cause symptoms, such as changes in heart rate, bowel movements, sweating, or skin dryness.
• Taking thyroid hormone consistently is the best way to help ensure you are taking the right amount, whether it is for replacement or suppressive therapy.

As part of your comprehensive follow-up care at SCCA, your team will explain all the details you need to know about taking thyroid hormone and ensure you’re getting the dose you need to stay healthy and help prevent a cancer recurrence.