Treatments for follicular thyroid cancer

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You may be offered the following treatments for follicular (including Hurthle cell) thyroid cancer. Your healthcare team will suggest treatments based on your needs, the stage of the cancer and the risk group. They will work with you to develop a treatment plan.

Follicular thyroid cancer isn't common and can be difficult to diagnose. Sometimes tests or symptoms may suggest thyroid cancer, but often doctors need to do a lobectomy to confirm a diagnosis.

Localized or regional follicular thyroid cancer has not spread outside of the thyroid. It is most often treated with surgery to remove part or all of the thyroid gland. Hormone therapy is used to replace the hormones normally made by the thyroid. Radiation therapy may also be used.

Metastatic follicular thyroid cancer has spread to distant parts of the body. It may be treated with radiation therapy, hormone therapy, targeted therapy and sometimes surgery.

Recurrent follicular thyroid cancer means that the cancer has come back after it has been treated. Treatment will depend on where the cancer recurs. If the cancer is in the neck, it may be removed with surgery if possible. Radiation therapy may also be used, either alone or with surgery. Targeted therapy or chemotherapy may be used if the cancer has spread to several places and does not respond to radiation therapy.

Surgery

Surgery is often the first treatment used for follicular thyroid cancer.

Lobectomy is removal of one part, or lobe, of the thyroid. It may be used to confirm a diagnosis of follicular thyroid cancer.

Completion thyroidectomy is removal of the remaining thyroid after lobectomy. It is done if a lobectomy confirms that it is follicular thyroid cancer.

Total thyroidectomy is removal of the entire thyroid gland. It is commonly used to treat follicular thyroid cancer.

Neck dissection removes lymph nodes from the neck. The surgeon may also remove other tissues around the thyroid. Neck dissection is done at the same time as a completion or total thyroidectomy. It is done if a biopsy shows there is cancer in the lymph nodes in the neck, or if the doctor thinks there is cancer in these lymph nodes based on the results of imaging tests such as an ultrasound or a CT scan. The type of neck dissection done depends on which lymph nodes the doctor thinks have cancer in them and how the lymph nodes look during surgery. It also depends on which tissues outside of the thyroid the cancer has spread to.

Find out more about surgery for thyroid cancer.

Radiation therapy

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is often used to treat follicular thyroid cancer. Radiation therapy may be used after surgery to treat any cancer cells or thyroid tissue that remains. It may also be used to treat cancer that has spread to lymph nodes or other parts of the body.

Radioiodine (RAI) therapy is a type of internal radiation therapy. After surgery, a radioiodine uptake test can be done to find out if the thyroid cancer takes up RAI. For cancers that take up RAI, RAI therapy is used. It is sometimes given after surgery for early follicular thyroid cancer (T1 or T2 tumours). It can also be used to treat more advanced follicular thyroid cancer (such as T3 or T4 tumours or cancer that has spread to lymph nodes or distant areas).

External radiation therapy may be used to treat follicular thyroid cancer that doesn't respond to RAI. It may also be used to treat metastatic follicular thyroid cancer.

Find out more about radiation therapy for thyroid cancer.

Hormone therapy

Hormone therapy is used to replace the hormone thyroxine, which would normally be made by the thyroid. It is also used to slow down the growth of any remaining cancer cells and help prevent the cancer from coming back, or recurring. It is a standard treatment after surgery to remove all of the thyroid.

The type of hormone therapy used is levothyroxine (Synthroid, Eltroxin). It is given as a pill once a day. Levothyroxine may not be started until RAI therapy is finished. You will have to take levothyroxine for the rest of your life if you have a total thyroidectomy.

Find out more about hormone therapy for thyroid cancer.

Targeted therapy

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. You may be offered targeted therapy for metastatic or recurrent follicular (including Hurthle cell) thyroid cancer. It may also be given if the cancer doesn't respond to other treatments. It is typically used when RAI therapy has not worked or has stopped working.

The targeted therapy drugs used for follicular thyroid cancer are sorafenib (Nexavar) and lenvatinib (Lenvima). They are given as a pill.

Find out more about targeted therapy for thyroid cancer.

Clinical trials

Talk to your doctor about clinical trials open to people with thyroid cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Expert review and references

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