Treatment options for thyroid cancer
A team of healthcare professionals decides what treatment options you have.
Treatment for thyroid cancer includes:
- surgery
- radioactive iodine
targeted cancer drugs 
radiotherapy chemotherapy
Deciding what treatment you need
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
The MDT includes:
- a surgeon - a doctor who does operations
- an oncologist – a cancer specialist
- an endocrinologist - a specialist doctor who treats illnesses affecting the hormone (endocrine) system
- a radiologist – a doctor specialising in reporting x-rays and scans
- a clinical nurse specialist (CNS) - a nurse who offers support and advice during and after treatment
- a nuclear medicine specialist - a doctor who specialises in tests and scans that use radioactive substances
- a pathologist - a doctor who specialises in looking at cells under the microscope
Your doctor will then talk to you about the treatment they suggest. They will explain its benefits and the possible side effects.
Your treatment will depend on:
-
where your cancer is
-
how big it is and whether it has spread (the stage)
-
your type of thyroid cancer
-
how abnormal the cells look under a microscope (the grade)
-
your general health and level of fitness
The main treatments for thyroid cancer are described below. You may have more than one of these treatments.
Surgery
Surgery is the most common treatment for thyroid cancer. The surgeon might remove:
- part of your thyroid - this is a lobectomy, partial thyroidectomy or hemithyroidectomy
- all of your thyroid gland - this is a total thyroidectomy
- lymph nodes in your neck
These are big operations, carried out under general anaesthetic.
Radioactive iodine treatment
Radioactive iodine is a type of internal radiotherapy. It uses a radioactive form of iodine called iodine 131 (I-131). Thyroid cells absorb iodine 131 and the radiation in the iodine kills the cancer cells.
It is only suitable for some types of thyroid cancer, including:
- follicular thyroid cancer
- papillary thyroid cancer
You usually have the radioactive iodine as a drink or capsule. You might need to stay in hospital for a few days.
Thyroid hormone replacement
You might have thyroid hormone replacement:
- after surgery to replace the hormones your thyroid gland would normally make
- as a treatment for your thyroid cancer
You usually take thyroxine (T4), or occasionally liothyronine (T3) tablets.
Targeted cancer drugs
Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. There are many different types of targeted drugs.
Doctors use a type called tyrosine kinase inhibitors (TKI) for thyroid cancer. You might have these drugs for thyroid cancer if:
- other treatments are not an option or no longer work
- your cancer begins to grow outside of the thyroid gland or spread to another part of your body
External radiotherapy for thyroid cancer
Radiotherapy uses high energy waves similar to x-rays to destroy cancer cells. External radiotherapy uses a radiotherapy machine to aim radiation beams at a cancer. You have this treatment in the hospital radiotherapy department.
You might have external radiotherapy if other treatments do not work very well.
Chemotherapy
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream.
Doctors don't often use chemotherapy to treat thyroid cancer. But you might have it if your cancer has spread to another part of the body, or if it comes back
Treatment for the different types of thyroid cancer
There are different types of thyroid cancer. Your type depends on several factors including what type of cell the cancer starts in.
Some types of thyroid cancer have similar treatment. Below we have information about treatment for some different types including:
- differentiated thyroid cancers - papillary, follicular and oncocytic (hurthle cell) thyroid cancer
- medullary thyroid cancer
- anaplastic thyroid cancer
The main treatments are:
- surgery
- radioactive iodine treatment
You might need to take thyroid hormones after your operation. If your treatment doesn't work, your doctor might suggest you have targeted cancer drugs or radiotherapy.
Low risk papillary thyroid cancer
If you have a very small, papillary thyroid cancer your doctor might call this low risk cancer. Your doctor might suggest active surveillance using ultrasound scans to monitor you. This means that you don’t have treatment straight away.
Surgery
You usually have an operation to remove part or all of your thyroid. The surgeon is more likely to remove your whole thyroid gland if you have oncocytic (Hürthle cell) thyroid cancer.
The surgeon might also remove lymph nodes in your neck.
Radioactive iodine
After surgery you might have radioactive iodine treatment. The aim of this is to treat any thyroid cancer that might have been left behind.
You might also have radioactive iodine treatment if the cancer comes back or has spread.
Thyroid hormone tablets
You have thyroid hormone tablets after surgery if the surgeon removes your whole gland. This is called thyroid hormone replacement. You generally don’t need to take hormones if you have only had part of your thyroid gland removed. But you may need them if blood tests show that the remaining part of your thyroid gland is not making the hormones you need.
These hormones may also help to stop follicular and papillary thyroid cancer coming back. They stop your body from producing another hormone called thyroid stimulating hormone (TSH). TSH encourages these types of thyroid cancer cells to grow.
Targeted cancer drugs
You might have a targeted drug if:
- radioactive iodine is no longer working, and
- your cancer has spread outside of the thyroid gland into the surrounding area, or to other parts of the body
There are different types of targeted cancer drugs. For differentiated thyroid cancer you usually have lenvatinib (Lenvima). Another option is sorafenib (Nexavar), although this isn't available in all parts of the UK.
Radiotherapy
You might have radiotherapy if
- treatment doesn’t work and you still have signs of thyroid cancer after surgery
- your doctor doesn’t think radioactive iodine will control your cancer
The main treatments are:
- surgery
- external beam radiotherapy
- targeted cancer drugs
Surgery
You usually have surgery to remove your thyroid gland for medullary thyroid cancer. After surgery you will need to take thyroid hormone replacement tablets.
External beam radiotherapy
You may have external beam radiotherapy after your surgery. You won’t have radioactive iodine. This is because medullary thyroid cancer does not absorb iodine in the same way differentiated thyroid cancer does.
Targeted cancer drugs
You might have a targeted drug if:
- you can’t have surgery to remove your medullary thyroid cancer
- your cancer has spread outside of the thyroid gland or to another part of your body
Targeted cancer drugs for medullary thyroid cancer include:
- cabozantinib (Cometriq)
- selpercatinib (Retsevmo)
Another drug called vandetanib isn't used very often any more.
Anaplastic thyroid cancer tends to grow more quickly than other types. When you are first diagnosed, your cancer may have already spread outside of your thyroid gland. So surgery to remove the cancer is not usually an option.
The main treatments for this type of thyroid cancer are:
- external beam radiotherapy
- targeted cancer drugs
- chemotherapy
You might have these treatments on their own, or together. You may have surgery, depending on your situation, but this is less common.
Targeted cancer drugs
You might have 2 targeted drugs called dabrafenib and trametinib if your cancer has changes to the
Clinical trials
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.
