Treating Thyroid Cancer

If you’re diagnosed with thyroid cancer, you’ll be assigned a care team, who will devise a treatment plan for you.

Your recommended treatment plan will depend on the type and grade of your cancer, and whether your care team thinks that a complete cure is realistically achievable.

Cancer Treatment Team

All NHS hospitals have multidisciplinary teams (MDTs) that treat thyroid cancer. An MDT is made up of a number of different specialists, and may include:

• A surgeon
• An endocrinologist (a specialist in treating hormonal conditions)
• An oncologist (a cancer treatment specialist)
• A pathologist (a specialist in diseased tissue)
• A radiotherapist or clinical oncologist (a specialist in non-surgical methods of treating cancer, such as chemotherapy and radiotherapy)
• A specialist cancer nurse, who will usually be your first point of contact with the rest of the team

Deciding on the best course of treatment can be difficult. Your cancer team will make recommendations after reviewing your case, but the final decision will be yours.

Before you go to hospital to discuss your treatment options, you may want to write a list of questions to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.

Your Treatment Plan

Your recommended treatment will depend on a number of things, including:

• The type of thyroid cancer you have
• The grade of your cancer
• Whether your care team thinks a complete cure is realistically achievable

Most differentiated thyroid cancers – papillary carcinomas and follicular carcinomas – and some medullary thyroid carcinomas have a good prospect of achieving a cure.

Differentiated thyroid cancers are treated using a combination of:

• Surgery to remove your thyroid gland (thyroidectomy)
• A type of radiotherapy called radioactive iodine treatment, which is designed to destroy any remaining cancer cells and prevent the thyroid cancer returning

Medullary thyroid carcinomas tend to spread faster than differentiated thyroid cancers, so it may be necessary to remove your thyroid gland and any nearby lymph nodes.

Radiotherapy iodine treatment is not effective at treating this type of thyroid cancer.

Stage 4 medullary thyroid carcinomas aren’t usually curable, but it should be possible to slow their progression and control any associated symptoms.

In most cases of anaplastic thyroid carcinoma, a cure isn’t usually achievable. This is because it’s usually spread to other parts of the body by the time it’s been diagnosed.

Radiotherapy and chemotherapy can be used to slow the progression of anaplastic thyroid carcinoma and help control any symptoms.

Some cases of differentiated thyroid cancer, medullary thyroid carcinoma and anaplastic thyroid carcinoma may benefit from a new type of treatment known as targeted therapies.

This is where medication is used to directly target the cancerous cells. However, these types of treatments are currently undergoing clinical trials and aren’t offered routinely on the NHS.

Thyroidectomy

In almost all cases of thyroid cancer it’s necessary to either remove some of your thyroid gland in a procedure called a hemithyroidectomy, or all of your thyroid gland (total thyroidectomy).

This decision will be influenced by:

• The type of thyroid cancer you have
• The size of the tumour
• Whether or not the cancer has spread beyond your thyroid gland

Your surgeon should discuss with you the type of surgery required and why so you can make an informed decision.

A thyroidectomy is carried out under a general anaesthetic and usually takes around two hours. The operation will leave a small scar on your neck, which shouldn’t be very noticeable. In a small number of cases, it may cause permanent hoarseness.

Most people are well enough to leave hospital three to five days after having thyroid surgery. However, you’ll need to rest at home for two to three weeks and avoid any activities that could put a strain on your neck, such as heavy lifting.

A member of your care team will be able to advise you about when you’ll be fit enough to resume normal activities and return to work.

Replacement Hormone Therapy

If some or all of your thyroid gland is removed, it will no longer be able to produce the hormones that regulate your metabolic system.

This means you’ll experience symptoms of an underactive thyroid (hypothyroidism), such as fatigue (extreme tiredness), weight gain and dry skin.

To compensate, you’ll need to take replacement hormone tablets for the rest of your life.

If your surgery is to be followed by radioactive iodine treatment, it’s likely you’ll be given a hormone tablet called triiodothyronine.

After radioactive iodine treatment is completed, you’ll be prescribed an alternative hormone tablet called thyroxine, which most people only need to take once a day.

You’ll need to have regular blood tests to check you’re receiving the right amount of hormones and to determine whether your dose needs to be adjusted.

It may take some time to achieve the optimum dose. Until this time, you may experience symptoms of tiredness or weight gain if your hormone levels are too low.

Alternatively, if your hormone levels are too high, you may experience symptoms such as weight loss, hyperactivity or diarrhoea. You shouldn’t experience any more side effects once the right dose has been achieved.

Calcium Levels

Occasionally, the parathryoid glands can be affected during surgery. The parathryoid glands are located close to the thyroid gland and help regulate the levels of calcium in your blood.

If your parathryoid glands are affected, your calcium levels may decrease, which can cause a tingling sensation in your hands, fingers, lips and around your nose.

These symptoms should be reported to your MDT or GP as you may need to take calcium supplements. Most people only need to take a short course of calcium tablets as the parathryoid glands will soon start to function normally again.

Radioactive Iodine Treatment

After having thyroid surgery, a course of radioactive iodine treatment may be recommended. This will help destroy any remaining cancer cells in your body and prevent the cancer returning.

If you’re taking thyroid hormone replacement tablets, you’ll need to stop taking them for two to four weeks before having radioactive iodine treatment. This is because they can interfere with the effectiveness of the iodine treatment.

If withdrawing your hormone replacement treatment is problematic, you may be given a medicine called recombinant human thyroid stimulating hormone (rhTSH). This is given as an injection on two consecutive days.

Your MDT will be able to advise you about whether or not rhTSH is suitable for you.

The Procedure

Radioactive iodine treatment involves swallowing radioactive iodine in either liquid or capsule form. The radiation in the iodine travels up into your neck through your blood supply and destroys any cancerous cells.

Side effects of radioactive iodine treatment are uncommon, but a small number of people may experience tightness, pain or swelling in their neck and may feel flushed (warm). These side effects usually pass within 24 hours.

After treatment, you may have a dry mouth and notice a change in your taste. These symptoms usually disappear after a few weeks or months, although they can be permanent in some people.

You’ll need to stay in hospital for three to five days after the procedure because the iodine will make your body slightly radioactive. As a precaution, you’ll need to stay in a single room protected by lead sheets so that hospital staff aren’t exposed to radiation.

You won’t be able to have visitors during this time and hospital staff will keep their contact with you to a minimum.

Your bodily fluids, such as urine, will also be slightly radioactive for three to five days after your treatment, so it’s important that you flush the toilet every time you use it. Your sweat will be radioactive, too, so you should bathe or shower every day.

You’ll be allowed home after the radioactive levels in your body have subsided.

Dietary Recommendations

While having radioactive iodine treatment, you’ll need to eat a diet low in iodine. An iodine-rich diet may reduce the effectiveness of your treatment. It’s recommended that you:

• Avoid all seafood
• Limit the amount of dairy products you eat
• Don’t take cough medicines or use sea salt as they both contain iodine

You should eat plenty of fresh meat, fresh fruit and vegetables, and pasta and rice. These are all low in iodine.

Pregnancy And Breastfeeding

You shouldn’t have radioactive iodine treatment if you’re pregnant or if there’s a good chance that you may be. The treatment could damage your baby.

Tell a member of your care team if you’re unsure whether you’re pregnant. Any treatment will need to be delayed until after your pregnancy.

You must stop breastfeeding before you can be treated with radioactive iodine. If possible, you should stop breastfeeding six weeks prior to treatment.

You should not resume breastfeeding after treatment for your current child, but you may safely breastfeed any babies you may have in the future.

Breastfeeding also isn’t recommended while receiving iodine treatment. If you’re breastfeeding, you should stop at least four weeks (but preferably eight) before starting iodine treatment.

You should also not resume breastfeeding your baby. However, it’s safe for you to breastfeed if you have another child in the future.

You should use a reliable method of contraception for at least six months after having iodine treatment. This is because there’s a small risk that any child conceived during this time could develop birth defects. This applies to both men and women.

Fertility

Radioactive iodine treatment doesn’t affect fertility in women. However, there’s a small risk that it could affect fertility in men who need to have multiple treatment sessions. Your care team will be able to advise you about the level of risk in your individual circumstances.

If there’s a significant risk you’ll become infertile after having radioactive iodine treatment, you may wish to consider having your sperm or eggs harvested and frozen so they can be used for fertility treatment at a later date.

External Radiotherapy

External radiotherapy, where radioactive waves are targeted at affected parts of the body, is usually only used to treat advanced or anaplastic thyroid carcinomas.

The length of time you’ll need to have radiotherapy for will depend on the particular type of thyroid cancer you have and its progression.

Side effects of radiotherapy include:

• Nausea
• Vomiting
• Tiredness
• Pain when swallowing
• Dry mouth

These side effects should pass two to three weeks after your course of radiotherapy has finished.

Chemotherapy

Chemotherapy is usually only used to treat anaplastic thyroid carcinomas that have spread to other parts of your body.

It involves taking powerful medicines that kill cancerous cells. It’s rarely successful in curing anaplastic cancer, but can slow its progression and help relieve symptoms.

Possible side effects of chemotherapy include:

• Nausea
• Vomiting
• Tiredness
• Loss of appetite
• Hair loss
• Mouth ulcers

If you’re receiving chemotherapy, you’ll also be more vulnerable to infection. See your GP if you suddenly feel ill or your temperature rises above 38C (100.4F).

Targeted Therapies

A number of targeted therapies are being tested in clinical trials to treat advanced cases of:

• Medullary thyroid cancers
• Differentiated thyroid cancers that don’t respond to radioactive iodine
• Anaplastic thyroid carcinomas

In targeted therapies, medication specifically targets the biological functions that cancers need to grow and spread.

As research is ongoing, some medications used in this type of treatment are unlicensed. In exceptional circumstances, your specialist may suggest using an unlicensed medication. They’ll do this if:

• They think it’s likely to be effective
• There are no better alternatives
• The benefits of treatment outweigh any associated risks

If your specialist is considering prescribing an unlicensed medication, they’ll tell you that it’s unlicensed and will discuss the possible risks and benefits with you.

The decision about whether to fund treatment with medications used in targeted therapies is often made by individual clinical commissioning groups (CCGs).

The Cancer Research UK website has more information about biological therapy for thyroid cancer.

SOURCE: NHS UK
http://www.nhs.uk/Conditions/Cancer-of-the-thyroid/Pages/Treatment.aspx