From the Guidelines
Thyroid cancer treatment should always begin with total or near-total thyroidectomy, followed by radioactive iodine therapy and lifelong thyroid hormone replacement with levothyroxine, as this approach has been shown to decrease the risk of locoregional recurrence and facilitate long-term surveillance 1.
Initial Treatment
The initial treatment of differentiated thyroid carcinoma (DTC) should always be preceded by careful exploration of the neck by ultrasound to assess the status of lymph node chains.
- Total or near-total thyroidectomy is the standard treatment for most cases of DTC, especially when the diagnosis is made before surgery and the nodule is ≥1 cm, or regardless of the size if there is metastatic, multicocal or familial DTC 1.
- Less extensive surgical procedures may be accepted in case of unifocal DTC diagnosed at final histology after surgery performed for benign thyroid disorders, provided that the tumor is small, intrathyroidal and of favorable histological type (classical papillary or follicular variant of papillary or minimally invasive follicular) 1.
Radioactive Iodine Therapy
- Radioactive iodine (I-131) therapy is often recommended for patients with larger tumors, lymph node involvement, or aggressive cancer types to destroy any remaining thyroid tissue or cancer cells 1.
- Typical I-131 doses range from 30-100 mCi for remnant ablation to 100-200 mCi for known metastatic disease.
Levothyroxine Therapy
- After treatment, patients require lifelong thyroid hormone replacement therapy, typically levothyroxine (starting dose usually 1.6-1.8 mcg/kg/day), which both replaces the hormone and suppresses TSH to prevent cancer recurrence 1.
- TSH suppressive treatment with levothyroxine is of benefit in high-risk thyroid cancer patients, but not in low-risk patients, and the target TSH level should be individualized based on the patient's risk class and disease status 1.
Monitoring and Follow-up
- Regular monitoring includes thyroglobulin measurements, neck ultrasounds, and TSH level checks.
- For advanced or metastatic disease that doesn't respond to standard treatments, targeted therapies like lenvatinib (24 mg daily) or sorafenib (400 mg twice daily) may be used 1.
- Treatment plans are individualized based on cancer type (papillary, follicular, medullary, or anaplastic), stage, patient age, and other health factors, with more aggressive approaches used for higher-risk cases.
From the FDA Drug Label
CABOMETYX is a kinase inhibitor indicated for the treatment of patients with ... adult and pediatric patients 12 years of age and older with locally advanced or metastatic differentiated thyroid cancer (DTC) that has progressed following prior VEGFR-targeted therapy and who are radioactive iodine-refractory or ineligible (1.3) CAPRELSA is indicated for the treatment of symptomatic or progressive medullary thyroid cancer in patients with unresectable locally advanced or metastatic disease.
The treatment guidelines for thyroid cancer are as follows:
- Differentiated thyroid cancer (DTC): CABOMETYX is indicated for patients with locally advanced or metastatic DTC that has progressed following prior VEGFR-targeted therapy and who are radioactive iodine-refractory or ineligible 2.
- Medullary thyroid cancer: CAPRELSA is indicated for the treatment of symptomatic or progressive medullary thyroid cancer in patients with unresectable locally advanced or metastatic disease 3. Key points:
- CABOMETYX is used for DTC that has progressed following prior VEGFR-targeted therapy.
- CAPRELSA is used for medullary thyroid cancer that is symptomatic or progressive.
- The dosage and administration of these drugs should be followed as recommended in the drug labels.
From the Research
Thyroid Cancer Treatment Guidelines
- The treatment options for patients with thyroid cancer include the surgical removal of the entire thyroid gland (total thyroidectomy), radioactive iodine therapy, and molecular-targeted therapies with tyrosine kinase inhibitors 4.
- The prognosis and treatment of thyroid cancer depend on the tumor type and its stage at the time of diagnosis, with many thyroid cancers remaining stable, microscopic, and indolent 4.
- For papillary thyroid cancer, total thyroidectomy is often preferred over lobotomy as the initial treatment, especially when the tumor diameter exceeds 1 cm or when there are risk factors for poor prognosis 5.
- Novel approaches for targeting small-localized well-differentiated thyroid cancer include thermal ablation, such as ultrasound-guided radiofrequency ablation, and remote access techniques like the transoral endoscopic thyroidectomy vestibular approach (TOETVA) 6.
- Epigenomic profiling of papillary thyroid carcinoma can reveal distinct subtypes with clinical implications, allowing for the development of epigenetic biomarker-based prediction systems to assess tumor aggressiveness preoperatively 7.
Surgical Treatment Options
- Total thyroidectomy + central lymph node dissection is recommended as the initial treatment for papillary thyroid cancer, especially in cases with risk factors for poor prognosis 5.
- Lateral lymph node dissection is also recommended when the tumor diameter exceeds 1 cm or when there are risk factors for poor prognosis 5.
- Minimally invasive thermal ablation, such as radiofrequency ablation, can be used to target small, localized well-differentiated thyroid cancer 6.