23rd May 2025

Management of thyroid cancer

Differentiated types

Management of differentiated types depends on grading of the tumour:

• If it is a very low risk tumour, active surveillance is recommended with US of the gland and neck lymph nodes (LNs) every 6-12 months. 
• For other grades or if active surveillance shows tumour size increase by ≥3mm or development of LN metastasis then thyroidectomy is recommended.
• In case of total thyroidectomy, thyroxine replacement is required. Additionally, TSH-suppressive doses of thyroid hormone therapy are used to prevent TSH cancer cells proliferation.
• In high-risk patients, following thyroidectomy, and in selected patients with intermediate-risk disease, radioactive iodine therapy is recommended.

Undifferentiated types

Management of undifferentiated types:

• Anaplastic thyroid cancer
  • This type of cancer usually presents late, hence, combining multiple therapeutic modalities is most effective and is individualised to each patient. 
  • Different combined modalities can be surgery and radiotherapy;  surgery and systemic therapy; or surgery and radiotherapy and systemic therapy. 
  • TSH suppression doses of levothyroxine if total thyroidectomy is done.
  • Radiotherapy is usually started early regardless of the surgical status, due to the aggressive nature of the cancer.
• Medullary thyroid cancer
  • 1st line management is surgical excision of the gland alongside central compartment lymph node dissection. 
  • Thyroxine hormone replacement is advised. 
  • Radiotherapy is advised for metastatic or recurrent tumours.
• Primary thyroid lymphoma
  • Management of this type depends on cell change. However, surgery alone is not sufficient for the management of this type of cancer. Hence combined chemotherapy and radiation is required.