Stage I Treatment for Papillary Thyroid Cancer

Surgery is the main treatment for Stage I papillary carcinoma (earliest possible stage of diagnosis). The cure rate with surgery alone is excellent.

Your surgeon might perform a lobectomy if your cancer is only in one lobe of your thyroid, the tumor is smaller than 1 centimeter (about ½ inch), and you have no signs of cancer in the lymph nodes (tiny bean-shaped organs throughout the body that help fight infections).

• Lobectomy - Lobectomy is the removal of only the affected side of the thyroid gland. If you have a papillary cancer that is smaller than 1 centimeter (about ½ inch) and there is no sign that it has spread beyond the thyroid gland, the surgeon may perform a lobectomy.

Your surgeon might perform a near-total (sub-total) thyroidectomy if your tumor is larger than 1 centimeter, it is growing outside the capsule that covers the thyroid gland, or it has spread to the lymph nodes.

• Near-total (sub-total) thyroidectomy - Because papillary thyroid cancer is often located in both left and right sides of the thyroid gland (multifocal), most surgeons will remove nearly all of the thyroid gland. However, the surgeon leaves small amounts of tissue around the parathyroid glands (which produce a hormone that helps the levels of calcium and phosphorus in the body) to reduce the risk of damage to these glands.

Some doctors recommend neck dissection in addition to lobectomy or near-total (sub-total) thyroidectomy. This treatment can reduce the risk that your cancer will come back (recur) in the neck area. It also makes it easier to figure out the stage of your cancer.  

• Modified radical neck dissection - The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone.

If you had a near-total (sub-total) thyroidectomy, especially if you are older than 45 or your tumor was larger than 1 centimeter, your doctor might recommend treatment with radioactive iodine. Radioactive iodine can destroy cancer cells not removed by surgery and those that have spread beyond the thyroid. This treatment is especially useful if you have a papillary cancer that is larger than 1.5 centimeters or has spread to the neck or other parts of the body. But it is not as effective for small cancers that are only located in the thyroid gland.

• Radioactive iodine (radioiodine) - Radioiodine can destroy the rest of the thyroid gland and thyroid cancer (if the cancer takes up iodine) without affecting the rest of your body. Radioiodine is usually given as a capsule or in liquid form about 6 weeks after surgery. If you receive the usual dose, you will probably stay in the hospital for about 2 or 3 days while you are treated. If you receive a small dose, you will probably not have to stay in the hospital.

Regardless of the type of surgery you had, you will be treated with thyroid hormone after surgery. However, if your doctor plans to treat you with radioactive iodine, you might not start taking thyroid hormone until after you finish your radioactive iodine treatments.

• Thyroid hormone replacement - These pills can give your body the natural thyroid hormone it can no longer make on its own. The thyroid hormone pills can also slow down the growth of any cancer cells that are left in your body. The generic name of the hormone is levothyroxine sodium. It is sold as Synthroid^®, Levoxyl^®, Levothroid^®, Unithroid^®, and other brand names.

This content has been reviewed and approved by Myo Thant, MD.