Advanced Thyroid Cancer — Managing Treatment & Quality of Life

“When patients present with more aggressive disease or high-risk disease, our focus is really on identifying how can we best treat these patients and decrease their risk for recurrence without causing unnecessarily aggressive harm from the treatments that we’re offering,” Dr. Mara Roth, an endocrinologist and associate professor at the University of Washington in the Fred Hutch Cancer Center, tells SurvivorNet.

Treatment might involve surgery, chemotherapy, thyroid stimulating hormone (TSH) therapy, radiation, or an array or combination of other approaches.

New Approaches

If a tumor has spread to other organs or has encased adjacent organs near the thyroid, doctors may be concerned that surgery alone will not be enough to remove cancerous cells and might increase the risk of complications after surgery.

In some cases of advanced cancer, it could be beneficial for patients to undergo chemotherapy to shrink tumors before surgery.

“For patients with really aggressive thyroid cancer where there’s concern that surgery may not optimally debulk [remove] that disease or it’s not safe to actually proceed with surgery, there’s a lot of new research and new data supporting the use of neoadjuvant chemotherapy before thyroid cancer surgery,” Dr. Roth says.

Most cancers have “kinases,” which act like switches that tell cancer cells to grow, spread, and avoid dying. They also affect the blood vessels that feed the tumor. New treatments called antiangiogenic multikinase inhibitors (aaMKIs) can help stop or slow down tumor growth and delay the cancer from getting worse.

“These are really specific cases where patients get treated with a class of drugs called tyrosine kinase inhibitors that are approved for the treatment of advanced or metastatic thyroid cancer where they can potentially shrink the primary tumor and the large nodal disease to then make this more amenable to surgical intervention. And so while this is actually very rare and somewhat experimental, it is being hopefully addressed potentially as being included in the guidelines in the future,” Dr. Roth explains.

Thyroid Stimulation Hormone (TSH) Therapy

Thyroid stimulating hormone acts on the thyroid cells to stimulate growth and hormone production. In the context of cancer cells, the aim with treatment is to precisely avoid their growth or multiplication.

Thus, one potential treatment option is to suppress the serum levels of TSH. This is achieved by administering thyroid hormone medication in slightly higher doses. This helps keep TSH levels low and reduces the chance of stimulating any remaining cancer cells.

“One thing we commonly will do for patients with high-risk thyroid cancer is we’ll treat them actually with what we call a suppressive dose of levothyroxine, where we’re trying to keep their TSH or thyroid stimulating hormone low to help potentially suppress the growth of thyroid cancer,” Dr. Roth says.

In some cases, radiation therapy may also be used in combination with these approaches — the treatment path and delicate balance of treatment approaches depends on the individual patient, the extent and type of the disease, and their personal preferences.

“We really have to focus on individualizing our approach to long-term surveillance and management for patients to impact and improve their quality of life,” Dr. Roth explains. The main goal regardless the disease stage is to target the patient’s needs.

An open discussion and a reliable relationship with your doctor is fundamental to provide better outcomes and decisions.

Questions To Ask Your Doctor

• Am I still eligible for surgery?
• Will I need to undergo additional treatment before or after surgery?
• What sort of medication will I need to be on long-term?
• What sort of side effects should I be on the lookout for?

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