Thyroid Cancer

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Tests

We perform a variety of tests to determine whether your thyroid nodule is benign or cancerous. About 10% of cases involve cancer. If you are found to have an early-stage cancerous nodule, treatment will typically include surgery, then treatment with our endocrinologists. Later stage treatment would start with our oncologists and/or endocrinologists.

Blood Tests

Blood tests are measure thyroid function so we can identify and adjust hormones to treat any abnormal thyroid behavior. They also measure levels of tumor markers, which are changes in your cells that can indicate cancer growth. Along with other tests, tumor marker tests help your doctor best diagnose and plan your treatment. Common markers for thyroid cancer include thyroglobulin for differentiated thyroid cancer, or calcitonin and carcinoembryonic antigen for medullary thyroid cancer.

Targeted Diagnostic Imaging

Surgeon- or radiologist-directed ultrasound imaging of the neck pinpoints the location, size, and extent of thyroid cancer and any possible spread to adjacent lymph nodes.

Fine Needle Biopsy and Molecular Testing

An ultrasound-guided fine needle is used to biopsy thyroid nodules to determine the likelihood of thyroid cancer. Tissue is then sent for testing to help your doctor decide if surgery or monitoring is best, and to tailor your treatment.

Laryngoscopy

This outpatient procedure checks whether the vocal cords move normally, and helps identify if tumors have spread to the nerves that help move the vocal cords. This procedure can also be used to evaluate of extent of disease.

Advanced Imaging

Radioactive iodine scans, CT scans, MRI, or PET-CT scans may be performed after surgery to determine if the cancer has been completely removed.

Genetic Counseling and Testing

Genetic counseling may be recommended when inherited thyroid cancers and related endocrine tumors are suspected.

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Duke Health offers locations throughout the Triangle. Find one near you.

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Treatments

Minimal Access or Robotic Thyroid Surgery

When surgery is an option, our doctors will try to use minimally invasive procedures using small incisions when appropriate. These surgeries may be performed in the outpatient setting when appropriate. This includes lobectomy, which removes the side of the thyroid where the tumor is located. Robotic thyroid surgery accesses the thyroid with no neck incision.

However, sometimes a larger incision is necessary for more complex surgeries.

Complex Surgeries

Near-total or total thyroidectomy removes most or the entire thyroid.
Lymph node removal may be required if metastatic cancer is diagnosed.
Removal of goiters (enlarged thyroid) that extend into the chest.
Removal of cancer that has spread to other areas of the neck (neck dissections) may be necessary when cancers spread to lymph nodes or organs in the neck.
Re-operations may be necessary for recurrent tumors or goiters.

Thyroid Hormone Therapy

Can prevent recurrence or progression of cancer cell growth and is used to control thyroid stimulating hormone (TSH) levels. Your endocrinologist will work with you to create personalized therapies.

Targeted Therapies

Radioactive Iodine: In pill or liquid form, it is typically administered four-to-eight weeks after surgery to destroy remaining cancerous thyroid cells.
Vandetanib (Caprelsa) and Cabozantinib (Cometriq): Both are approved to treat late-stage medullary thyroid cancer in patients who are ineligible for surgery.
Sorafenib (Nexavar) and Lenvatinib (Lenvima): Oral medication approved by the FDA for the treatment of advanced differentiated thyroid cancer.

Ablative Therapies

Radiofrequency ablation (RFA), microwave ablation, and cryoablation are minimally invasive, image-guided techniques that use extreme heat or cold to kill cancer cells. Ablation therapy is typically reserved for patients who are unable to have surgery or undergo radiation.

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Why Choose Duke

Nationally Ranked Cancer Program
As a National Cancer Institute-designated Comprehensive Cancer Center, we are recognized for exploring new treatment opportunities through ongoing clinical trials. We offer you the latest research discoveries before they are available elsewhere.

A Team Approach
Your team may include board-certified endocrinologists as well as medical, surgical and radiation oncologists, nuclear medicine specialists, cytopathologists, nutritionists, and integrative medicine specialists. We've made it possible for you to see your team and undergo appropriate testing on one convenient day. Our specialists meet weekly to discuss patients, develop optimal care plans, and offer you the best personalized care.

Surgical Experience and Expertise
Our surgeons have performed thousands of successful, thyroid-specific surgeries, ranging from minimally invasive to complex procedures. We strive to ensure our patients have lower complication rates, shorter hospital stays, less likelihood of cancer recurrence, and fewer repeat operations as compared to nationally published data.

Latest Medical Advances
We are authorized to offer the latest medical advances including vandetanib (Caprelsa), cabozantinib (Cometriq), sorafenib (Nexavar), and Lenvatinib (lenvima).

Clinical Trial Access
We were one of the world’s first medical centers to enroll patients in clinical trials investigating small-molecule therapies for extensive and metastatic thyroid cancer. Our expanding portfolio of clinical trials and growing tissue bank gives you access to experimental uses of approved drugs and newer therapies.

Latest National Practice Standards
We work with the American Thyroid Association, the American Association of Endocrine Surgeons, and the National Comprehensive Center Network (NCCN) to help set the national standards for best practice treatment guidelines. We were also one of the first institutions to work with the Collaborative Endocrine Surgery Quality Improvement Program to improve quality in endocrine surgery.

Support for You and Your Family
Our comprehensive support services range from helping you minimize the side effects of cancer treatment to helping you and your family cope with the emotional and psychological effects of diagnosis and treatment. View all of our cancer support groups in our event calendar.

Personalized Therapies
We offer personalized therapies based on thyroid biopsies, or small tissue samples, which means your treatments are tailored to your specific type of cancer.

Latest Medical Advances
We are authorized to offer patients the latest medical advances including vandetanib (Caprelsa), cabozantinib (Cometriq), and sorafenib (Nexavar).

Clinical Trial Access
We were one of the world’s first medical centers to enroll patients in clinical trials investigating small-molecule therapies for extensive and metastatic thyroid cancer. Our expanding portfolio of clinical trials and growing tissue bank affords our patients access to experimental uses of approved drugs and newer therapies, including selumetinib.