The type of treatment your doctor recommends will depend on the type and stage of the thyroid cancer, and your age and general health.
Active surveillance
In some cases, your doctor may recommend closely monitoring the cancer, rather than having treatment straightaway. This is known as active surveillance and it usually involves regular ultrasounds and physical examinations.
There is good evidence that active surveillance is safe for small papillary thyroid cancers where there is no sign that the cancer has spread from the thyroid. It may be an option when the tumour is under 10 mm, isn’t causing any symptoms and is considered to be low risk.
Some people choose to have active surveillance if the possible side effects from treatment would have more impact on their quality of life than the cancer itself. Other people find that active surveillance makes them feel anxious and prefer to have treatment straightaway. Treatment can be considered at any stage if you change your mind or if the cancer grows or spreads.
Fertility concerns
Many people diagnosed with thyroid cancer are under 40 years old and may be concerned about how treatment will affect their ability to conceive a child. Fertility is usually not affected by surgery or radioactive iodine treatment. In the short term, it is recommended that you delay pregnancy for six months after treatment.
You may wish to talk to someone about how you are feeling. Call 13 11 20 to speak with our compassionate and trusted cancer nurses.
Find out more about fertility and cancer
Surgery
Surgery is the most common treatment for thyroid cancer. You will be given a general anaesthetic, and the surgeon will make a small cut (5–7 cm) across your neck. How much tissue is removed will depend on how far the cancer has spread:
- Partial thyroidectomy – only the affected lobe or section of the thyroid is removed. This surgery may be an option if the cancer is small and the other lobe looks normal on the ultrasound. It might also be used to diagnose thyroid cancer if a fine needle aspiration biopsy doesn’t provide a clear diagnosis.
- Total thyroidectomy – most people with thyroid cancer need to have a total thyroidectomy. This involves removing the whole thyroid (both lobes and the isthmus).
- Lymph node removal – nearby lymph nodes may also be removed to help work out staging or if the initial scans show that the cancer has spread to them. This is called a neck dissection. Even if the cancer doesn’t appear to have spread, the nodes behind the thyroid are occasionally removed to reduce the risk of the cancer returning.
- Other tissue – in very rare cases, the surgeon also removes other tissue near the thyroid that has been affected by the cancer.
You will probably stay in hospital for one or two nights to recover from surgery. Your neck wound will be closed with stitches, adhesive strips or small clips.
All tissue removed during the surgery is examined for cancer cells by a pathologist. The results will help confirm the type of cancer you have, and work out if the cancer has spread to any of the nearby lymph nodes and whether you need further treatment.
What to expect after surgery
Most people who have thyroid surgery will feel better within 1–2 weeks, but recovery may take longer for some people.
- Hoarse voice – your voice may sound hoarse or weak, or feel tired. This is often temporary and improves with time. Your singing voice may also be affected.
- Sore neck – you will probably feel some pain or discomfort where the cut was made. The position you are placed in for surgery can sometimes give you a stiff neck and back. Pain medicines, neck massage, physiotherapy and a triangle-shaped pillow to support your neck can help.
- Eating and drinking – to help your body recover from surgery, you need to be well nourished. Try to eat small amounts of healthy, nutritious food.
- Painful swallowing – try to eat soft foods that are easy to swallow. Swallowing can feel stiff for a few months, but usually gradually improves.
- Scarring – you will have a horizontal scar on your neck above the collarbone. In most cases, the scar is about 5–7 cm long and is often in a natural skin crease. At first, this scar will look red, but it should fade and become less noticeable with time.
- Activity levels – most people return to their usual activities within a week but you will likely need to avoid heavy lifting, vigorous exercise and turning your neck quickly for a couple of weeks after surgery.
- Mood changes – changes in hormone levels may affect your mood. If you feel anxious or have panic attacks, let your doctor or nurse know as they may recommend medicines to help. Some people find meditation or relaxation techniques helpful.
- Low calcium levels – you may have low blood calcium levels if surgery affects the parathyroid glands. This may cause headaches and tingling in your hands, feet and lips, as well as muscle cramps. Your doctor will do blood tests to check your calcium levels, and you may be prescribed vitamin D and/or calcium supplements.
Thyroid hormone replacement therapy
Many people who have a partial thyroidectomy won’t need thyroid hormone replacement therapy because the remaining lobe will continue to make enough hormones.
After the whole thyroid is removed, your body will no longer produce the hormones that maintain your metabolism, and you will be prescribed a hormone tablet to replace T4 (thyroxine). You will need to take a hormone tablet every day for the rest of your life. Taking thyroid hormone tablets can have two roles:
- Keeping your body’s metabolism functioning at a normal healthy rate – without hormone replacement medicine, your metabolism will slow down, and you will develop the symptoms of hypothyroidism, such as depression or weight gain.
- Reducing the risk of the cancer coming back – taking thyroid hormone tablets stops your pituitary glands from releasing too much of another hormone called thyroid-stimulating hormone (TSH). High levels of TSH may encourage any thyroid cancer cells remaining after treatment to grow.
You’ll be carefully monitored and have blood tests every 6–8 weeks to help your doctor adjust the dosage until it is right for you. Usually, the initial dose needs only small adjustments and you should not experience side effects once you are taking the right dose.
Tips for taking T4 medicines
- Take your T4 medicine at the same time every day to get into a routine. Take it on an empty stomach with a glass of water and wait 30 minutes before eating.
- Store medicines in the fridge to maintain the T4 level in the tablets. If you are travelling, the medicine will last up to 30 days without refrigeration. Some T4 medicines do not need refrigeration.
- If you miss a dose, you should usually take it as soon as you remember. But if it’s almost time to take the next dose, skip the dose you missed.
- Wait two hours before taking calcium or iron supplements as these affect the stomach’s ability to absorb the T4.
- Check with your doctor if it’s safe to continue taking other medicines or supplements.
- Tell your doctor if you are pregnant or are planning to get pregnant, as you may need to take a higher dose.
- Don’t stop taking the T4 medicine without discussing it with your doctor.
Radioactive iodine treatment
Radioactive iodine (RAI) is also known as I131 and is a type of radioisotope treatment. Radioisotopes are radioactive substances given in a pill that you swallow. Although RAI spreads through the body, it is mainly absorbed by thyroid cells or thyroid cancer cells. RAI kills these cells while leaving other body cells relatively unharmed.
You may be given RAI to destroy tiny amounts of remaining cancer cells or healthy thyroid tissue left behind after surgery. It is usually recommended for papillary, follicular, or oncocytic thyroid cancers that have spread to the lymph nodes or that have a higher risk of coming back after surgery.
RAI doesn’t work for medullary or anaplastic thyroid cancer because these types do not take up iodine.
When to have RAI treatment
RAI is generally not given until some weeks after surgery, once any swelling has gone down. This is because swelling can affect the blood flow and stop the RAI circulating well.
It is not safe to have RAI treatment if you are pregnant or breastfeeding, so treatment may be delayed. RAI may be given up to six months after surgery.
Preparing for RAI treatment
- Limit foods high in iodine – A diet high in iodine makes RAI treatment less effective. You will need to start avoiding high-iodine foods two weeks before treatment. This includes foods such as seafood, iodised table salt and sushi.
- Discuss imaging scans – CT scans and other imaging scans sometimes use an injection of a dye called contrast to make the images clearer. This contrast can interfere with how well RAI works, so it is important to tell your doctor if you have had a scan using contrast in the month before RAI treatment.
- Raise TSH levels – For RAI treatment to work, you will need a high level of TSH in your body. The option recommended for raising your TSH levels will depend on your stage of disease and what is suitable for you.
Having RAI treatment
You will be admitted to hospital on the day of the RAI treatment. It will make you radioactive for a few days, and you will need to stay in hospital until it is safe to go home.
A few days after treatment, you will have a full body radioisotope scan to detect if any thyroid cancer cells are left in the body. It is normal to see an area of RAI uptake in the neck on this initial scan, due to small amounts of healthy thyroid tissue remaining in your neck after surgery.
The RAI will take several months to destroy this tissue. The radioisotope scan may also show if cancer has spread to your lymph nodes or other areas of your body.
Safety precautions during RAI treatment
Your treatment team, family members and friends will have to take precautions to limit their exposure to radiation. Safety measures vary between hospitals, and usually include:
- keeping you in an isolated, shielded room
- not allowing or restricting visitors to the room – particularly children and pregnant women
- if visitors are allowed, limiting the time they can stay in the room and asking them to stay 2–3 metres away from you
- measuring your radiation levels with an instrument called a Geiger counter
- wearing gloves to clean up body fluids (e.g. urine, sweat, saliva, blood) and leftover food and drink
- washing hands thoroughly and often.
When you go home, you may have to continue following some safety measures for a few days, including:
- sleeping alone
- washing your clothing separately
- washing your hands extra well before preparing food
- taking care with body fluids for a certain period of time
- sitting down to urinate, and putting the lid down and flushing the toilet several times after use.
Following these safety measures may make you feel frightened and lonely. Discuss any concerns you have with your doctors, nurses, counsellor or by calling Cancer Council on 13 11 20.
Side effects of RAI treatment
Being temporarily radioactive is the only major side effect of RAI treatment, which can be helped by drinking lots of water. You might also have a dry mouth as well as taste and smell changes for a few weeks. Some people will have ongoing problems with swelling and pain in their salivary glands.
RAI may have a short-term effect on eggs and sperm, so you’ll be advised to use contraception for a time. Other side effects, such as tiredness, are often caused by thyroid hormone withdrawal, but will improve when your thyroid hormone levels return to normal.
Other treatments
Targeted therapy
Targeted therapy drugs attack specific features of cancer cells to stop the cancer growing and spreading. The most common drugs used for thyroid cancer are tyrosine kinase inhibitors (TKIs). These drugs block the chemical messengers (enzymes) that tell cancer cells to grow, multiply and spread.
If you have advanced thyroid cancer that hasn’t responded to RAI treatment, you may be offered a TKI such as lenvatinib. This drug is given as a tablet, which you take daily. You will usually keep taking the tablets for several years.
Other TKIs may be available on clinical trials, including the drug selpercatinib, which targets mutations in the RET gene. In rare or aggressive thyroid cancers, genetic tests may help your doctor tailor targeted therapy to a specific genetic mutation.
Talk with your doctor about the latest developments and whether you are a suitable candidate.
The most common side effects of TKIs include fatigue, diarrhoea, skin rash, bleeding and high blood pressure. In some people, TKIs can affect the way the heart and kidneys work. Some TKIs can also cause
tenderness, tingling and blisters on the skin of the palms and soles. It is important to tell your doctor about any side effects immediately.
External beam radiation therapy
External beam radiation therapy (EBRT) uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread.
Most people diagnosed with thyroid cancer do not need EBRT, but it may be recommended in particular circumstances. In a small number of cases, it may be given:
- after surgery and RAI treatment if the cancer has not been completely removed or if there is a high risk of the cancer returning (recurrence)
- as palliative treatment to relieve symptoms such as pain caused by cancer that has spread to nearby tissue or structures
- to help control medullary or anaplastic thyroid cancer (because these types do not respond to RAI).
Radiation therapy is usually given five days a week over several weeks. You may be fitted for a plastic mask to wear during treatment, which will help you stay still so that the radiation is targeted at the same area of your neck during each session.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells or slow their growth. While chemotherapy is not often used to treat thyroid cancer, it may sometimes be used to treat advanced thyroid cancer that is not responding to RAI treatment or targeted therapy.
It may also be used in combination with radiation therapy to treat anaplastic thyroid cancer. The drugs are usually given by injection into a vein or as tablets. You will probably have several treatment sessions over a few weeks.
Immunotherapy and radionuclide therapy
Most thyroid cancers respond well to the standard treatments. However, a small number of thyroid cancers are more difficult to treat, so new treatments are being investigated.
Immunotherapy is a drug treatment that uses the body’s own immune system to fight cancer. In Australia, clinical trials are currently testing whether immunotherapy works for anaplastic thyroid cancer.
For advanced medullary thyroid cancer, a type of radioactive nuclear medicine known as radiopeptide therapy may be available through clinical trials. This is also known as peptide receptor radionuclide
therapy (PRRT). PRRT involves an injection of a protein (peptide) that has been combined with a small amount of radioactive substance (radionuclide). This mixture targets cancer cells and delivers a high
dose of radiation that kills or damages them.
Talk to your specialist to find out more about immunotherapy or radionuclide therapy and how to join clinical trials.
Palliative treatment
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. It helps to improve people’s quality of life by managing symptoms of cancer without trying to cure the disease.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, cultural, social and spiritual needs. Palliative care also provides support to families and carers.
Find out more
Understanding Thyroid Cancer
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Expert content reviewers:
A/Prof Diana Learoyd, Endocrinologist, Northern Cancer Institute, and Northern Clinical School, The University of Sydney, NSW; Dr Gabrielle Cehic, Nuclear Medicine Physician and Oncologist, South Australia Medical Imaging (SAMI), and Senior Staff Specialist, The Queen Elizabeth Hospital, SA; Dr Kiernan Hughes, Endocrinologist, Northern Endocrine and St Vincents Hospital, NSW; Yvonne King, 13 11 20 Consultant, Cancer Council NSW; Dr Christine Lai, Senior Consultant Surgeon, Breast and Endocrine Surgical Unit, The Queen Elizabeth Hospital, and Senior Lecturer, Discipline of Surgery, University of Adelaide, SA; A/Prof Nat Lenzo, Nuclear Physician and Specialist in Internal Medicine, Group Clinical Director, GenesisCare Theranostics, and The University of Western Australia, WA; Ilona Lillington, Clinical Nurse Consultant (Thyroid and Brachytherapy), Cancer Care Services, Royal Brisbane Women’s Hospital, QLD; Jonathan Park, Consumer.
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The information on this webpage was adapted from Understanding Thyroid Cancer - A guide for people with cancer, their families and friends (2020 edition). This webpage was last updated in July 2021.
