Steps in the Treatment of Thyroid Cancer

The Treatment Pathway for Patients with Thyroid Cancer: An Overview

The initial treatment of thyroid cancer usually consists of removing part or all of the thyroid and, in the case of a total thyroidectomy, possibly a radioiodine remnant ablation.  Patients are monitored after initial treatment to check for recurrence of the cancer.1-3  The information that follows applies to either papillary or follicular thyroid cancer, also referred to as well-differentiated thyroid cancer.

Steps in the treatment of well-differentiated thyroid cancer

Surgery

Once diagnosed, the first step in the treatment process for well-differentiated thyroid cancer is surgery to remove all or part of the thyroid. This is called a thyroidectomy. Thyroid surgery is a very delicate procedure because the thyroid is surrounded by many blood vessels and nerves.2 Thyroid surgeries are done in a hospital operating room under a general anesthetic. The surgeon may remove all (total thyroidectomy) or part (hemi-thyroidectomy) of the thyroid gland depending on the size of the tumor and whether the cancer has spread outside of the thyroid.1

Thyroid Hormone Replacement

Following surgery, your surgeon or endocrinologist will likely prescribe thyroid hormone replacement. This will replace the hormone your thyroid was producing prior to its removal. Without thyroid hormone replacement, you may become hypothyroid, which, according to scientific studies, may affect your ability to perform normal day-to-day activities.1,2

Thyroid hormone therapy usually consists of taking a daily dose of T4. This is important because thyroid hormone has a role to play in regulating your metabolism.4  Taking thyroid hormone replacement therapy is aimed at normalizing your thyroid stimulating hormone level to avoid hypothyroidism.  Learn more about about hypothyroidism.

Lifestyle recommendations

Additionally, your doctor may recommend some things you’ll want to incorporate into your life that will help you take good care of yourself and remain healthy. These include:

  • Regular exercise
  • Good eating habits
  • Time for relaxation

For more information about what to expect after initial treatment, visit the Long-Term Monitoring section of this website.

Radioactive Iodine Remnant Ablation

Approximately 6 weeks after a total thyroidectomy, you will discuss with your physician whether remnant ablation with radioactive iodine will be needed.  The radioactive iodine is absorbed by any remaining thyroid cells in the body to destroy the cells to help ensure any cancerous cells are eliminated.Your doctor may prepare you for thyroid remnant ablation by stopping your thyroid hormone replacement therapy or using a prescription medication which allows you to remain on hormone replacement therapy. Learn more about remnant ablation.

Long-term Monitoring

Periodically your endocrinologist will request that you obtain tests, blood tests or ultrasound of your entire neck region.3  Additionally, visits with your endocrinologist will be needed approximately every 6 months for 18-24 months after diagnosis.  Learn more about long-term monitoring.

References

  1. Haugen BR, Alexander EK, Bible K, et al. 2015 American Thyroid Association (ATA) Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer.  Thyroid. 2015; DOI: 10.1089/thy.2015.0020.
  2. National Comprehensive Cancer Network. Thyroid Cancer. Version 2.2015. http://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf. Accessed Oct 30, 2015.
  3. Norman, J.  Endocrineweb. Thyroid Cancer.  2015. http://www.endocrineweb.com/conditions/thyroid-cancer/thyroid-cancer. Accessed Oct 30, 2015.
  4. American Cancer Society. Thyroid hormone therapy. 2014. http://www.cancer.org/cancer/thyroidcancer/detailedguide/thyroid-cancer-treating-thyroid-hormone-therapy. Accessed Nov 4, 2015.

Thyrogen® (thyrotropin alfa for injection) 0.9 mg/mL after reconstitution

IMPORTANT SAFETY INFORMATION

There have been reports of events that led to death in patients who not had surgery to have their thyroid gland removed, and in patients with thyroid cancer cells that have spread to other parts of the body.

Patients over 65 years old with large amounts of leftover thyroid tissue after surgery, or with a history of heart disease, should discuss with their physicians the risks and benefits of Thyrogen.

Thyrogen can be administered in the hospital for patients at risk for complications from Thyrogen administration.

Since Thyrogen was first approved for use, there have been reports of central nervous system problems such as stroke in young women who have a higher chance of having a stroke, and weakness on one side of the body.

Patients should remain hydrated prior to treatment with Thyrogen.

Leftover thyroid tissue after surgery and cancer cells that have spread to other parts of the body can quickly grow and become painful after Thyrogen administration.

Patients with cancer cells near their windpipe, in their central nervous system, or in their lungs may need treatment with a glucocorticoid (a medication to help prevent an increase in the size of the cancer cells before using Thyrogen.)

ADVERSE REACTIONS

In clinical studies, the most common side effects reported were nausea and headache.

USE IN SPECIFIC PATIENT POPULATIONS

Pregnant patients: Thyrogen should be given to a pregnant woman only if the doctor thinks there is a clear need for it.

Breastfeeding patients: It is not known whether Thyrogen can appear in human milk. Breastfeeding women should discuss the benefits and risks of Thyrogen with their physician.

Children: Safety and effectiveness in young patients (under the age of 18) have not been established.

Elderly: Studies do not show a difference in the safety and effectiveness of Thyrogen between adult patients less than 65 years and those over 65 years of age.

Patients with kidney disease: Thyrogen exits the body much slower in dialysis patients and can lead to longer high TSH levels.

INDICATIONS AND USAGE

Thyrogen is used to help identify thyroid disease by testing the blood for a hormone called thyroglobulin in the follow up of patients with a certain type of thyroid cancer known as well differentiated thyroid cancer. It is used with or without a radiology test using a form of iodine.

Limitations of Use:

The effect of Thyrogen on long term thyroid cancer outcomes has not been determined.

When Thyrogen is used to help detect thyroid cancer, there is still a chance all or parts of the cancer could be missed.

Thyrogen is also used to help patients prepare for treatment with a form of iodine to remove leftover thyroid tissue in patients who have had surgery to take out the entire thyroid gland for patients with well differentiated thyroid cancer who do not have signs of thyroid cancer which has spread to other parts of the body.

Limitations of Use:

In a study of people being prepared for treatment with a form of iodine after thyroid surgery, results were similar between those who received Thyrogen and those who stopped taking their thyroid hormone. Researchers do not know if results would be similar over a longer period of time.

See full Prescribing Information for more details.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.