Treatment options range from active surveillance (more on that below) to monitor a small cancerous nodule for changes over time to surgery for a larger cancer.
When surgery is recommended for thyroid cancer, the results are usually excellent, Dr. Gibson says. This is partly because many such cancers are removed before they have spread, but even “when cancer does go beyond the thyroid, there's usually just local invasion, such as some lymph-node involvement in the neck, which we still can largely control surgically," she adds.
Total thyroidectomy, or removal of the entire thyroid, is used to treat thyroid cancers that are larger than 4 centimeters in diameter. (This procedure is called a “partial thyroidectomy” if less than the entire thyroid is removed.) This traditional open or minimally invasive surgery is followed by lifelong therapy with a synthetic hormone to replace the hormone that would be produced by a healthy thyroid gland.
Another type of surgery, lobectomy, involves removal of only one of the two thyroid lobes. This procedure is usually sufficient if lesions are 4 centimeters or smaller in diameter, and there is no evidence that the cancer has spread beyond the thyroid, Dr. Gibson says. In most cases in which a cancerous lesion is less than 4 centimeters and there is no lymph-node involvement, a lobectomy leaves patients with enough residual thyroid function that lifelong hormone treatment isn’t needed, she adds.
While thyroid surgery is generally safe, in rare cases it can lead to complications such as low calcium levels if the parathyroid glands are damaged in a total thyroidectomy, and hoarseness if the laryngeal nerves are irritated, Dr. Gibson says.
Several weeks after surgery, patients who are at higher risk for recurrence than others, depending on such factors as the size and type of the initial cancer, may be given a single treatment of radioactive iodine therapy, a targeted form of radiation in the form of a pill, liquid, or injection. This therapy is far less likely to cause side effects or complications that can happen with more intensive forms of radiation used for some other cancers, because it targets only the thyroid tissue and any cancer cells within it—and not the rest of body, Dr. Gibson says.
Meanwhile, experts are following research into expanding the use of radiofrequency ablation (RFA) for primary thyroid cancers (those that originate in the thyroid). RFA is a minimally invasive technique that involves inserting a needle into the thyroid nodule and sending radio waves that produce heat to destroy the cells within the nodule. So far in the U.S., RFA is used only for benign thyroid conditions and small recurrent cancers. “We don't have enough information yet to say for sure that RFA could be a primary treatment option for thyroid cancer,” Dr. Gibson says.