One of the most hotly debated topics in thyroid cancer treatment is whether or not to have a thyroidectomy. Radioactive iodine has been used for decades, but recent studies show that it may be less effective than previously thought.
This article discusses the pros and cons of each procedure to make an informed decision about your options. Remember, however, that we are not providing medical advice here – your GP or endocrinologist is the one who is medically qualified to give you the direction for your individual medical needs.
What is a thyroidectomy?
A thyroidectomy is a surgical procedure in which all or part of the thyroid gland is removed. It’s typically used to treat cancer, either because it has spread beyond the thyroid (known as papillary carcinoma) or because of large amounts of abnormal tissue in the thyroid (known as multinodular goitre). If you have cancer, the surgeon will try to remove all abnormal tissue while sparing healthy tissue.
What is the radioactive treatment for thyroid disease or thyroid cancer?
Radioactive iodine treatment involves taking medication that contains radioactive particles, which are then absorbed by your thyroid gland. These particles damage or destroy any thyroid cells left behind after surgery, making it impossible for those cells to produce thyroid hormones.
In recent years, doctors have been prescribing radioactive iodine instead of thyroidectomy for patients with papillary and follicular cancers because it’s less invasive, has fewer side effects, and can be done as an outpatient procedure. However, this treatment may not be as effective as previously thought. In the US, the FDA now recommends that radioactive iodine and thyroidectomy be used to treat papillary, follicular, anaplastic, medullary, poorly differentiated cancers. In the UK, radioactive iodine is still the preferred treatment.
What are the pros and cons of thyroidectomy and radioactive iodine treatment?
The main advantage of a thyroidectomy over radioiodine therapy is that it reduces your chances of getting cancer in other parts of your body, such as your adrenal glands or lungs. However, this only applies if you’ve already been diagnosed with thyroid cancer. Those who have not been affected by the disease usually don’t need a thyroidectomy to reduce their risk of it in future, so this is one pro that doesn’t apply to everyone.
There are several potential benefits and risks associated with both procedures:
Radioactive iodine treatment pros:
- Less invasive than a thyroidectomy
- Can be done as an outpatient procedure, so you can go home the same day – Fewer post-operative complications
Radioactive iodine treatment cons:
- Cannot prevent cancer from spreading to other parts of your body. Radioactive iodine may cause more distant metastases than a total thyroidectomy due to its radiation effect on the thyroid’s blood vessels.
- May is not as effective at preventing cancer from returning, leading to a higher risk of recurrence
Patients who receive radioactive iodine therapy may experience side effects such as:
- Radiation exposure (shallow)
- Dry mouth and eyes
- Sore throat, cough or hoarseness
- Swelling of the salivary glands
- Stomach upset, nausea or vomiting
- Reduces cancer recurrence rate. It also reduces the risk of distant metastases to other organs, such as your adrenal glands and lungs. However, this only applies if you’ve already been diagnosed with thyroid cancer. Those who have not been affected by the disease generally don’t need a thyroidectomy to reduce their risk of it in future, so this is one pro that doesn’t apply to everyone.
- No radiation exposure
- Requires general anaesthesia and must be done in an operating room or surgical suite under sedation or IV (intravenous) anaesthesia. You’ll also need to stay overnight in the hospital for observation
- More invasive than radioactive iodine treatment
- Requires a larger incision and therefore has a more extended recovery period (about three weeks, depending on your circumstances)
Since thyroidectomy is more invasive than radioiodine therapy, it’s associated with higher rates of surgical complications. Post-operative complications may include:
- Damage to your parathyroid glands (which produce hormones that regulate calcium levels in the body), which can lead to hyperparathyroidism.
- Slower wound healing or excessive scar tissue formation
- Narrowing of your airway, requiring you to wear a breathing tube during your recovery period
- Difficulty swallowing or speaking, requiring a feeding tube for several weeks – pneumonia (infection in your lungs)
How do I know if I’m a candidate for thyroidectomy or radioactive thyroid treatment?
Your doctor will likely perform imaging tests to determine the extent of your thyroid cancer and whether it’s spread. They’ll also order blood tests to check your thyroid hormone levels and calcium levels to determine if you’re a candidate for radioactive iodine treatment.
If your doctor believes that cancer has spread beyond the thyroid, or might return after radioactive iodine is used, then surgery may be recommended instead.
How to prepare for a thyroidectomy or radioactive thyroid treatment?
During your recovery period:
- You’ll need someone to drive you home after your surgery, so plan accordingly.
- You’ll need to keep your incision clean and dry for the first two weeks following surgery. Avoid exposing it to water during this period unless permission from your doctor or nurse – even liquid hand soap can irritate it, so be sure to ask before showering or bathing.
- Avoid applying any lotions or ointments to your incision area during the first two weeks following surgery, as these can cause infection in an open wound. You may be able to return to using petroleum jelly after that period if permitted by your doctor or nurse – make sure you only apply it when dressing changes are required.
Which do you think is best for you?
The decision about which treatment option is right for you depends on several factors, including what type of thyroid cancer you have, how large the tumour is, your overall health, whether or not it has spread, and your treatment preferences. For example, suppose you have a low risk of thyroid cancer recurrence or metastasis. In that case, radioactive iodine may be the best choice because it can usually destroy any remaining thyroid tissue without surgery.
However, if there are large amounts of abnormal cells in your thyroid gland, both medications (radioactive iodine and thyroidectomy) may be needed to ensure that all cancer cells are destroyed.
What are the side effects of radioactive iodine treatment?
The two most common side effects of radioactive iodine treatment are a dry mouth and a metallic taste in your mouth. You may also experience increased salivation, an increase or decrease in appetite, nausea, vomiting, diarrhoea, cough, shortness of breath (dyspnea), chest pain, and a sore throat. If you experience any of these side effects, contact your doctor immediately.
Because thyroidectomy and radioactive iodine treatment cause permanent hypothyroidism (thyroid gland failure), patients need to take thyroid hormone replacement medication for the rest of their lives. Your endocrinologist can help figure out what dosage is best for you.
Thyroxine replacement medication is still needed
While radioactive iodine is often preferred because it can be done as an outpatient procedure, thyroidectomy may be a better choice if large amounts of cancerous tissue in your gland or cancer have spread to other parts of the body. Patients who have had both treatments report being equally satisfied with each option, so talk to your doctor about which treatment is best for you.
It’s important to remember that both radioactive iodine and thyroidectomy are effective cancer treatments. Patients who have had one of these procedures report being just as satisfied with their results, so talk to your doctor about what type of medication or surgery would be the right choice for you.