Treatment of thyroid cancer

Thyroid cancers are primarily treated by surgery, which cures most cases, especially differentiated follicular-derived cancers. Depending on the tumor’s size, either half or the entire thyroid is removed. However, the treatment adopted in the MCM will depend on the tumor’s size and spread; whether it is localized, advanced or metastatic; and the patient’s risk of recurrence as determined after the surgery. 

Based on a histological analysis of the excised tissue, the treatment will consist of:

• Active monitoring as an alternative to surgery,
• Hormone replacement therapy if the thyroid was surgically removed,
• Radioactive iodine therapy in addition to complete removal of the thyroid.

In addition, as a TUTHYREF expert center, Institut Curie discusses treatment options for patients with especially complex metastatic cancers at national, bimonthly MCMs, giving patients access to the most innovative treatments and clinical trials in France. 
 

Active monitoring of thyroid cancer

For small, localized, non-progressive thyroid tumors less than 1 centimeter in size, clinical exams and ultrasounds (every six months, then yearly if the patient is stable) can eliminate the need for surgery. 

Surgery for thyroid cancer

Thyroid cancer surgery involves removing parts (one lobe and isthmus) or all of the thyroid. If the cancer has spread, nearby lymph nodes are also removed to determine if they are cancerous and to guide subsequent treatment.   

For medullary thyroid cancers, calcitonin levels are measured before surgery as a guide for the extension work-up. This work-up involves a series of tests designed to determine the cancer’s progression and whether it may have metastasized. 

Hormone replacement therapy with thyroid cancer

After a total thyroidectomy, patients must take synthetic thyroid hormones daily for the rest of their lives to replace natural hormone production. Regular follow-up ensures proper dosage over time and will help to prevent hyperthyroidism (excessive sweating, agitation) and hypothyroidism (fatigue, weight gain). 

Radioactive iodine therapy for thyroid cancer

This treatment, known as iratherapy, is available at Institut Curie. Patients ingest a capsule of radioactive iodine. Iratherapy is generally administered after total thyroid removal in patients who have a higher risk of recurrence. These patients are given a capsule of radioactive iodine (I-131) in one of four specially protected and equipped rooms in Institut Curie’s nuclear medicine unit in Saint-Cloud.

That iodine circulates in the blood and is absorbed by any remaining thyroid or potentially cancerous cells, which are then destroyed over the course of several weeks. A scintigraphy scan is performed a few days after the treatment to display iodine uptake in the body and check for metastasis.

Targeted therapy and chemotherapy for thyroid cancer

In rare cases, targeted therapies may be prescribed, such as oral therapy for iodine-refractory cancers. This treatment focuses on molecular abnormalities, angiogenesis factors, or RET mutations.

Chemotherapy is seldom used but may be indicated in combination with radiotherapy for anaplastic thyroid cancers, which require urgent care.

To learn more about targeted therapies

To learn more about chemotherapy

To learn more about radiotherapy