Papillary Thyroid Cancer: Diagnosis, Treatment, and Follow-Up

Q: Papillary Thyroid Cancer: Diagnosis, Treatment, and Follow-Up

Dear Mr. Huang： Thank you for your inquiry. Here is the response： 1. Surgery is typically the first step in treating thyroid cancer, aiming to remove as much cancerous tissue as possible. In rare cases of localized and well-differentiated thyroid cancer, a l

Papillary Thyroid Carcinoma

Hello Doctor: On February 21, I was diagnosed with a 6 cm tumor on the left side of my thyroid and two tumors measuring about 1-2 cm on the right side.
I underwent a surgical removal, and the pathology results showed that the right side was benign while the left side was diagnosed as stage I papillary thyroid carcinoma.
The doctor has recommended a total thyroidectomy to prevent recurrence, and I will need to take medication for life.
I have a few questions for you: 1.
How can I check for metastasis to other areas? 2.
After a total thyroidectomy, will I need to undergo chemotherapy or radiation therapy?

Huang Li-Cheng, 50~59 year old female. Ask Date: 2017/03/07

Dr. Lai Yicheng reply Oncology

Dear Mr.
Huang:
Thank you for your inquiry.
Here is the response:
1.
Surgery is typically the first step in treating thyroid cancer, aiming to remove as much cancerous tissue as possible.
In rare cases of localized and well-differentiated thyroid cancer, a lobectomy of the affected side may be considered; however, most patients should undergo a total thyroidectomy.
After the total thyroidectomy, patients will receive a moderate dose of iodine-131 a few weeks later to eliminate any remaining thyroid tissue (both benign and malignant).
Subsequently, a whole-body iodine-131 scan will be arranged to check for any residual thyroid tissue or malignancy (at this point, normal residual thyroid tissue can usually be visualized in the neck).
After the scan, patients can begin daily oral thyroid hormone replacement to gradually restore thyroid function and exert a tumor-suppressive effect; thyroid hormone must be taken for life.
For patients with lymphatic metastasis or local recurrence, surgery remains the best option.
2.
During follow-up, if new masses are discovered, fine-needle aspiration cytology remains the best method for examination.
After surgery and radioactive iodine treatment, thyroid function and thyroglobulin levels should be checked every three to six months to adjust the thyroid hormone dosage and monitor for recurrence.
Additionally, patients should have a chest X-ray annually to check for pulmonary metastasis.
Due to the risk of osteoporosis from excessive thyroid hormone supplementation, female patients should have their bone density checked annually.
Approximately every year, patients should discontinue thyroid hormone for one month and undergo a whole-body iodine-131 scan to detect any recurrence.
Bone scans and computed tomography may also be utilized as necessary.
In certain cases, positron emission tomography (PET) can also detect recurrence sites.
3.
After total thyroidectomy, whether chemotherapy or radiation therapy is needed primarily depends on iodine-131 treatment.
Iodine-131 radioactive isotope therapy, along with thyroid hormone therapy, may occasionally be combined with radiation therapy, chemotherapy, and targeted therapies.
The physician will choose different treatment combinations based on factors such as tumor type, stage, extent of spread, and patient age.
It is best to discuss this with your attending physician.
Changhua Hospital cares about you.
Thank you for your consultation.
Sincerely,
Dr.
Lai Yi-Cheng
Department of Radiation Oncology

Reply Date: 2017/03/07

More Info

Understanding Papillary Thyroid Cancer (PTC) involves a comprehensive approach that includes diagnosis, treatment, and follow-up care. Papillary thyroid cancer is the most common type of thyroid cancer and is generally associated with a favorable prognosis, especially when diagnosed at an early stage.

Diagnosis
In your case, the diagnosis was made following the identification of a 6 cm tumor on the left side of the thyroid and two smaller tumors on the right side. The left tumor was confirmed to be malignant (papillary thyroid carcinoma), while the right was benign. The diagnosis typically involves imaging studies such as ultrasound, followed by a fine needle aspiration biopsy (FNAB) to obtain tissue samples for histological examination. The presence of papillary features in the tumor, along with nuclear characteristics, helps pathologists confirm the diagnosis.

Treatment
The standard treatment for papillary thyroid cancer, especially when it is diagnosed at an early stage, is surgical intervention. In your case, the recommendation to perform a total thyroidectomy (removal of the entire thyroid gland) is common practice, particularly when there is a risk of recurrence or metastasis. The rationale behind this approach is to minimize the chances of cancer returning and to manage any remaining thyroid tissue that could potentially harbor malignant cells.

After surgery, patients typically require lifelong thyroid hormone replacement therapy. This is crucial because the thyroid gland produces hormones that regulate metabolism, and its removal necessitates supplementation to maintain normal metabolic function.

Follow-Up Care
1. Monitoring for Metastasis: After surgery, follow-up care is essential to monitor for any signs of metastasis or recurrence. This is typically done through regular physical examinations, blood tests to measure thyroglobulin levels (a marker for thyroid cancer), and imaging studies such as neck ultrasounds. In some cases, radioactive iodine (I-131) therapy may be administered post-surgery to eliminate any remaining thyroid tissue or cancer cells.

2. Need for Chemotherapy or Radiation: Generally, papillary thyroid cancer does not require chemotherapy or external beam radiation therapy, especially in early-stage cases. The primary treatment modality remains surgery and, if indicated, radioactive iodine therapy. However, if there are aggressive features or if the cancer is diagnosed at a more advanced stage, additional treatments may be considered based on the oncologist's assessment.

Conclusion
In summary, your diagnosis of papillary thyroid cancer, particularly at an early stage, is associated with a good prognosis. The recommended total thyroidectomy followed by lifelong hormone replacement therapy is a standard approach. Regular follow-up appointments and monitoring are crucial to ensure that any potential recurrence is detected early. If you have further concerns or symptoms, it is essential to communicate with your healthcare provider to tailor a follow-up plan that suits your individual needs.
Always remember that while the diagnosis of cancer can be daunting, the majority of patients with papillary thyroid cancer lead normal, healthy lives post-treatment with appropriate management and follow-up care.

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