Thyroid cancer treatment is very successful. About 95% of thyroid cancer patients live more than five years, and most thyroid cancer patients experience a normal life span and full quality of life after appropriate treatment. Even patients with advanced thyroid cancer may often do well with modern targeted therapies.
Surgery is the cornerstone of thyroid cancer treatment for most types of thyroid cancer. If the physician suspects that the cancer has spread to lymph nodes in the neck, these will also be removed during surgery. A complete surgery is sufficient treatment for the majority of patients with thyroid cancer.
Patients with a high risk of disease recurrence may also be offered radiation therapy with radioactive iodine. When the thyroid cancer cannot be completely removed, or demonstrates extremely aggressive biology, radiation therapy with beam radiation can also be used. Chemotherapy and newer targeted therapies are also available for patients who have metastatic disease to organs outside of the neck.
UCLA endocrine surgeon James Wu, MD, presented a live-streaming webinar to discuss active surveillance of low-risk tumors, a recommended treatment approach for many incidentally discovered papillary thyroid cancers.
We tailor the aggressiveness of the surgery to the risk level of the thyroid cancer and on the personal values of each individual patient. If surgery is recommended as part of your treatment plan, the possible procedures are:
In general, small, low-risk cancers can be adequately treated with thyroid lobectomy. Total thyroidectomy may be recommended for larger or higher risk cancers, if you have pre-existing thyroid disease, or if you have nodules on the other half of the thyroid gland. During physical examination and neck ultrasound, sometimes we identify nearby abnormal lymph nodes. If so, we may extend the surgery to include removal of those lymph nodes.
|Thyroid Lobectomy||Total Thyroidectomy|
|Benefits||No risk to the opposite vocal cord nerve||Required to receive radioactive iodine|
|No risk of insufficient parathyroid hormone||Allows monitoring using a blood test (thyroglobulin)|
|Risks||25% chance of needing thyroid hormone supplementation||Will need lifelong replacement of thyroid hormone (100%)|
|2.5% risk of temporary hoarseness||5% risk of temporary hoarseness|
|<1% hematoma, infection||<1% hematoma, infection|
|May need 2nd surgery to remove other half of thyroid||3% risk of insufficient parathyroid hormone|
Every year, approximately 50,000 new diagnoses of thyroid cancer are made. Since very few patients die from their thyroid cancer, recurrences are frequently encountered. Fortunately, most recurrences in the neck can still salvaged with surgical resection.
Recurrences can be detected through blood tests, neck ultrasound, or even physical examination. Consultation with endocrinologist and endocrine surgeon should be sought to determine the site and extent of recurrent disease.
Treatment options for recurrent thyroid cancer include additional surgery, use of radioactive iodine and in some cases, chemotherapy or tyrosine kinase inhibitors. The choice of further treatment often hinges on the location of the recurrent disease. Diseased lymph nodes in the neck are usually removed surgically. Disease outside the neck is often treated with radioactive iodine, external beam radiation, chemotherapy, or combination treatments.
A new technique called Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) has been developed. With this surgery, the thyroid gland is removed without leaving any visible scars in the neck. Small incisions are made inside the mouth, and the thyroid gland is removed using a video camera and laparoscopic instruments. In some cases, an additional well-hidden ½ inch incision is made just under the chin.
Good candidates for Scarless Thyroidectomy include patients with smaller thyroid nodules or cancers. This technique is not appropriate for patients with very large or invasive thyroid cancers.
Some centers have begun testing new, minimally invasive techniques to destroy benign thyroid nodules or small thyroid cancers without surgery. These involve heating the lesion using laser or radiowaves, or injecting alcohol as a caustic agent. For now, these procedures should be considered experimental and only be performed as part of a clinical trial.
As a referral center for difficult cases, we also have experience in treating patients with special circumstances.
We are also part of specialized teams that care for patients and their families with: