Thyroid cancer is a malignant neoplasm that develops in the tissues of the thyroid gland. Several histological types are distinguished, including papillary, follicular, medullary, and anaplastic thyroid cancer. Treatment strategy depends on the tumor type, disease stage, and the patient’s overall condition.
Main approaches to thyroid cancer treatment
Surgical treatment is the cornerstone of therapy for most types of thyroid cancer.
Types of surgery:
- Hemithyroidectomy: removal of one lobe of the thyroid gland.
- Total thyroidectomy: complete removal of the thyroid gland.
- Lymph node dissection: removal of involved cervical lymph nodes in the presence of metastases.
At early stages of papillary and follicular thyroid cancer, surgery alone may be sufficient to achieve complete cure.
Radioiodine therapy (Iodine-131 therapy):
- Used after total thyroidectomy to ablate residual thyroid tissue or iodine-avid metastases.
- Indicated for papillary and follicular thyroid cancers, as these tumor cells retain the ability to uptake iodine.
Hormone therapy: After thyroidectomy, levothyroxine (L-thyroxine) is prescribed to replace thyroid hormones and to suppress thyroid-stimulating hormone (TSH), which may otherwise stimulate the growth of residual cancer cells.
Targeted therapy: Used in progressive or metastatic disease, particularly in medullary and anaplastic thyroid cancer.
Radiation therapy: Employed less frequently, mainly in anaplastic thyroid cancer or in cases where radioiodine therapy is ineffective.
Chemotherapy: Rarely used; mainly reserved for anaplastic thyroid cancer that does not respond to other treatment modalities.
Treatment according to thyroid cancer type
Papillary and follicular thyroid cancer:
- Surgical treatment (total thyroidectomy).
- Radioiodine therapy to destroy residual disease.
- Lifelong thyroid hormone replacement therapy.
In most cases, prognosis is favorable.
Medullary thyroid cancer:
- Total thyroidectomy with central and/or lateral neck lymph node dissection.
- Radioiodine therapy is ineffective, as medullary cancer cells do not uptake iodine.
- Targeted therapy in metastatic or progressive disease.
Anaplastic thyroid cancer:
- Multimodal treatment combining surgery, external beam radiotherapy, and chemotherapy.
- Palliative approach is often required due to the aggressive nature of the disease.
Diagnosis and treatment planning
Imaging and procedures:
- Thyroid ultrasound.
- Fine-needle aspiration biopsy (FNAB) to establish cytological diagnosis.
- Computed tomography (CT) or magnetic resonance imaging (MRI) when metastatic disease is suspected.
- PET-CT to detect metabolically active metastases.
Laboratory tests:
- Thyroid-stimulating hormone (TSH) level.
- Calcitonin and CEA as tumor markers for medullary thyroid cancer.
- Genetic testing for RET gene mutations in medullary thyroid cancer.
Histopathological examination: Performed after tumor removal to confirm the exact cancer subtype.
Rehabilitation and follow-up
Regular surveillance includes:
- Neck ultrasound.
- Blood tests for TSH, thyroglobulin (in differentiated thyroid cancer), calcitonin and CEA (in medullary thyroid cancer).
- Radioisotope imaging when indicated.
Hormone replacement therapy: Lifelong levothyroxine therapy is required after total thyroidectomy.
Lifestyle and nutritional management:
- A balanced diet rich in vitamins and essential micronutrients.
- Body weight monitoring, as metabolism may change during long-term thyroid hormone replacement therapy.
Treatment of thyroid cancer in Belarus is based on an individualized approach determined by tumor type and disease stage. Modern surgical techniques, radioiodine therapy, and targeted treatments provide high rates of cure and long-term remission. Regular follow-up after treatment plays a crucial role in early detection of recurrence and long-term disease control.
