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Medullary Thyroid Cancer: Treatments

For this form of thyroid cancer, a total thyroidectomy--surgery to remove the entire thyroid--is the only option.

The main aspect of medullary thyroid cancer treatment is relatively straightforward: remove the thyroid. Regardless of the form of medullary thyroid cancer (MTC), a total thyroidectomy is performed to prevent the cancer from spreading to other parts of the thyroid gland.

We have an article that thoroughly explains thyroid surgery. Read it to get all the details on total thyroidectomy (and other thyroid surgeries).

Removing the entire thyroid makes the long-term treatment for MTC easier because after the surgery, the doctor can measure the amount of thyroid hormone being produced in your body—which should be near zero if the thyroid has been removed in a total thyroidectomy. It's easier to tell if the thyroid cancer is gone—or if the cancer comes back.

Other Medullary Thyroid Cancer Treatments

All medullary thyroid cancer patients will have a total thyroidectomy, but there are other possible treatments that your doctor may recommend.

As part of the operation to remove the thyroid, you will need a central neck dissection. In this aspect of the thyroid operation, the surgeon will remove some of the lymph nodes in your neck. If medullary thyroid cancer spreads (metastasizes), it usually spreads to the lymph nodes first. A central neck dissection has two possible goals (depending on if your cancer has metastasized):

  • to prevent MTC from spreading to the lymph
  • to remove cancer that has already metastasized to the lymph nodes—and prevent it from spreading more.

In certain instances, the surgeon will be required to remove lymph nodes in the side of your neck (and not just from the central part of your neck). This is called a modified radical neck dissection. If your surgeon believes this procedure is necessary, he or she will explain it to you so that you understand the reasons why you need it.

If you have a form of medullary thyroid cancer that is MEN-associated, you will need more treatment for the other endocrine disorders. Your doctor will run tests to develop a complete treatment plan for your other disorders that are affecting other endocrine glands, such as the parathyroid glands or the adrenal glands.

For example, MEN 2A always involves hyperparathyroidism. Your doctor will review hyperparathyroidism treatment options with you and recommend the best option for you.

What about Radioactive Iodine?

You may know that most types of thyroid cancer are treated with radioactive iodine; as a general rule, medullary thyroid cancer cannot be treated with radioactive iodine.

For other thyroid cancers, radioactive iodine is usually used after thyroid surgery to kill off any remaining cancer cells. Thyroid hormone-producing cells are the only cells that can absorb iodine, and a particular form of radioactive iodine will destroy these cells.

However, medullary thyroid cancer doesn't occur in thyroid hormone-producing cells; it occurs in another type of cell called parafollicular cells. Those cells are part of the thyroid, but they don't produce thyroid hormone, so radioactive iodine is not absorbed by cells with MTC.

Effectiveness of Medullary Thyroid Cancer Treatments

The earlier medullary thyroid cancer is diagnosed, the better the prognosis. If MTC hasn't spread to the lymph nodes when it's diagnosed, there is a better chance of recovery.

The key to medullary thyroid cancer treatment is aggressiveness. That's why total thyroidectomy with a neck dissection to remove the lymph nodes is the surgery of choice. Additionally, following surgery and any other treatments, your doctor will closely monitor your health and vigilantly watch out for signs of medullary thyroid cancer recurrence.