Thyroid Cancer Treatment

How is thyroid disease discovered?

As with any disease, it is important that you watch for the early warning signs. However, only your doctor can tell for sure whether or not you have thyroid disease. He or she can measure the amount of thyroid hormones in your blood, as well as look at the structure and function of your thyroid gland. If a nodule is found, your doctor can test whether or not it is cancerous.

What are the signs and symptoms of thyroid disease?

When your doctor examines you for thyroid disease, he or she should first ask about your symptoms and then check for physical signs. Your doctor will ask questions about your memory, emotions, or menstrual flow, and then check your heart rate, muscles, skin, and thyroid gland.

Which blood tests will my doctor use?

After a physical examination, your doctor may examine certain hormone levels in your blood. The most common tests check the levels of thyroid hormones (T₄ and T₃) and thyroid stimulating hormone (TSH). Your doctor may also perform a test with an injection of thyrotropin releasing hormone (TRH). If your doctor suspects Hashimoto’s thyroiditis or Graves’ disease, he or she will probably test you for antithyroid antibodies or thyroid stimulating antibodies.

What does the radioactive iodine uptake show?

Iodine is an important building-block for thyroid hormones. Your doctor may give you a small amount of radioactive iodine and then measure the amount absorbed by the thyroid gland. If the thyroid absorbs a lot of this iodine, you may be hyperthyroid. Low iodine uptake may signal hypothyroidism or thyroiditis.

Why is the structure of my thyroid important?

Examining the structure of your thyroid gland and the surrounding area tells your doctor about a lump (nodule) which may be cancerous or enlargement of the thyroid (goiter).

Which tests look at the structure of my thyroid?

• A thyroid image (or scan) shows the size, shape, and function of the gland. It uses a radioactive chemical, usually iodine or technetium, which the thyroid absorbs from the blood. A special camera then creates a picture, showing how much chemical was absorbed by each part of the gland. The test shows the size of the thyroid and tells whether lumps are hot (usually benign) or cold (either benign or malignant). The scan is frequently done at the same time as the radioactive iodine uptake.
• In needle aspiration biopsy, a small needle is inserted into the nodule in an effort to suck out (aspirate) cells. If the nodule is a fluid-filled cyst, the needle often removes some or all of the fluid. If the nodule is solid, several small samples are removed for examination under the microscope. Over 90% of the time, this testing tells the doctor whether the nodule is cancerous or not.
• Ultrasound uses high-pitch sound waves to find out whether a nodule is solid or filled with fluid. About 10% of nodules are fluid-filled cysts, and they are usually not cancerous. Ultrasound may also detect other nodules that are not easily felt by the doctor. The presence of multiple nodules reduces the likelihood of cancer.

What do antithyroid drugs do?

Antithyroid drugs block pathways leading to thyroid hormone production.

Antithyroid drugs used in this country are Propylthiouracil (PTU) and Tapazole®. Some physicians will recommend antithyroid medication as a first line of treatment to see if the patient is one of the lucky 30% of patients who go into a remission after taking antithyroid medication for one to two years. (Patients are said to be in remission if their hyperthyroidism does not recur after discontinuing the antithyroid drugs.) If antithyroid drugs do not work for the patient, then physicians usually recommend radioactive iodine.

Antithyroid drugs are also used to treat very young children, older patients with heart conditions, and pregnant women. For severe or complicated cases of hyperthyroidism, especially in older patients, PTU or Tapazole® can be given for four to six weeks to bring the hyperthyroidism under better control prior to administering radioactive iodine treatment.

In cases when women are diagnosed with Graves’ disease while they are pregnant, PTU is prescribed. The smallest dose possible is given because the medication does cross over to the fetus. The mother should be checked every three to four weeks during the pregnancy so that the lowest possible dose can be given. Too much PTU can cause fetal goiter, hypothyroidism, and mental retardation.

® Tapozole is a registered trademark of Jones Medical Industries.

Are there any side effects?

Antithyroid drugs cause side effects in about 10% of patients. Reactions can include:

• skin rash
• swollen, stiff, painful joints
• sore throat and fever
• low white blood count, which can lead to serious infections
• jaundice (yellow coloring of the skin) and, rarely, liver failure.

Most side effects clear up once the drugs are stopped. If you think you are having a reaction to anti-thyroid drugs, call your doctor immediately.

What can be expected with antithyroid drug treatment?

• Several pills are taken from one to four times a day, every day for six to 24 months.
• Some patients complain that the pills have an unpleasant smell and taste.
• There is usually some symptom relief within one to two weeks. In some cases, it can take several months to relieve symptoms.
• Antithyroid drugs have a relatively low success rate. While PTU or Tapazole® may correct the problem temporarily or for a few years, the chances of a permanent remission are about 30% once the drugs are stopped.
• The likelihood of achieving a permanent remission is increased if the patient takes the medication for one to two years.
• There are side effects in 10% of the people treated with Tapazole® or PTU. These are:
  • skin rash over most of the body swollen, stiff, painful joints
  • sore throat and fever — if this happens, the antithyroid drugs should be stopped immediately and the physician contacted
  • jaundice
  • liver damage, which is fatal in rare cases
• Because antithyroid drugs pass into breast milk, only PTU in a dosage less than 200 mg a day is advised if the baby is not weaned.
• Within 15 years, the thyroid gland may burn out, resulting in hypothyroidism, and the patient will need thyroid hormone replacement.

When are thyroid hormone pills used?

Thyroid hormone pills provide the body with the right amount of thyroid hormone when the gland is not able to produce enough by itself. The pills are frequently needed after surgery or radioactive iodine therapy.

Thyroid hormone tablets are the standard treatment for hypothyroidism. While symptoms usually get better within a few months, most patients must take the pills for the rest of their lives. This is especially true for hypothyroidism caused by Hashimoto’s thyroiditis or radioactive iodine treatment.

If the entire thyroid gland has been surgically removed, thyroid hormone tablets replace the body’s own source of the hormone. If only a part of the gland has been removed, the pills may keep the remaining gland from working too hard. This decreases the chance that the thyroid gland will grow back.

How much hormone do I need?

The preferred hormone for treatment is levothyroxine (T₄). You should use only the brand-name that your doctor prescribes, since generic brands may not be as reliable. Name-brand levothyroxine pills include Synthroid®, Levoxyl®, Levothroid®, Euthyrox®, and Eltroxin®.

Patients sometimes take more pills than they should, trying to speed up the treatment or lose weight. However, this can lead to hyperthyroidism and long term complications, such as osteoporosis. You should take the pills as your doctor prescribes.

At different times in your life, you may need to take different amounts of thyroid hormone. Therefore, you should see your doctor at least once a year to make sure everything is all right.

® Synthroid is a registered trademark of Knoll Pharmaceuticals.
® Levoxyl is a registered trademark of Jones Medical Industries.
® Levothroid is a registered trademark of Forest Pharmaceuticals.
® Euthyrox is a registered trademark of EM Pharma.
® Eltroxin is a registered trademark of Roberts Pharmaceuticals.

Are thyroid hormone pills needed after treatment for hyperthyroidism?
Many patients treated for hyperthyroidism become hypothyroid. They will need to take thyroid hormone pills for the rest of their lives. In addition, they will need to see their doctor at least once a year.