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Thyroid Cancer Diagnosis and Treatment

Diagnosis

Some patients find that they have a thyroid lump (nodule) when a family member or healthcare provider notices a lump on their neck. In other cases, thyroid lumps are found when getting tested for some other health problem.

How will they decide if my lump is cancerous?

To start, your doctor (endocrinologist) will take your medical history. Then you’ll have a physical exam. Your doctor will look at the size and firmness of your thyroid and for any enlarged lymph nodes in your neck. Next, you will have a thyroid ultrasound. At UM we use the latest techniques in ultrasound so that our doctors can gather the most information to find out if your lump is cancerous. You may have other tests such as lab work and a biopsy. For a biopsy, a sample of cells from the area of concern is removed and looked at under a microscope. The most common type of biopsy to look for thyroid cancer is called fine needle aspiration. To make your visit more convenient, your doctor may do the ultrasound and biopsy at your first visit.

Learn more about endocrinologists, endocrinology and the diagnosis and treatment of thyroid disorders by visiting the University of Michigan's Metabolism, Endocrinology and Diabetes website.

Treatment

At the University of Michigan, we use a team approach (called multidisciplinary care). This means that we have members from many healthcare professions reviewing and talking about your medical condition and treatment choices.

How will my lump be treated if it is cancerous?

After going through the diagnosis process, if we are worried your lump is cancerous, surgery is often recommended. Some lumps stay in the unknown (indeterminate) grouping after testing. Your doctor will discuss choices with you about this grouping of lumps. Thyroid hormone therapy may also be used to stop cancer cells from growing. If thyroid cancer is advanced when diagnosed, treatment may also include chemotherapy or radiation therapy. It is very rare to need chemotherapy. Radioactive iodine is the most common form of radiation therapy used to treat thyroid cancer after surgery and is very well tolerated.

Surgery

What are my choices for surgery?

Surgery for thyroid cancer usually involves removing the whole thyroid gland (total thyroidectomy), but other options may be appropriate for some patients. The University of Michigan is one of only a few health systems in the U.S. that offers video-assisted surgery for the treatment of thyroid disease. This may be a choice in certain cases, including patients with unknown lumps that need to be removed.

Your surgeon will talk with you about the right choice for you. We use the most advanced surgical techniques along with intraoperative nerve monitoring. This technique helps to maintain the quality of your voice.

Learn more about thyroid surgery at the University of Michigan.

Radioactive Iodine

How is Radioactive Iodine Therapy given?

After surgery, some patients get radioactive iodine treatment (also known as radioiodine, I-131 or RAI). This treatment is used to get rid of any very small (microscopic) amounts of left over thyroid cancer. If your doctor orders radioactive iodine for your cancer, you will take the medication by mouth (pill or liquid).

Thyroid Hormone Replacement Therapy

After you have ended your radioactive iodine treatment, you will take daily thyroid hormone replacement therapy. The dose will be carefully monitored and adjusted by the team taking care of your thyroid cancer.

Treatment for Advanced Thyroid Cancer

What happens if my thyroid cancer is advanced?

At times thyroid cancer in the neck cannot be treated by surgery and radioactive iodine therapy. Sometimes thyroid cancer spreads (metastasizes) beyond the neck to other organs. If this happens, these metastases may not be treatable by surgery and radioactive iodine therapy. Some patients with these advanced forms of thyroid cancer can be treated with external beam radiotherapy. External beam radiation uses high doses of radiation to destroy cancer cells and shrink tumors.

In addition, new forms of oral (taken by mouth) chemotherapy have been shown to be effective in advanced cases of thyroid cancer, though chemotherapy is rarely curative. If your cancer cannot be treated by external beam radiation or chemotherapy, we offer clinical trials. The care of patients with advanced thyroid cancer is discussed at our weekly Tumor Board meetings.

Long Term Follow-up

Your doctor will want to see you on a regular basis to make sure your cancer has not come back (recurrence). At these visits your medical history will be reviewed and you will have a physical exam, paying close attention to the neck area. An ultrasound of the neck is sometimes done to check for lumps or cancerous lymph nodes.

If needed, other imaging tests will be done. Blood tests also are important to help determine if thyroid cancer has recurred and to see if the thyroid hormone therapy is working. Administration of a drug called Thyrogen is sometimes used to help evaluate for recurrences. All patients who have had their thyroid removed need thyroid hormone replacement with levothyroxine.

Continue to learn about thyroid cancer

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Learn more about thyroid and other endocrine diseases

Visit the Metabolism, Endocrinology and Diabetes web pages on UofMHealth.org.

Learn about thyroid surgery

Visit the Endocrine Surgery page on UofMHealth.org.