Long Term Monitoring and Treating Recurrent or Persistent Disease

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Long-Term Monitoring
Treating Persistent or Recurrent Disease
External Beam Radiation
Chemotherapy, Including Targeted Therapies
Clinical Trials
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Long-Term Monitoring

After your treatment, you will receive life-long monitoring. This is for two main reasons.

  • First, long-term monitoring is important to make sure that your dose of thyroid hormone replacement is appropriate— neither too low nor too high for your specific needs.
  • Second, you will receive testing to find out if there is persistent disease or possible recurrence. Many people with differentiated thyroid cancer experience persistent disease or a recurrence, sometimes many years after the initial treatment. The prognosis for any person with a recurrence is better if it is discovered early. This is why life-long monitoring is important.
  • The exact type of monitoring, and how often it takes place, depends on the size of the original tumor and whether the cancer had spread locally or distantly, as well as other factors.
  • People free of disease receive less monitoring or testing than those with evidence of persistent disease.
  • Also, testing is spread out and becomes less frequent when the patient becomes free of disease. You and your doctor should discuss a plan to fit your situation.

Monitoring will most likely include:

  • Physical neck examination, including feeling the thyroid bed area. Typically, this is done every 3 to 6 months for the first 2 years, and at least once a year thereafter.
  • Blood tests. Certain blood tests will determine if you are on the right dosage of thyroid hormone replacement. Your medication dose may change over time. Blood testing is also useful to monitor for cancer recurrence. The blood tests will depend on your type of thyroid cancer.
  • Neck ultrasound. This test is increasingly used because it is a very sensitive way to find potential disease in the neck. It involves moving an instrument along your neck, without any pain, and there is no radiation exposure associated with it.

Also, for people in medium-risk or high-risk circumstances, long-term monitoring may sometimes include:

  • RAI Whole Body Scan for people with papillary or follicular thyroid cancer, or a variant. This is generally a “stimulated” scan, with your TSH elevated. Therefore, it will be done either after thyroid hormone withdrawal (you stop taking your pills for a period of time), or after you receive Thyrogen injections. Either method will raise the level of thyroid stimulating hormone (TSH). The low-iodine diet is followed for about two weeks before this scan.
  • CT Scan, particularly of the head and neck and/or the chest. If you have papillary or follicular thyroid cancer, CT testing will generally be done without contrast dye because the dye is very high in iodine. If the test reveals cancer, the use of contrast would delay potential RAI treatment until the iodine could be cleared from the body.
  • MRI, particularly of the head and neck and/or the chest. The contrast dye used in an MRI is gadolinium and does not contain iodine.
  • PET/CT Scan. A PET scan or combined PET/CT scan is sometimes done when blood testing in someone with differentiated thyroid cancer reveals Thyroglobulin levels above a certain measure, but the disease does not show up on an ultrasound or an RAI whole body scan.
  • Chest X-ray. An X-ray may be used for low-risk patients whose initial cancer was treated via a lobectomy.

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Treating Persistent or Recurrent Disease

If your testing shows persistent or recurrent disease, your treatment may include some or all of these treatments. Your treatment will be tailored to your own circumstances.

Treatments may include:

  • Surgery—usually the first step for treating any thyroid cancer
  • Radioactive iodine
  • External beam radiation – for some patients
  • Chemotherapy, including new targeted therapies, sometimes in a clinical trial – for some patients
  • There are additional treatment modalities, such as radiofrequency ablation, and percutaneous ethanol (alcohol) injections, for selected circumstances.
  • Clinical Trial

Each Time.

Each time you are tested, discuss the results and your future testing or treatment needs with your doctor.

Surgery and Radioactive Iodine are discussed in other sections, linked on the left side of this page. Here is basic information about external beam radiation, chemotherapy, and clinical trials.

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External Beam Radiation

External beam radiation is sometimes given:

  • As an added treatment in addition to the primary treatment, or
  • As a curative treatment when the cancer cannot be removed by surgery, or
  • As a palliative approach to relieve symptoms and improve quality of life.

It is most often used for cancer that returns after initial treatments, especially if there is evidence that the cancer cells do not take up radioactive iodine, or to treat bone metastases from cancer that has spread.

More about External Beam Radiation Therapy:

  • External beam radiation therapy uses high-energy rays to destroy cancer cells. A machine directs a carefully focused beam of radiation at the cancer.
  • This therapy usually involves treatments 5 days a week for about 6 weeks.
  • Each treatment takes only a few minutes. The set-up time takes longer, because precision is required to direct the beam of radiation to the appropriate area.
  • The side effects depend mainly on how much radiation is given and which part of your body is treated. The radiation can destroy nearby normal tissue as well.
  • Radiation to the neck may cause a dry, sore mouth and throat, hoarseness, and/or trouble swallowing. Many patients will have skin irritation similar to a sunburn – the skin in the treated area may become red, dry, and tender.
  • Fatigue, especially in the later weeks of treatment, is also a common side effect.
  • The side effects usually go away after the treatment ends.

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Chemotherapy, Including Targeted Therapies

Chemotherapy is used for advanced differentiated thyroid cancer that no longer responds to other treatments, as well as for anaplastic thyroid cancer and medullary thyroid cancer.

Some newer forms of chemotherapy are called targeted therapies.

  • Chemotherapy involves the use of drugs to destroy cancer cells or to stop the pathways or mechanisms that allow them to grow and divide.
  • These drugs act in a systemic fashion. This means that they enter the bloodstream and are circulated throughout the body, reaching cancer cells or pathways to cancer, wherever they may be.
  • Some treatments slow disease progression, while others stop it, reduce it, or eliminate it completely.
  • Chemotherapy drugs are given by injection into a vein, by injection into a muscle, or as a pill.
  • Chemotherapy may be received in an outpatient clinic, in the hospital, at the doctor’s office, or at home. Some people may need to stay in the hospital following treatment.
  • During treatment you will be monitored for side effects and to determine the result of the chemotherapy. Your dose may be adjusted during your treatment.
  • Side effects depend mainly on which drugs are given, and the dose. Your doctor can suggest ways to prevent or control many of these side effects.
  • Most side effects go away or reduce after the treatment ends.
  • Side effects may include fatigue, increased chance of infections due to low blood counts, loss of appetite, mouth sores or other sores or rash, changes in bowel habits, nausea, neuropathy, and others.
  • Specific chemotherapy drugs may have other specific side effects that require monitoring.
  • The length of treatment varies, depending on the drug and how effective it has been for a particular person. Some people receive a maintenance dose of a drug on a long-term basis.

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Clinical Trials

If conventional treatments are not successful, you might discuss participating in a clinical trial with your doctor.

  • A clinical trial is a research study where physicians try treatment that has theoretical promise, but has not been proven to work. During clinical trials physicians systematically collect information to find out whether the treatment works.
  • Making the decision about participation is not easy. On the one hand, it offers hope of increased longevity or a cure. Clinical trials also result in knowledge that might help others. On the other hand, clinical trials often involve drug side effects, and travel and expense. These can reduce a person’s quality of life.
  • This is a personal decision best reached by consideration and discussion with your doctors, family, and friends.
  • Clinical trials take place in many different locations—in cancer centers, other major medical centers, community hospitals and clinics, physicians’ offices and veterans’ and military hospitals.
  • Clinical trials usually involve travel to one or more research centers funded for the trial. The cost of the trial itself is usually free, but physician care fees, medical tests, travel, and lodging are not usually covered. However, there are often hotels with special patient/caregiver rates. Some areas have special residences that are supported by charitable donations and that may ask for a small fee from the patient.

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Last updated: May 21, 2013