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NCCN Guidelines for Patients



Thyroid Cancer, Version 1.2017


Cancer stages and treatment Treatment planning | Treatment and follow-up care

Treatment planning

Before treatment, you may have more tests or ones

you did not have when your doctor first checked for

cancer. These tests may include an ultrasound of the

thyroid, along with the front and sides of the neck

to check for abnormal lymph nodes. Other imaging

tests may include a CT or MRI of nodules that require

further testing. This might be a nodule attached to

a structure (fixed), large (bulky), or growing down

towards the chest area (substernal). Cancer can

sometimes harm the vocal cords, so this may be

checked as well.

Your doctor might order these tests either before or

after thyroid cancer is confirmed. You will then move

on to primary treatment once the tests are complete

and your doctor can review your results.

Treatment and follow-up care

The first treatment options are called primary

treatment. This is the first treatment in line when it

comes to your treatment plan. Further treatment may

be needed after primary treatment. Primary treatment

is usually surgery for thyroid cancer. As always, a

clinical trial is a treatment option.

When your treatment is finished, testing will be

done to check treatment results. Blood samples are

drawn for testing. This includes checking TSH, Tg,

and anti-Tg antibody levels. They should be low

or negative after treatment. Imaging tests are also

frequently used. Ultrasound is the most commonly

used imaging test. Other imaging tests may include

whole body radioiodine imaging and CT of the

chest. Your doctor will also check if you show any

symptoms or signs of thyroid cancer.

Surveillance and maintenance

After primary treatment, your doctor will assess your

situation and decide if you need more treatment or

if you should just be watched closely. Keep in mind,

you will be watched closely by your treatment team

whether you start treatment right away or not.

Surveillance includes seeing your doctors for

physical examination, blood tests, and imaging

studies. Other follow-up tests may also be done after

treatment ends to look for new tumors or the return

of cancer. It may be that some people only need

primary treatment and then move to surveillance

and maintenance after surgery. Some people have

surgery followed by other treatments like radioactive

iodine, or occasionally, radiation therapy.

If you need more treatment, your doctor will plan

your next treatment based on many factors. Further

treatment depends on the type of thyroid cancer and

if there is thought to be any remaining disease after

primary treatment.

Next steps

Follow-up care is needed after any cancer treatment

is finished. Follow-up care includes a medical history,

physical exam, blood tests, and imaging tests. During

this time, you will have more than one doctor’s visit

to monitor your health. If the cancer re-appears, a

biopsy may be done to confirm there is cancer. If

cancer is present, your doctor may try the treatment

options listed in this part of the book or recommend a

clinical trial.

Your doctor will base your next treatment on many

factors. The decision is based on things specific to

you and the characteristics of the tumor. Your next

steps also depend on whether the cancer is gone,

stable, or growing.