Stage IV thyroid cancer—also called metastatic disease—has spread beyond the thyroid to the soft tissues of the neck, lymph nodes in the neck, or distant locations in the body. The lungs and bone are the most frequent sites of distant spread. Papillary carcinoma more frequently spreads to regional lymph nodes than to distant sites. Follicular carcinoma is more likely to invade blood vessels and spread to distant locations.
The prognosis for patients with distant metastases is poor.
The following is a general overview of treatment for stage IV thyroid cancer. Cancer treatment may consist of surgery, radioactive iodine treatment, radiation, chemotherapy, or a combination of these treatment techniques. Combining two or more of these treatment techniques has become an important approach for increasing a patient's chance of cure and prolonging survival.
In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Treatments that may be available through clinical trials are discussed in the section titled Strategies to Improve Treatment.
Circumstances unique to each patient's situation influence which treatment or treatments are utilized. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.
Treatment for stage IV thyroid cancer is usually a combination of treatment techniques including surgery and radioactive iodine treatment.
Surgery for stage IV thyroid cancer typically consists of removing the entire thyroid, a procedure called a total thyroidectomy.
Total thyroidectomy is associated with a side effect called hypoparathyroidism, which is a low level of a hormone that is normally released from the thyroid called parathyroid hormone. Parathyroid hormone is important for maintaining calcium levels in the blood. Without a functioning thyroid, blood calcium levels become abnormally low, causing a variety of symptoms that typically include weakness and muscle cramps and tingling, burning, and numbness in the hands. This condition is called hypoparathyroidism. This complication may be reduced if a small amount of thyroid tissue is left, a procedure that may be referred to as a near-total thyroidectomy.
Iodine is a natural substance that the thyroid uses to make thyroid hormone. The radioactive form of iodine is collected by the thyroid gland in the same way as non-radioactive iodine. Since the thyroid gland is the only area of the body that uses iodine, the radiation does not concentrate in any other areas of the body. The radioactive iodine that is not taken up by thyroid cells is eliminated from the body, primarily in urine. It is therefore a safe and effective way to test and treat thyroid conditions.
Research indicates that treatment with radioactive iodine improves survival for patients with thyroid cancer that has spread to nearby lymph nodes or to distant locations in the body. 1
However, some patients with progressive metastatic disease do not take up iodine in their thyroid cells. Treatments are more limited for these patients and they may benefit from participating in a clinical trial evaluating new, innovative approaches to treating thyroid cancer.
The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of stage IV thyroid cancer will result from the continued evaluation of new treatments in clinical trials.
Patients may gain access to better treatments by participating in a clinical trial. Participation in a clinical trial also contributes to the cancer community's understanding of optimal cancer care and may lead to better standard treatments. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Areas of active investigation aimed at improving the treatment of stage IV thyroid cancer include the following:
Intensity-modulated radiation therapy (IMRT): IMRT allows radiation to be delivered more precisely with the use of the following advanced techniques:
- Three-dimensional scans of the cancer help determine where the radiation should be targeted.
- A rotating device delivers radiation from every point around the cancer, rather than only a few points as with conventional radiation therapy.
- Special blocking devices—called leaves—direct the radiation away from sensitive organs and toward the cancer.
IMRT appears to reduce the chance of injury to healthy body structures that are near the cancer while delivering higher doses of radiation to the cancer. In the treatment of thyroid cancer, this means that sensitive cells in the neck area—such as the cells that line the throat—may be spared from radiation damage, reducing side effects and improving quality of life.
Preliminary findings reported by researchers in New York suggest that IMRT is an effective treatment for select cases of thyroid cancer. However, long-term research is needed to confirm these findings. 2IMRT may be available through a clinical trial.
Chemotherapy: Chemotherapy uses drugs that kill rapidly dividing cells, a hallmark of cancer. Cancer chemotherapy may consist of single drugs or combinations of drugs. It can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment.
Doctors have observed that chemotherapy may help relieve symptoms of advanced thyroid cancer and may increase survival of some patients. 3
Surgery to remove metastases: Surgery to remove metastases from thyroid cancer has been shown to benefit some patients. In a clinical trial, metastases from thyroid cancer were removed from the mediastinum (area behind the breast bone), lung, bone, kidneys, and brain of 29 patients with advanced thyroid cancer. All patients were also treated with multiple radioiodine treatments. External-beam radiation therapy, chemotherapy, and other measures to relieve symptoms of the cancer were used. 4
1 Podnos YD, Smith D, Wagman LD, Ellenhorn JD. Radioactive iodine offers survival improvement in patients with follicular carcinoma of the thyroid. Surgery. 2005;128(6):1072-6.
2 Rosenbluth BD, Serrano V, Happersett L, et al. Intensity-modulated radiation therapy for the treatment of nonanaplastic thyroid cancer . International Journal of Radiation Oncology Biology Physics. 2005;63(5):1419-26.
3 De Besi P, Busnardo B, Toso S, et al. Combined chemotherapy with bleomycin, adriamycin, and platinum in advanced thyroid cancer. Journal of Endocrinology Investigation. 1991;14(6):475-80.
4 Pak H, Gourgiotis L, Chang WI, et al. Role of metastasectomy in the management of thyroid carcinoma: the NIH experience. Journal of Surgical Oncology. 2003;82(1):10-8.