Thyroid Hormone Replacement Therapy
Thyroid hormone replacement therapy is often prescribed after thyroid surgery to replace the hormones that are no longer being produced by your thyroid tissue. Depending on how much of your thyroid was taken out, you may have to take the medication most commonly levothyroxine for the rest of your life.
Thyroid hormone replacement can also help prevent the growth or recurrence of thyroid cancer. It does this by lowering your circulating level of the hormone TSH, which is secreted by your brains pituitary gland and tells your thyroid to make more thyroid hormone. High TSH levels can stimulate the growth of thyroid cancer cells. Higher doses of replacement thyroid hormone tell your body to make less TSH, slowing the growth of any thyroid cancer cells and lowering the odds of your cancer coming back.
It can take a few adjustments to find the correct dosage of thyroid hormone replacement. During this time, you may need to see the doctor every 6 to 8 weeks for a blood draw to determine if your levels are optimal.
What Is Thyroid Ablation
RFA is a non-surgical procedure that uses electric radio waves to destroy thyroid nodule tissue. During the procedure, a small, 7-millimeter to 10-millimeter electrode is inserted into your thyroid gland using ultrasound guidance.
With this technology, your doctor can pinpoint the exact location of the abnormal thyroid tissue. Once the electrode is in place, a radiofrequency generator is activated, which pushes an electrical current into the tissue. The vibrating tip of the electrode moves slightly to target the nodule tissue while leaving the healthy thyroid cells untouched.
The entire procedure takes 15-60 minutes and only requires a local anesthetic. This means you are awake during the whole process and will likely not experience pain or discomfort while being treated.
It is an outpatient procedure, so you should be able to resume your normal activities immediately after treatment. Although there may be some minor swelling and neck tenderness for several days after treatment, these symptoms are temporary. They can be managed with over-the-counter pain reliever medications and an ice pack.
What Causes Thyroid Cancer
In most cases, the cause of thyroid cancer is unknown. However, certain things can increase your chances of developing the condition.
Risk factors for thyroid cancer include:
- having a benign thyroid condition
- having a family history of thyroid cancer
- having a bowel condition known as familial adenomatous polyposis
- acromegaly a rare condition where the body produces too much growth hormone
- having a previous benign breast condition
- weight and height
Read more about the causes of thyroid cancer
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When To Get Medical Advice
See a GP if you have symptoms of thyroid cancer. The symptoms may be caused by less serious conditions, such as an enlarged thyroid , so it’s important to get them checked.
A GP will examine your neck and can organise a blood test to check how well your thyroid is working.
If they think you could have cancer or they’re not sure what’s causing your symptoms, you’ll be referred to a hospital specialist for more tests.
Find out more about how thyroid cancer is diagnosed.
What Is Thyroid Cancer
There are several different types of thyroid cancer, the most common is papillary thyroid cancer, which usually grows in one lobe of the thyroid gland . Follicular thyroid cancer accounts for about 20% of thyroid cancers.
Less common thyroid cancers include medullary thyroid cancer, anaplastic thyroid cancer and thyroid sarcoma or lymphoma.
It is projected that 3830 new cases of thyroid cancer will be diagnosed in Australia in 2021, and it is more common in women.
The five year survival rate for thyroid cancer is 97%.
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Thyroid Nodules May Be Found During A Routine Medical Exam And Are Usually Not Cancer
Your childs doctor may find a lump in the thyroid during a routine medical exam, or a nodule may be seen on an imaging test or during surgery for another condition. A thyroid nodule is an abnormal growth of thyroid cells in the thyroid. Nodules may be solid or fluid-filled.
When a thyroid nodule is found, an ultrasound of the thyroid and lymph nodes in the neck is done. A fine-needle aspiration biopsy may be done to check for signs of cancer. Blood tests to check thyroid hormone levels and for anti-thyroid antibodies in the blood may also be done. This is to check for other types of thyroid disease.
Thyroid nodules usually donât cause symptoms or need treatment. Sometimes the thyroid nodules become large enough that it is hard to swallow or breathe and more tests and treatment are needed. Only one in five thyroid nodules become cancer.
Living With Advanced Cancer
Advanced cancer usually means cancer that is unlikely to be cured. During this time palliative care services can help. Most people with thyroid cancer respond well to treatment and do not need to access palliative care services. However, people at any stage of advanced thyroid cancer may benefit from palliative treatment.
Most people continue to have treatment for advanced cancer as part of palliative care, as it helps manage the cancer and improve their day-to-day lives. Many people think that palliative care is for people who are dying but palliative care is for any stage of advanced cancer. There are doctors, nurses and other people who specialise in palliative care.
Treatment may include chemotherapy, radiation therapy or another type of treatment. It can help in these ways:
- Slow down how fast the cancer is growing.
- Shrink the cancer.
- Help you to live more comfortably by managing symptoms, like pain.
Treatment depends on:
- how far it has spread
- your general health
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Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- The age of the patient at the time of diagnosis.
- The type of thyroid cancer.
- The stage of the cancer.
- Whether the cancer was completely removed by surgery.
- Whether the patient has multiple endocrine neoplasia type 2B .
- The patient’s general health.
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Outlook For Thyroid Cancer
Around 9 in every 10 people are alive 5 years after a diagnosis of thyroid cancer. Many of these are cured and will have a normal lifespan.
But the outlook varies depending on the type of thyroid cancer and how early it was diagnosed. At present the outlook is:
- more than 9 in 10 people with papillary carcinoma live at least 5 years after diagnosis
- more than 9 in 10 people with follicular carcinoma live at least 5 years after diagnosis
- more than 7 in 10 men, and around 9 in 10 women with medullary thyroid carcinoma live at least 5 years after diagnosis
- around 1 in 10 people with anaplastic thyroid carcinoma live at least 5 years after diagnosis
Up to 1 in 4 people treated for thyroid cancer are later diagnosed with cancer in another part of the body, such as the lungs or bones, but cancer can often be treated again if this happens.
Page last reviewed: 28 August 2019 Next review due: 28 August 2022
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What Are The Signs And Symptoms Of Thyroid Problems
What you feel when you have a thyroid problem depends on if you have an underactive thyroid or an overactive thyroid.
Signs of an underactive thyroid include:
Swelling or tenderness in the neck
Tremors or shaking
If you have any of the symptoms listed above, tell your doctor or health care team right away. Often, the symptoms of a thyroid problem can look like the symptoms of other conditions. Relieving side effects is an important part of cancer care and treatment. It is called palliative care or supportive care.
Thyroid Cancer Treatment Options By Stage
Stages I and II Papillary and Follicular Thyroid Cancer
Treatment of stage I and II papillary and follicular thyroid cancer may include the following:
- Total or near-total thyroidectomy, with or without radioactive iodine therapy.
- Lobectomy and removal of lymph nodes that may contain cancer, followed by hormone therapy. Radioactive iodine therapy may be given following surgery.
Stage III Papillary and Follicular Thyroid Cancer
Treatment of stage III papillary and follicular thyroid cancer usually includes the following:
- Total thyroidectomy. Cancer that has spread outside the thyroid, as well as any lymph nodes that may have cancer in them, will also be removed..
- Radioactive iodine therapy or external radiation therapy may be given after surgery.
Stage IV Papillary and Follicular Thyroid Cancer
Treatment of stage IV papillary and follicular thyroid cancer that has spread only to the lymph nodes can often be cured. When cancer has spread to other places in the body, such as the lungs and bone, treatment usually does not cure the cancer, but can relieve symptoms and improve the quality of life. Treatment may include the following:
For tumors that take up iodine:
- Radioactive iodine therapy.
For tumors that do not take up iodine
- Hormone therapy.
- Targeted therapy with a tyrosine kinase inhibitor .
- Surgery to remove cancer from areas where it has spread.
- External-beam radiation therapy.
- A clinical trial of chemotherapy.
- A clinical trial of a targeted therapy.
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What Is Radioactive Iodine Therapy
Radioactive iodine can be used for the treatment of overactive thyroid and certain types of thyroid cancer. The term radioactive may sound frightening, but it is a safe, generally well-tolerated, and reliable treatment that targets thyroid cells so there is little exposure to the rest of your bodys cells.
Symptoms Of Thyroid Cancer
Thyroid cancer usually develops slowly, without many obvious symptoms. However, some people experience one or more of the following:
- a painless lump in the neck
- trouble swallowing
- difficulty breathing
- changes to the voice
- swollen lymph glands in the neck .
Although a painless lump in the neck is a typical sign of thyroid cancer, thyroid lumps are common and turn out to be benign in 90% of adults. Having an underactive or overactive thyroid is not typically a sign of thyroid cancer.
Not everyone with these symptoms has thyroid cancer. If you have any of these symptoms or are worried, always see your doctor.
What Are The Symptoms Of Papillary Thyroid Cancer
The main sign of papillary thyroid cancer is a painless lump or nodule on your thyroid gland. PTC usually doesnt cause any other symptoms.
In rare cases, you may experience pain in your neck, jaw or ear from PTC. If the nodule is large enough to compress your windpipe or esophagus, it may cause difficulty with breathing or swallowing.
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What Is The Prognosis Of Papillary Thyroid Cancer
Overall, the prognosis of papillary thyroid cancer is excellent, especially if youre younger than 40 at diagnosis and have a small tumor. PTC can often be treated successfully and is rarely fatal, even if it has spread to lymph nodes in your neck.
Factors that may lead to a worse prognosis include:
- Being older than 55 years at diagnosis.
- Having a large tumor.
- If the cancer has spread to distant parts of your body.
- If you have a rare subtype of PTC, which are typically more aggressive, including the tall cell variant, diffuse sclerosis variant or solid variant.
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How Does Radioactive Iodine Treat Thyroid Cancer
The radioactive iodine enters the bloodstream after ingestion and is taken up by any thyroid-like cells. The radioactivity then destroys the cancer cells, and it gives off radiation that also destroys nearby cancer cells over time. The most common forms of thyroid cancer can generally be treated with massive doses of radioactive Iodine. A tracer dose of radioactive iodine can also be used to track cancer cells that may have spread to other parts of the body.
Picture courtesy: Professor Chris Nutting
Thyroid Cancer Causes And Risk Factors
Its not clear exactly what causes thyroid cancer to develop. However, there are a number of known potential risk factors, some of which can be modified and others that cant. According to the National Cancer Institute, risk factors for developing thyroid cancer include:
Other research led by Dr. Harari is looking at whether certain environmental exposures, including to pesticides and flame retardants, have a link to thyroid cancer.
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Sporadic Medullary Thyroid Cancer
Sporadic medullary thyroid cancer comes from the C cells of your thyroid gland. These cells make a hormone that controls the amount of calcium in your blood.
Between of medullary thyroid cancers are sporadic, meaning they arent hereditary. Sporadic medullary thyroid cancer occurs mainly in older adults.
If diagnosed in stages I through III, MTC can have a good outlook.
What Are The Warning Signs Of Thyroid Cancer
You or your healthcare provider might feel a lump or growth in your neck called a thyroid nodule. Donât panic if you have a thyroid nodule. Most nodules are benign . Only about 3 out of 20 thyroid nodules turn out to be cancerous .
Other thyroid cancer symptoms include:
- Difficulty breathing or swallowing.
- Swollen lymph nodes in your neck.
What are the signs that thyroid cancer has spread?
If you have thyroid cancer that has spread to other areas of your body, you may experience symptoms such as:
- Exposure to radioactive fallout from nuclear weapons or a power plant accident.
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What Will Happen After Treatment
Most people do very well after treatment, but you may need follow-up care for the rest of your life. This is because most thyroid cancers grow slowly and can come back even 10 to 20 years after treatment. Your cancer care team will tell you what tests you need and how often they should be done.
Be sure to go to all of these follow-up visits. You will have exams, blood tests, and maybe other tests to see if the cancer has come back. At first, your visits may be every 3 to 6 months. Then, the longer youre cancer-free, the less often the visits are needed.
Sometimes treatments may not cure your cancer. You many need to keep getting treatment and care. From time to time tests will be done to see how your treatment is working.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life.
Tips For Talking To Your Doctor
- make a list of what you are feeling and how often it happens, including as much detail as possible
- think about your family/whnau history of cancer and tell your doctor
- go back to your doctor if you don’t feel better, even if tests show you don’t have a problem – you can ask for a second opinion if you want one
- take a family/whnau member or friend with you to the appointment for support
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Possible Health Complications Of Thyroid Cancer
With all of that said, there are some longer-term health risks associated with thyroid cancer that may become apparent later on, especially in patients who are diagnosed and treated at a young age. For instance, some possible health-related complications include:
- Heart rhythm disorders
- Heart valve disease
Some of these risks are related to the ways in which the cancer is treated. For example, in some cases the entire thyroid gland is surgically removed. This treatment may be followed by radiation therapy given in the form of radioactive iodine, as well as high-dose thyroid hormone replacement, which may cause certain side effects.
If The Cancer Comes Back
If your cancer does come back at some point, your treatment options will depend on the where the cancer is, what treatments youve had before, and your current health and preferences. Treatment options might include surgery, radiation therapy, chemotherapy, targeted therapy or some combination of these. For more on how recurrent cancer is treated, see Treatment of Thyroid Cancer, by Type and Stage.
For more general information on recurrence, see Understanding Recurrence.
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Waking Up Without A Thyroid
After my second surgery at the Carol G. Simon Cancer Center in Morristown, my thyroid was gone, and I was put on a very high dose of Synthroid . The drug is “thyroid replacement hormone,” said Dr. Whitman. It does two things: It recreates the function of a thyroid and suppresses thyroid-stimulating hormone , so cancer cells are less likely to develop.
It’s just a tiny blue pill, but this synthetic hormone was no picnic. My TSH levels drastically changed, and that meant all the body processes that the thyroid usually controls were out of whack. My body temperature was always shifting I felt hot when it wasn’t hot out and chilly when it wasn’t cold. I had anxiety and felt very down, very blue. I was constantly drained.
Even though my diet did not change, I started to gain weight, and my fatigue made it difficult to exercise. I toughed it out and prepped for the next phase of treatment: radioactive iodine treatment in pill form. That meant being quarantined in my apartment for four days so I couldn’t contaminate Jack and my dog, Lucy. For the first 24 hours, my eyes, neck, and head hurtand I dry-heaved. I couldn’t eat for at least 48 hours, so I stuck to ice chips, water, and diet ginger ale.