If You Have Thyroid Cancer

Ask your doctor to use this picture to show you where your cancer is.

The thyroid gland

The thyroid gland is below the Adam’s apple (thyroid cartilage) in the front of the neck. In most people, you can’t see or feel the thyroid. It’s butterfly shaped, with 2 sides called lobes. A thin piece of thyroid tissue called the isthmus connects the lobes.

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The thyroid gland makes hormones that help control heart rate, blood pressure, body temperature, and weight.

Types of thyroid cancer

There are 4 main types of thyroid cancer. They are listed below. Your doctor can tell you more about the kind you have.

• Papillary thyroid cancer is the most common type. It tends to grow very slowly and is most often in only one lobe of the thyroid. Even though they grow slowly, papillary cancers can spread to the lymph nodes in the neck.
• Follicular thyroid cancer is the next most common type. It’s more common in countries where people don’t get enough iodine in their diet. These cancers usually don’t spread to lymph nodes, but they can spread to other parts of the body, like the lungs or bones.
• Medullary thyroid cancer (MTC) is rare. It starts in thyroid cells called C-cells. C-cells make calcitonin, a hormone that helps control the amount of calcium in the blood.
• Anaplastic thyroid cancer is rare. It often spreads quickly into the neck and to other parts of the body, and it can be hard to treat.

Questions to ask the doctor

• Why do you think I have thyroid cancer?
• Is there a chance I don’t have thyroid cancer?
• Would you please write down the kind of thyroid cancer you think I might have?
• What will happen next?

How does the doctor know I have thyroid cancer?

Most thyroid cancers are found when people see a doctor because of new neck lumps (called nodules). Sometimes doctors find neck lumps during a physical exam. Thyroid cancer may also be found during an ultrasound test for other health problems.

If signs are pointing to thyroid cancer, more tests will be done.

Tests that may be done

Blood tests: Blood tests alone can’t tell if a thyroid lump is cancer. But they can help show if your thyroid is working the way it should.

Ultrasound: For this test, a small wand is moved over the skin in front of your neck. It gives off sound waves and picks up the echoes as they bounce off your thyroid gland. The echoes are made into a picture on a computer screen. How a lump looks on ultrasound can sometimes help doctors figure out if it’s cancer. But an ultrasound alone can’t tell for sure.

Radioiodine scan: For this test, a low dose of radioactive iodine (called I-131) is swallowed or put into a vein. Over time, the iodine is absorbed by your thyroid cells. A special camera is then used to see the radioactivity. Thyroid nodules that have less iodine than the rest of the thyroid can sometimes be cancer.

CT or CAT scan: This is a special kind of x-ray test that makes detailed pictures of your thyroid. It can also show if the cancer has spread.

MRI scan: This test makes pictures using radio waves and strong magnets instead of x-rays. MRI scans can be used to look for cancer in the thyroid, or cancer that has spread.

PET scan: In this test, you are given a special type of sugar that can be seen inside your body with a camera. If there is cancer, this sugar shows up as “hot spots” where the cancer is found. This test can be useful if your thyroid cancer doesn’t take up radioactive iodine.

Thyroid biopsy: In a biopsy, the doctor takes out a small piece of tissue to check it for cancer cells. A biopsy is the only way to tell for sure if you have cancer.

The most common kind of thyroid biopsy is a fine needle aspiration (FNA). To do this, the doctor puts a thin, hollow needle into the nodule to take out some cells and a few drops of fluid. These are then tested for cancer. If the diagnosis is not clear after an FNA biopsy, you might need another kind of biopsy to get more cells to test.

Questions to ask the doctor

• What tests will I need?
• Who will do these tests?
• Where will they be done?
• How and when will I get the results?
• Who will explain the results to me?
• What do we need to do next?

How serious is my cancer?

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If you have thyroid cancer, your doctor will want to find out how far it has spread. This is called staging. Figuring out the stage of your cancer helps your doctor decide what type of treatment is best for you.

The stage describes the size of the cancer in your thyroid gland. It also describes if the cancer has spread to nearby areas, or to other organs farther away.

Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more advanced cancer. Be sure to ask the doctor about your cancer stage and what it means for you.

Questions to ask the doctor

• Do you know the stage of the cancer?
• If not, how and when will you find out the stage?
• What does the stage mean in my case?
• Based on the stage of the cancer, what treatment options are best for me?
• What will happen next?

What kind of treatment will I need?

There are many ways to treat thyroid cancer, but surgery is the main treatment. The treatment plan that’s best for you will depend on:

• The type of thyroid cancer you have
• The stage of the cancer
• Your age and overall health
• The chance that a type of treatment will cure the cancer or help in some way
• Your feelings about the treatment and the side effects that might come with it

Depending on the type and stage of your thyroid cancer, you may need more than 1 type of treatment.

Surgery

Most people with thyroid cancer have some type of surgery. Surgery is done to take out the tumor and all or part of your thyroid gland. Sometimes lymph nodes are taken out from your neck, too.

Side effects of surgery

Any type of surgery can have risks and side effects. Be sure to ask your doctor what you can expect. Possible side effects of thyroid surgery include:

• Infection
• Bleeding or a blood clot in the neck
• Damage to the parathyroid glands (small glands that sit behind the thyroid)
• Problems with your voice (short or long-term)
• Low thyroid hormone levels. If so, you’ll need to take thyroid replacement therapy. (see below)

Radioactive iodine treatment (RAI)

Your thyroid gland absorbs nearly all the iodine in your body. When a high dose of radioactive iodine (RAI), also called I-131, is taken into your body, it collects in thyroid cells. The radiation then destroys the cells, including the ones that are cancer. This type of radiation doesn’t have much effect on the rest of your body.

Side effects of RAI

Common side effects of RAI treatment are:

• Neck soreness and swelling
• Nausea and vomiting
• Swollen and sore salivary glands
• Dry mouth
• Taste changes
• Problems with tears (such as dry eyes)

Radiation treatments

Radiation uses high-energy rays (like x-rays) to kill cancer cells. This treatment is sometimes used to kill any cancer cells that might be left after surgery.

Side effects of radiation treatments

If your doctor suggests radiation treatment, talk about what side effects might happen. Side effects depend on the type of radiation that’s used. The most common side effects of radiation are:

• Skin changes where the radiation is given
• Dry mouth
• Hoarse voice
• Feeling very tired (fatigue)

Most side effects get better after treatment ends. Some might last longer. Talk to your cancer care team about what you can expect.

Chemo

Chemo is short for chemotherapy, the use of drugs to fight cancer. These drugs go into the blood and spread through the body. Chemo is given in cycles or rounds. Each round of treatment is followed by a break. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months.

Chemo is not often used to treat thyroid cancer.

Side effects of chemo

Chemo can make you feel very tired and sick to your stomach. It can also cause your hair to fall out. But these problems tend to go away after treatment ends.

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There are ways to treat most chemo side effects. If you have side effects, be sure to talk to your cancer care team so they can help.

Targeted drugs

Some newer, targeted drugs may be used for certain types of thyroid cancer. This is not the same as chemo because these drugs mainly affect cancer cells and not the normal cells in your body. They may work even if other treatments don’t. Your doctor might test your cancer cells to see if one of these drugs could help you.

Side effects of targeted drugs

The side effects of targeted drugs depend on which drug is used. Common side effects can include:

• High blood pressure
• Fatigue (feeling tired)
• Diarrhea
• Nausea
• Rash

Thyroid hormone replacement

If your thyroid gland is taken out with surgery or destroyed with radiation, you will need to take thyroid hormone pills to replace the missing thyroid hormones your body needs.

Taking higher doses of thyroid hormone may also help keep some kinds of thyroid cancer from coming back.

Clinical trials

Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with other treatments that may be better.

Clinical trials are one way to get the newest cancer treatment. They are also the best way for doctors to find better ways of treating cancer. If your doctor can find a clinical trial for your kind of cancer, it’s your choice whether to take part in it. If you do sign up for a clinical trial, you can always stop at any time.

If you would like to be in a clinical trial, start by asking your doctor if your clinic or hospital does clinical trials. See Clinical Trials to learn more.

What about other treatments I’ve heard of?

When you have cancer, you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things.

Some of these might help, but many have not been tested. Some have been shown not to help. A few have even been found harmful. Talk to your doctor about anything you’re thinking of using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor

• What treatment do you think is best for me?
• What’s the goal of this treatment? Do you think it could cure the cancer?
• Will treatment include surgery? If so, who will do the surgery? What will the surgery be like?
• Will I need other types of treatment, too? What is the goal of these treatments?
• What side effects could I have from these treatments?
• What can I do about these side effects?
• Will this treatment make it harder for me to have children?
• Do I need to avoid pregnancy for a while?
• Is there a clinical trial that might be right for me?
• What about special vitamins or diets that friends tell me about? How will I know if they are safe?
• How soon do I need to start treatment?
• What should I do to be ready for treatment?
• Is there anything I can do to help the treatment work better?
• What’s the next step?

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 ends. 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 few months. The longer you’re cancer-free, the less often you’ll need visits.

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 for 24/7 support. Or talk to your cancer care team about steps you can take to feel better.

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