Featuring Dr. Richard Bebb, MD, ABIM, FRCPC, Endocrinologist

Duration: 3 minutes, 51 seconds

Treatment for thyroid cancer depends on a number of factors.

The first would be what type of thyroid cancer it is. Now thyroid cancer of the differentiated type, and usually that’s papillary thyroid cancer or follicular thyroid cancer, is a very good prognosis cancer.

It would be wrong to say that no one ever dies from differentiated thyroid cancer, but it’s very, very uncommon. This is a very readily treated type of cancer.

It’s also a very slow-growing cancer, which is both a blessing and a curse. It’s a blessing because it’s so slow-growing, it gives us, patients and their practitioners, lots of time to deal with it without being in a rush.

And it’s been shown that if you delay therapy for a thyroid nodule that turns out to be cancer, for up to a year, it doesn’t adversely affect the outcome. The downside is that sometimes you can be misled that a small, slowly-growing thyroid nodule is actually not a cancer, when in fact it is.

So it’s important to get a biopsy of it, make sure you know what it is, and then if it is elected to not do anything because you think it’s not a cancer, if it starts to grow more aggressively, rebiopsy it.

The treatment for thyroid cancer falls into surgery, replacement with thyroid hormone that’s slightly higher than normal physiological levels, and in some situations, radioactive iodine therapy. Those are the three cornerstones of therapy.

Occasionally with more aggressive cancer, external beam radiation is necessary, and very, very rarely, chemotherapy would be used for thyroid cancer. That would be an exception for more aggressive forms of thyroid cancer. So the concern about taking the whole thyroid versus part of it is a very, very apt question.

The reason being is if you have otherwise a structurally normal thyroid that’s not diseased, and you lose half of it, about 90 percent of us do not require thyroid hormone replacement, which is quite nice, and it makes life less complicated, and that’s a very desirable outcome.

With thyroid cancer, unless it’s very small, and by small, I mean less than a centimetre, it’s considered to be the standard of care to remove the whole thyroid. And the reason for that is threefold. Firstly, once your thyroid has shown it likes to make thyroid cancers, it has a nasty habit of doing it again. So get the whole thing out before it forms another one.

The second reason is that if you have a substantial thyroid cancer, usually we like to use radioactive iodine therapy, and you can’t use that properly if you have residual thyroid tissue in the neck.

And the third reason is it makes monitoring for any persistence or recurrence of the thyroid cancer a whole lot easier on the patient and for the physician if the whole thyroid has been removed.

If you have further questions about the diagnosis or treatment or long-term follow-up of thyroid cancer, discuss it with your family doctor, or your family doctor may refer you to a physician experienced with this particular type of cancer.

Presenter: Dr. Richard Bebb, Endocrinologist, Victoria, BC

Local Practitioners: Endocrinologist