There are a number of non-surgical treatments for thyroid problems.
Before deciding on treatment, you’ll need some tests. If you have thyroid nodules, this will probably mean thyroid function tests and a thyroid ultrasound. Depending on the ultrasound results, you may also need a fine needle biopsy. You and your doctor can talk about your test results and treatment alternatives.
Benign thyroid nodules
Most thyroid nodules are benign (not cancer) but a few – about 5% – are malignant (cancer). Benign nodules don’t necessarily need treatment unless they’re causing you problems with breathing or swallowing, or if you’re bothered by their appearance.
Even if your nodule is cancerous, if it’s less than 10mm in size you may not need surgery as they can be observed safely. Your doctor can discuss options with you.
Aspiration of a liquid nodule
If a thyroid nodule is filled with fluid, the fluid can be drained out with a needle. This can provide temporary relief, but the cyst almost always recurs.
This is a similar procedure to aspiration and can be used for simple liquid-filled nodules. Using ultrasound to locate the nodule, your doctor inserts a needle to remove fluid from the nodule before replacing it with a sterile ethanol (alcohol) solution. This eventually creates scar tissue and helps to reduce the chance that the nodule will recur.
There are two types of goitre (enlarged thyroid): toxic goitre and nontoxic goitre.
Toxic goitre produces excess thyroid hormone and is associated with hyperthyroidism. Nontoxic goitre doesn’t produce excess hormone. It doesn’t need treatment unless it’s unsightly, or causing you problems like compressing your windpipe or voice box, getting bigger, or extending into your chest.
Thyroxine is one of the hormones produced by your thyroid gland, and can be used if your thyroid has stopped working. It doesn’t reduce the growth of goitres, and if your thyroid is working normally, it can cause osteoporosis and heart disease.
If you’re too old or sick to tolerate thyroid surgery, and have severe symptoms, your doctor may prescribe a therapy called radioactive iodine.
It’s a single-dose pill which targets your thyroid with radiation. If you have this therapy, you’ll become radioactive for several days and need to keep your distance from other people, especially children or pregnant women. Your doctor can advise you about how long you need to take these precautions.
Side effects include neck tenderness and swelling, nausea and vomiting, swelling and tenderness of the salivary glands, dry mouth, taste changes and dry eyes.
Women need to avoid getting pregnant for at least 1 year after radioactive iodine therapy as it can affect the foetus. Your fertility (male or female) can be affected, especially if you have multiple treatments.
Many people with nontoxic goitre develop hypothyroidism after radioactive iodine treatment. This may mean you’d need to take thyroid hormone tablets for the rest of your life, as you would if you had your thyroid gland removed.
Radioactive iodine therapy isn’t generally as effective as surgery for goitre.
Hyperthyroidism (or Graves’ disease)
Graves’ disease is the most common cause of hyperthyroidism in Australia. It’s caused by your immune system attacking your thyroid gland, making it overproduce hormones. There’s no treatment to stop the immune system from attacking your thyroid gland.
Non-surgical treatments for hyperthyroidism either treat the symptoms, stop your thyroid from producing its hormones or destroy thyroid tissue.
Medications that block your thyroid gland from producing its hormones include Neo-mercazole® (carbimazole) and PTU (propylthiouracil). These medications are used initially to see if the Graves’ hyperthyroidism goes away by itself rather than being used long term. If they’re needed for more than one year, radioactive iodine or surgery is preferred.
Your doctor can prescribe radioactive iodine to treat hyperthyroidism. See details under Alternatives for goitre (above).
A diagnosis of thyroid cancer can be overwhelming and upsetting. Overall, your chance of surviving for 5 years after diagnosis is around 98%. Most thyroid cancers don’t behave aggressively.
Before any thyroid cancer surgery, you should have an ultrasound to see if your lymph nodes are affected. You should ideally be managed by a team of specialist doctors who work together to plan your treatment.
If your cancer is 1cm-4cm in size, hasn’t spread to nearby healthy tissue (local invasion), and hasn’t affected your lymph nodes, removing half or all of your thyroid are reasonable options.
If your cancer is more than 4cm (some doctors may say 2cm), it’s spread or affected your lymph nodes, you’ll probably need to have your entire thyroid gland removed, and possibly the lymph nodes.
If the cancer is small (<10mm) with no risk factors, you may be eligible for active surveillance.
Many thyroid cancers that are found incidentally by an X-ray, CT or MRI scan would otherwise go undetected and never cause problems. They’re unlikely to grow or spread to other parts of your body. Other thyroid cancers are more likely to grow and spread if they’re not removed. A biopsy to confirm the type of cancer will help to determine whether it’s one that’s likely to spread, but sometimes it’s hard to tell for sure.
If your cancer is <10mm in size with no sign of local invasion or enlarged lymph nodes, you and your doctor may decide to take an approach of ‘active surveillance’ with periodic ultrasound to check if the cancer has grown or spread. If you prefer surgery, removing only half the thyroid should be enough. Ask your specialist doctor if this approach may work for you.
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