Thyroid nodules: treatment

Suppression with thyroid hormone

The thyroid gland produces thyroxine (T4) and triiodothyronine (T3) as its major hormones. Thyroid hormone suppression is achieved by taking thyroid hormone (usually in the form of T4) in a dose slightly higher than what would normally be produced by your thyroid gland. This results in a suppression of the blood level of the thyroid stimulating hormone (TSH). When the TSH level is "suppressed," thyroid nodules will sometimes become smaller. This suppression can be used to help differentiate benign from cancerous thyroid nodules, decrease the size of a nodule for cosmetic reasons or as an attempt to avoid thyroid surgery.

What if I was exposed to radiation as a child?

Unfortunately, some people have been exposed to radiation as children, either through environmental disasters such as Chernobyl or through the use of medical radiotherapy to the head and neck area. Depending on the dose of radiation, there could be an increased lifetime risk of thyroid cancer. If you are having an assessment of a thyroid nodule, let your physician know if have been exposed to radiation.

The radiation from diagnostic X-rays such as those used by your dentist or during a routine chest X-ray does not increase your risk of thyroid cancer.

What if I find out I have thyroid cancer?

If your fine needle aspiration biopsy (FNAB) suggests thyroid cancer, your physician will refer you to a surgeon experienced in thyroid surgery. With few exceptions, the best course of action is the complete removal of the thyroid for several reasons:

  • It ensures removal of any other thyroid cancers, and some people will have more than one.
  • It allows for more treatment options after surgery to prevent the cancer recurring.
  • If the entire thyroid is removed at the time of initial diagnosis, determining a reoccurrence of cancer becomes easier. There is no advantage to leaving part of the thyroid behind, as most people with thyroid cancer will be on lifelong suppression therapy with thyroid hormone.

The prognosis for properly diagnosed and treated thyroid cancer is excellent. Treatment always includes the initial surgery and usually long-term suppression therapy with thyroid hormone. Depending on the size and type of thyroid cancer, many patients will be treated with high dose radioactive iodine after surgery as this not only decreases the recurrence rate but also may increase the survival rate.

Potential treatment options for thyroid cancer

  • thyroidectomy (surgical removal of the thyroid)
  • suppression therapy with thyroid hormone
  • high dose radioactive iodine after surgery
  • external beam radiation
  • chemotherapy

  Dr. Richard Bebb, MD 
in association with the MediResource Clinical Team 

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