The Treatment Pathway for Patients with Thyroid Cancer: An Overview

The initial treatment of thyroid cancer is usually surgery to remove all or part of the thyroid. When the whole thyroid is removed, surgery may be followed by a procedure called radioactive iodine ablation. Patients are monitored after initial treatment to check for recurrence of the cancer.1-3

The information that follows applies to well-differentiated thyroid cancer.

Possible steps in the treatment of well-differentiated thyroid cancer

steps for treatment of well differentiated thyroid cancer steps for treatment of well differentiated thyroid cancer


The first step in treating well-differentiated thyroid cancer is surgery to remove all or part of the thyroid. This is called a thyroidectomy. Thyroid surgery is a very delicate procedure because the thyroid is surrounded by many blood vessels and nerves.2

Thyroid surgeries are done in a hospital operating room under a general anesthetic. The surgeon may remove:

  • all of the thyroid gland – also known as a total thyroidectomy
  • half of the thyroid gland – also known as a hemi-thyroidectomy or lobectomy

The type of surgery required depends on the size of the tumor and whether the cancer has spread outside of the thyroid.1

Thyroid Hormone Replacement

Following surgery, your surgeon or endocrinologist will likely prescribe a thyroid medication. Thyroid medication usually involves taking a daily dose of a hormone called T4 (the generic levothyroxine or common brands such as Synthroid and Levoxyl). This medication will replace the hormone your thyroid was producing before its removal. After removal of the entire thyroid gland and without thyroid hormone replacement, you will become hypothyroid. This could affect your ability to perform normal day-to-day activities.1,2 Learn more about hypothyroidism.

Lifestyle recommendations

Your doctor may also recommend some things that will help you take good care of yourself and remain healthy. These include:

  • Regular exercise
  • Good eating habits
  • Time for relaxation

Radioactive Iodine Ablation

After removal of the entire thyroid, some patients may need another therapy to remove any leftover thyroid tissue. This procedure is called radioactive iodine ablation. It is performed by giving patients a dose of radiation called radioactive iodine. This targets and destroys any remaining thyroid tissue or cells that may be present in the body.3 Radioactive iodine ablation is not recommended for all patients. Learn more about radioactive iodine ablation.

Long-term Monitoring

After your initial treatment has finished, your endocrinologist will continue to monitor you to check the results of your initial treatment and if your cancer has returned. Your endocrinologist will likely request that you have some tests done periodically, such as a stimulated or not stimulated thyroglobulin blood test or imaging like a whole body scan or an ultrasound.Learn more about long-term monitoring.


Thyroid Cancer Glossary

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Thyrogen® (thyrotropin alfa for injection) 0.9 mg/mL after reconstitution


Diagnostic: Thyrogen is used to help identify thyroid disease by testing the blood for a hormone called thyroglobulin in the follow up of patients with a certain type of thyroid cancer known as well differentiated thyroid cancer. It is used with or without a radiology test using a form of iodine.

Limitations of Use:

The effect of Thyrogen on long term thyroid cancer outcomes has not been determined.

When Thyrogen is used to help detect thyroid cancer, there is still a chance all or parts of the cancer could be missed.

Ablation: Thyrogen is also used to help patients prepare for treatment with a form of iodine to remove leftover thyroid tissue in patients who have had surgery to take out the entire thyroid gland for patients with well differentiated thyroid cancer who do not have signs of thyroid cancer which has spread to other parts of the body.

Limitations of Use:

In a study of people being prepared for treatment with a form of iodine after thyroid surgery, results were similar between those who received Thyrogen and those who stopped taking their thyroid hormone. Researchers do not know if results would be similar over a longer period of time.


There have been reports of events that led to death in patients who not had surgery to have their thyroid gland removed, and in patients with thyroid cancer cells that have spread to other parts of the body.

Patients over 65 years old with large amounts of leftover thyroid tissue after surgery, or with a history of heart disease, should discuss with their physicians the risks and benefits of Thyrogen.

Thyrogen can be administered in the hospital for patients at risk for complications from Thyrogen administration.

Since Thyrogen was first approved for use, there have been reports of central nervous system problems such as stroke in young women who have a higher chance of having a stroke, and weakness on one side of the body.

Patients should remain hydrated prior to treatment with Thyrogen.

Leftover thyroid tissue after surgery and cancer cells that have spread to other parts of the body can quickly grow and become painful after Thyrogen administration.

Patients with cancer cells near their windpipe, in their central nervous system, or in their lungs may need treatment with a glucocorticoid (a medication to help prevent an increase in the size of the cancer cells before using Thyrogen.)


In clinical studies, the most common side effects reported were nausea and headache.


Pregnant patients: Thyrogen should be given to a pregnant woman only if the doctor thinks there is a clear need for it.

Breastfeeding patients: It is not known whether Thyrogen can appear in human milk. Breastfeeding women should discuss the benefits and risks of Thyrogen with their physician.

Children: Safety and effectiveness in young patients (under the age of 18) have not been established.

Elderly: Studies do not show a difference in the safety and effectiveness of Thyrogen between adult patients less than 65 years and those over 65 years of age.

Patients with kidney disease: Thyrogen exits the body much slower in dialysis patients and can lead to longer high TSH levels.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit, or call 1-800-FDA-1088.


  1. Haugen BR, Alexander EK, Bible K, et al. 2015 American Thyroid Association (ATA) Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2015; DOI: 10.1089/thy.2015.0020.
  2. National Comprehensive Cancer Network. Thyroid Cancer. Version 2.2015. Accessed January 2019.
  3. Norman, J. Endocrineweb. Thyroid Cancer. 2015. Accessed January 2019.