Thyroid Microcarcinoma:
A Guide for Patients

The thyroid is a small, butterfly-shaped gland in the front of your neck. It makes hormones that travel through your blood to every part of your body. These hormones help your body use energy, stay warm, and keep your brain, heart, muscles, and other organs working well.

There are three options for managing a thyroid microcarcinoma (described below):

1. Active surveillance (careful monitoring)

2. Surgery

3. Ultrasound-guided ablation

Your doctor will help you choose the option that best fits your health and your preferences.

Many thyroid microcarcinomas never cause health problems. Because of this, some people choose to monitor the cancer instead of having treatment right away.

If you choose active surveillance, you will need to have regular thyroid ultrasounds performed and reviewed by experienced thyroid specialists to check for changes. Most people have an ultrasound:

• Every 6 months for the first 1 to 2 years
• Then once a year

If you switch doctor, be sure to get your scans and reports to share with your new doctor.

If the cancer grows or spreads to nearby lymph nodes, surgery remains an effective option, and the outlook is still excellent. For most people, choosing active surveillance does not lower the chance of successful surgery if surgery is needed later.

Active surveillance may not be the right option for everyone. Some people feel comfortable knowing the cancer is being watched closely. Others feel worried or stressed knowing the cancer is still there. These feelings are important and can help guide your decision.

Active surveillance may not be the best choice if the tumor is very close to important parts of the neck, such as the nerves that control your voice (laryngeal nerves), your windpipe (airway), or your swallowing pipe. In these cases, surgery may be the safer choice.

The most common surgery removes half of the thyroid that contains the cancer. This is called a lobectomy or hemithyroidectomy.

Nearby lymph nodes are usually left in place unless they look abnormal on an ultrasound or during surgery.

Most people with a thyroid microcarcinoma do not need radioactive iodine treatment.

Like any surgery, thyroid surgery has some risks. These include:

• Bleeding
• Infection
• Problems with anesthesia
• Voice changes (rare)
• Low calcium levels (rare)

Most people do very well after surgery, especially when it is performed by an experienced thyroid surgeon. Permanent problems are uncommon.

About 1 out of 5 people who have half of their thyroid removed may need to take thyroid hormone pills. Anyone who has the entire thyroid removed will need thyroid hormone pills for life to replace the hormones produced by the thyroid.

Ultrasound-guided ablation is a treatment that destroys the cancer without removing part of the thyroid. A doctor uses ultrasound to guide a thin needle through the skin into the thyroid.

Different types of ablation use heat or alcohol to destroy the cancer.

For some carefully chosen people, ablation may be an option if they do not want surgery or active surveillance.

Compared with surgery, people who have ablation are less likely to need thyroid hormone pills. However, it can be harder to know if all of the cancer has been destroyed.

In some studies, about 1 to 5 out of 100 people had the cancer come back or spread to nearby lymph nodes after ablation.

This treatment is not available at every medical center or office. It should be performed by a doctor with special training and experience.

• Most thyroid microcarcinomas never grow or grow very slowly.
• They rarely spread to nearby lymph nodes.
• The prognosis is usually excellent.
• Three treatment options are available:
  • Active surveillance (careful monitoring)
  • Surgery to remove half of the thyroid
  • Ultrasound-guided ablation
• Your doctor can help you choose the option that is best for you.

Talk with your healthcare provider about your questions and concerns. Together, you can decide on the treatment plan that is right for you.