Thyroid Cancer Treatment
Once a person is diagnosed with thyroid cancer then they start on the challenging road of finding the most appropriate treatment. That can be hard because there is a lot of information on thyroid cancer treatment, and some choices in terms of how to treat it. In the following I will present the information available to help you decide. The information in this section is limited to treatments for the Differentiated Thyroid Cancers (DTC), including papillary & follicular thyroid carcinomas.
Factors that need to be considered:
- Extent of thyroid surgery
- What to do with the lymph nodes
- Risks associated with different types of thyroid surgeries
- Cure rates
- Recurrence rates
- Cancer follow up
- Radioactive iodine treatment
Thyroid Surgery (Thyroidectomy)
Thyroid surgery is the main treatment for papillary and follicular thyroid cancer. A great majority of the people who have these cancer will have a tumor limited to the thyroid gland and only require surgery and nothing more to be cured. At The CENTER, we will do a full assessment of each patient to see what is the true stage of their tumor, and what are the possible & appropriate surgical options.
There are generally 2 types of thyroid surgeries, and 2 types of surgeries on the lymph nodes when trying to treat thyroid cancer.
- Hemi-Thyroidectomy (or Thyroid Lobectomy)
- Total Thyroidectomy
- Central Neck Dissection
- Lateral Neck Dissection
Thyroid lobectomy or hemi-thyroidectomy involves the removal of only half of the thyroid through a very small incision (3 cm, or just over an inch). All of the normal surrounding tissue and organs, including the voice box nerves (recurrent & superior laryngeal nerves), the parathyroids, breathing tube, swallowing tube and blood vessels are seen and carefully preserved so that they function normally. This surgery is done on an outpatient basis and the person may go home and sleep in their own bed the same evening.
The lymph nodes immediately below the thyroid lobe (central compartment lymph nodes) are examined both before the surgery on ultrasound and during surgery by seeing them and feeling them. If on any exam they are suspicious or concerning, then they may be removed as well; this is called central compartment neck dissection. The lymph nodes can then be examined by the pathologist to see if there has been any spread of cancer to them. This will help your surgeon decide if more needs to be done to cure the cancer; such as removing the entire thyroid.
Reasons to Remove Only Half of The Thyroid
- Papillary thyroid cancer smaller then 4cm without evidence of the tumor eating through the thyroid capsule or involving the lymph nodes
- The thyroid cancer is not advanced and will not require radioactive iodine.
- A person who understands their own particular thyroid cancer, and is aware and accepting of the fact that thyroglobulin blood markers for cancer cannot be used to monitor the cancer. Only ultrasound will be available for monitoring, which in early stage cancer is appropriate.
- A person who wishes to either not need thyroid hormone medications or minimize the need for it
Total thyroidectomy involves the removal of the entire thyroid gland through a very small incision (3 cm, or just over an inch). All of the normal surrounding tissue and organs, including the voice box nerves (recurrent & superior laryngeal nerves), the parathyroids, breathing tube, swallowing tube and blood vessels are seen and carefully preserved so that they function normally. In most instances, this surgery is done with an overnight stay. By the following morning the patient may go home. There is no drain and the incision is closed with absorbable sutures under the skin.
Before surgery, at the CENTER Dr. Larian performs an ultrasound himself to look at all the lymph nodes; if any of the lateral compartment lymph nodes appear suspicious then he will perform a needle biopsy to see if there is the spread of cancer to the nodes. If that is the case then in addition to a total thyroidectomy, he will recommend doing both a central & lateral node dissection. This does involve making a longer incision to access the nodes to the side.
Total Thyroidectomy Important Facts
- Total thyroidectomy is a very effective treatment for almost all types, and stages of thyroid cancer.
- Small well hidden cosmetic incision
- In some cases it can be done on an outpatient basis
- As all four parathyroid glands areas are exposed, there is a risk of low parathyroid function. This risk is directly related to the experience of surgeon.
- The voice box nerves are identified on both sides, and to minimize the risk of injury nerve monitoring breathing tubes are used that alert the
Thyroid Lobectomy vs. Total Thyroidectomy Recurrence & Cure Rates
In the past, all people who thyroid cancer were recommended to have a total thyroidectomy. Then researchers looked back at the results and found that 10 year survivals were not significantly different; 97.5% for total thyroidectomy and 98.4% for Lobectomy. There was a small difference in the recurrence rate of thyroid cancer, 9.8% for a lobectomy vs. 7.7% for total thyroidectomy, but that did not seem to impact the ultimate survival rate for the cancer. This means that even though the patients that had a thyroid lobectomy had the tumor come back 2% more then the ones who had a total thyroidectomy, this increased recurrence did not translate into a higher mortality. Or in other words, recurrences can be treated in most cases effectively.
Reasons to Have Radioactive Iodine treatment After The Entire Thyroid Has Been Removed
- A thyroid cancer that is eating through the thyroid capsule and has spread outside of the thyroid gland (extra-thyroidal extension)
- Papillary thyroid cancer that has spread to more then 2 lymph nodes
- Aggressive variants of papillary thyroid cancer (Tall Cell Variant, Diffuse Sclerosing, & Columnar Cell Variants)
- Papillary or follicular thyroid cancer that has spread to other parts of the body
- Papillary or follicular thyroid cancer that has come back and is small in size.