How is thyroid cancer treated?

**Is there a cure for thyroid cancer?** Thyroid cancer is a type of cancer that develops in the thyroid gland. This cancer is a relatively rare type of cancer, but its incidence has been increasing in recent years. The cause of thyroid cancer is unknown. Some factors such as radiation exposure, family history of thyroid cancer, heredity and some genetic conditions may increase the risk of developing this disease. The most common symptom of thyroid cancer is a lump or swelling in the neck. But there may be other symptoms such as hoarseness, difficulty in swallowing and enlarged lymph nodes. Treatment options for thyroid cancer depend on the type and stage of the cancer and may include thyroid surgery, radioactive iodine therapy, and thyroid hormone therapy. With appropriate and timely treatment, most people with thyroid cancer have an excellent recovery process. As we said, thyroid surgery is one of the main ways to treat this disease, which makes choosing **the best thyroid surgeon** vital! Dr. Ahmad Fanai, a thyroid and parathyroid surgeon and a member of the American Thyroid Association, performs thyroid cancer treatment and surgery in the best way without side effects. He, who is known as the golden claw surgeon of the thyroid, performs surgeries with a neurometer device to prevent damage to the vocal nerves, as well as the most up-to-date technology in the world. To get an appointment and advice, call the numbers listed on the site or book your appointment online. **What are the ways to treat thyroid cancer?** Thyroid cancer may not require immediate treatment, but its treatment methods depend on various factors. The type and stage of cancer, age, medical conditions of the patient, etc. are very influential in choosing the type of treatment. In the following, we will introduce these methods: ### **Treatment of thyroid cancer with surgery** For most patients with thyroid cancer, surgery is chosen as the first treatment method and the most basic method. The goal of surgery is to remove the cancerous thyroid gland and any nearby lymph nodes that may contain cancer cells. In this procedure, part or all of the thyroid is removed to remove cancer cells. Depending on the size and location of the tumor, a lobectomy (removal of a lobe of the thyroid) or a total thyroidectomy (removal of the entire thyroid gland) may be performed. Lobectomy is sometimes used to treat differentiated (papillary or follicular) thyroid cancers. Lobectomy is also used to diagnose thyroid cancer. The advantage of this procedure is that some patients may not need thyroid hormone pills after surgery. In thyroidectomy, if the thyroid gland is completely removed, after surgery, the patient must receive thyroid hormone medication regularly to act as a thyroid hormone replacement. This drug is used to control the level of thyroid hormone in the patient's body To know when thyroid cancer surgery is necessary, click on the link. ### **Treatment of thyroid cancer with drugs** If the thyroid cancer is in the early stages, the doctor may suggest the use of drugs as a medical treatment method. These drugs are usually used to reduce the volume of cancer cells or reduce the level of thyroid hormone in the patient's body. In this treatment, drugs are used that target specific molecules that play a role in the growth and spread of cancer cells. Targeted drug therapy is a newer treatment option for advanced thyroid cancer and is generally used when other treatments have not worked. Chemotherapy and thyroid hormone therapy are two methods of thyroid cancer treatment that are done by drugs. These two methods are explained below. - **Chemotherapy**: In this treatment, drugs are used to destroy cancer cells. Chemotherapy is generally not very effective for thyroid cancer. But it may be used in cases where the cancer has spread outside the thyroid gland. **Thyroid hormone therapy**: This treatment includes the use of thyroid hormone replacement drugs to replace the hormones that the thyroid gland normally produces. In this method, it is used to prevent the growth of any of the remaining thyroid tissues and to suppress the production of thyroid stimulating hormone (TSH), which can stimulate the growth of the remaining thyroid cells. ### **Treatment of thyroid cancer with iodine therapy** In some cases, the doctor may prescribe iodine therapy for the patient after surgery. This treatment is used to destroy the remaining cancer cells in the thyroid. Iodine therapy is done by ingesting medicine and destroys cancer cells by absorbing the radioactive substances contained in it. After treatment with iodine therapy, all the radioactive substances that remain in the patient's body must be removed. In radioactive iodine treatment, iodine is used to destroy the remaining thyroid tissue after surgery. Radioactive iodine is taken orally and absorbed by the remaining thyroid cells, which are then destroyed using radiation. Click on the link to know when and how thyroid iodine treatment is performed. **External radiation therapy**: In this treatment method, high-energy X-rays are used to destroy cancer cells. In cases where the cancer has spread outside the thyroid gland or when surgery is not possible, external radiation therapy is used. ### **Treatment of thyroid cancer with a combination of different methods** In some cases, your doctor may recommend a combination of different methods to treat thyroid cancer. For example, in some cases after surgery, iodine therapy is prescribed to the patient to act as a complementary treatment method. **What are the types of thyroid cancer and what are their treatment methods?** There are different types of thyroid cancer and each of them is treated in special ways, which include: ### **Treatment of papillary cancer and its types** The symptoms of **papillary cancer** include sore throat and bruising, swelling in the lymph nodes of the neck, etc. If the neck and thyroid are affected by papillary cancer, a biopsy and **thyroid sampling** are performed by ultrasound to confirm the cancer. If the tumor can be removed, thyroid surgery is often used. If the cancer shows up on a radioactive iodine scan (meaning the cells are taking up iodine), radioactive iodine (RAI) therapy may be used alone or with surgery. If the cancer does not show up on the radioactive iodine scan but is found by other imaging tests (such as an MRI or PET scan), radiation therapy may be used. If the cancer has spread to multiple sites and RAI and other treatments are not helpful, targeted therapies such as lenvatinib (Lenvima) or sorafenib (Nexavar) may also be prescribed. If these drugs are not effective, the patient may be prescribed cabozantinib (Cabometyx). ### **Treatment of follicular cell cancer** Thyroid cancer surgery is usually recommended for follicular thyroid cancer. Usually, a second surgery will be needed to remove the rest of the thyroid. (This is called supplementary thyroidectomy or total thyroidectomy). If the patient wants only one operation, the surgeon may remove the entire thyroid gland in the first operation, but for most patients, this is not recommended. Usually, a lobectomy is performed first, and if thyroid cancer is confirmed, a total thyroidectomy is performed. As with papillary cancer, some lymph nodes are usually removed and tested for cancer. If the cancer has spread to the lymph nodes, surgical removal of the lymph nodes from the neck may be performed. Since the thyroid gland is removed, patients must start taking thyroid hormone. A radioactive iodine scan is usually done after surgery to look for areas that are still using iodine. Cancer spread to nearby lymph nodes and distant sites shown on the scan can be treated with radioactive iodine (RAI). For cancers that do not use iodine, external beam radiation therapy may help treat the tumor or prevent it from growing in the neck. Cancer that has spread to the lungs or liver may require radiation therapy or targeted drug therapy such as lenvatinib (Lenvima) or sorafenib (Nexavar). ### **treatment of medullary thyroid cancer** Difficulty in swallowing, shortness of breath, etc. are **symptoms of medullary cancer**. Most surgeons recommend that patients with medullary thyroid carcinoma (MTC) be tested for other types of tumors commonly seen in patients with MEN 2 syndrome. This syndrome is caused by a mutation (defect) in the RET gene. About 2 out of 10 medullary thyroid carcinomas (MTCs) are caused by inheriting an abnormal gene. These cases are known as familial medullary thyroid carcinoma (FMTC). FMTC can occur alone or in association with other tumors. **Stage one and two medullary cancer**: Total thyroidectomy is the main treatment for MTC and surgery is often prescribed for patients. Nearby lymph nodes are also usually removed. Since the thyroid gland is removed, thyroid hormone therapy is required after surgery. Since MTC cells do not take up radioactive iodine, radioactive iodine has no role in the treatment of MTC. **Stage three and four medullary cancer**: Thyroid surgery is the main treatment. Thyroid hormone therapy is usually performed after screening for MEN 2 syndrome and pheochromocytoma. When the tumor is extensive and invades many nearby tissues or cannot be completely removed, radiation therapy may be given after surgery to reduce the chance of recurrence in the neck. For cancers that have spread to other parts of the body, surgery, radiation, or similar treatments may be used if possible. If these treatments fail, targeted drugs such as vandetanib (Caprelsa) or cabozantinib (Cometriq) may be prescribed. ### **Treatment of anaplastic thyroid cancer** This type of cancer is not common. Because this cancer is currently difficult to diagnose, surgery is often not helpful as a treatment. If the cancer is limited to the area around the thyroid, which is rare, the entire thyroid and nearby lymph nodes may be removed. The goal of surgery is to remove as much cancer as possible in the neck area, ideally leaving no cancer behind. Because of the way anaplastic cancer spreads, this is often difficult or impossible. In this cancer, radioactive iodine treatment is not used because it has no effect. External radiation therapy may be prescribed alone or together with chemotherapy, which can be caused by the following. - Trying to shrink the cancer before surgery to increase the chance of removing it completely - After surgery to control any remaining cancer in the neck. - When the tumor is too large or spread to be treated with surgery. If the cancer is causing breathing problems, a surgical hole may be placed in the front of the neck and in the trachea to bypass the tumor and allow the patient to breathe more easily. This hole is called a tracheostomy. For cancers that have spread, chemotherapy alone may be used. If the cancer cells have changes in certain genes, treatment with targeted drugs may be helpful, such as: Dabrafenib (Tafinlar) and trametinib (Mekinist) can be used to treat cancers with certain BRAF gene mutations. Selpercatinib (Retevmo) can be used to treat cancers with specific RET gene mutations. - Larotrectinib (Vitrakvi) or entrectinib (Rozlytrek) can be used to treat cancers with NTRK gene mutations. **The future of thyroid cancer treatment with people's DNA!** An article entitled (Investigation of gene promoter methylation in papillary thyroid cancer) was presented to the ATA Congress (American Thyroid Surgeons Association) in 2023 by Dr. Seyed Ahmed Fanai and other colleagues and researchers of the Thyroid Research Center. This article has been accepted by ATA. Dr. Seyed Ahmed Fanai, a thyroid and parathyroid surgeon, was one of the active surgeons of this association who participated in this research. According to Dr. Seyed Ahmad Fanai, the treatment of thyroid cancer, as one of the most common types of cancer, may be done in the future with the help of examining the DNA of people's genes. DNA testing can be used as a useful tool in predicting the risk of thyroid cancer and also in choosing the appropriate treatment method for patients. Dr. Fanai further stated that methylation is an event that happens in the gene. The lower the methylation level, the higher the risk of tumor malignancy. Therefore, for the treatment of thyroid tumors, the methylation of the patient's gene can be checked in terms of whether it is high or low. The result of this research will help revolutionize thyroid cancer treatment. Click on the link to see the full article. Finally, it should be noted that the treatment of thyroid cancer is different depending on the type and stage of cancer and may even be different individually. Therefore, the type of thyroid cancer treatment should be determined by the attending physician. Also, after the treatment, the patient should be regularly examined by the doctor to prevent the occurrence of cancer and its return.