Surgery
Surgery is often recommended in the management of thyroid cancer. Depending on the type and size of the cancer, the extent of disease, the gene mutation, the patient’s age and the comorbid conditions, the type of surgery may vary.
Common types of surgery for thyroid cancer are:
Lobectomy/Hemi-thyroidectomy/Subtotal thyroidectomy: This surgery is often reserved for less aggressive and early stage differentiated thyroid cancers (papillary or follicular) without aggressive gene mutations. The cancer-containing part of the thyroid is usually removed. An advantage of this technique is that the patient may not require lifelong thyroid hormone replacement after surgery.
Total thyroidectomy: Total thyroidectomy involves removing the entire thyroid gland. After total thyroidectomy, the patient is required take daily thyroid hormone replacement. One of the advantages of this technique is that monitoring for recurrence of the cancer using whole body thyroid scans and blood tests (thyroglobulin monitoring) is facilitated.
Neck dissection: When thyroid cancer has spread or is suspected to have spread to the lymph nodes in the neck, a surgical neck dissection may be required. If this is the case, selected areas in the neck will be explored and lymph nodes will be removed.
Radioactive Iodine Therapy
Radioactive iodine therapy is required at times as an adjuvant to surgery in the treatment of thyroid cancer. This procedure uses the radioactive form of iodine to identify and treat residual cancer cells that remain in the body after surgery. This treatment is often undertaken to decrease the likelihood of thyroid cancer recurrence, especially in patients with aggressive thyroid cancer.
Radiotherapy
Radiation therapy uses ionizing radiation to destroy or inhibit the growth of cancer cells that form a tumor. This type of radiotherapy is usually reserved as an adjuvant in the treatment of aggressive thyroid cancer. The treatment is generally done over several weeks, with the total number of sessions determined by the radiation oncologist.
Chemotherapy
Chemotherapy is usually reserved for the treatment of aggressive thyroid cancer. Specific treatments can at times be individualized once the gene mutation in the cancer is uncovered.
Thyroid hormone replacement
When thyroid hormone replacement is required, it is initiated after surgery. Medical follow-up with blood tests is very important to assess the dosage of thyroid hormone replacement.
One of the most common forms of thyroid hormone replacement is through oral intake of synthetic levothyroxine (T4) once a day. The dosage is determined by many factors. Regular blood tests are performed to ensure that the appropriate dosage is being given.