Stage II through IV Treatment for Papillary Thyroid Cancer

If you have Stage II to IV papillary carcinoma (advanced progression of disease), your surgery will probably be near-total (sub-total) or total thyroidectomy. Some doctors also recommend modified radical neck dissection to reduce the risk that your cancer will come back (recur) in the neck area and to help figure out the stage of your cancer. If your cancer has spread to other neck lymph nodes, you are likely to receive a radical neck dissection.

• Near-total (sub-total) thyroidectomy - This is the most common type of surgery for thyroid cancer. 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.
• Total thyroidectomy - The surgeon removes the entire thyroid, and sometimes nearby lymph nodes, through an incision in the neck. In some rare cases, the surgeon also takes out other tissues in the neck that have been affected by the cancer.
• Neck dissection - The surgeon removes lymph nodes in the front and side of the neck that may contain cancer.
• Modified radical - 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. However, the surgeon does not take out sections of muscle, nerve, and the large veins in the neck.
• Radical -  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. The surgeon also takes out sections of muscle, nerve, and the large veins in the neck.

You will probably also be treated with radioactive iodine, which can destroy cancer cells not removed by surgery and those that have spread beyond the thyroid.

• 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.

If your metastases cannot be treated successfully with radioactive iodine, you might be treated with external beam radiation therapy, which uses high-energy x-rays or other types of radiation to kill cancer cells. It is sometimes used to reduce the chance that the disease will come back (recur) in the neck.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. Most people are treated with EBRT for a few minutes 5 days a week for a few weeks or months as an outpatient.

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.