Treatments for papillary thyroid cancer

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You may be offered the following treatments for papillary 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.

Localized or regional papillary 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. If you have a small, low-risk tumour, you may be offered active surveillance.

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

Recurrent papillary 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 usually the main treatment for papillary thyroid cancer. The type of surgery done depends on your age, the size of the tumour and if the cancer has spread outside the thyroid.

Total thyroidectomy is removal of the entire thyroid gland. It is the most common type of surgery used for papillary thyroid cancer. It is done if the doctor plans to use radioactive iodine therapy (also called RAI therapy).

Lobectomy is removal of one part, or lobe, of the thyroid. It may be done for some low-risk cancers. Lobectomy may be used if the area has never been exposed to radiation, there is no distant metastases, the tumour is only in the thyroid and the tumour is 1 to 4 cm in diameter.

Neck dissection removes lymph nodes from the neck. The surgeon may also remove other tissues around the thyroid. It is done if a biopsy shows there is cancer in the lymph nodes in the neck or 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 in the neck the doctors think 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.

Active surveillance

Active surveillance may be used to treat some very small, low-risk papillary thyroid cancers. Active surveillance involves watching the cancer with regular tests and exams to check if it is starting to grow or cause symptoms.

Radiation therapy

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is often used to treat papillary 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.

Radioactive iodine (RAI) therapy is a type of internal radiation therapy. After surgery, a radioactive iodine 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 papillary thyroid cancer (T1 or T2 tumours). It can also be used to treat more advanced papillary 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 areas of distant spread that don't respond to RAI therapy.

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. If you are having RAI therapy, 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 papillary 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 papillary 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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