Anaplastic is the rarest and most serious thyroid cancer. It can spread early to lymph nodes, thus usually the cause for a visit to the doctor is a mass in the neck. It also is the form of thyroid cancer most likely to spread to other organs beyond the thyroid or lymph nodes. This type of thyroid cancer is more common in those over 65 and in men. Long-term survival rates are far less than for the other three types of cancer.

Treatments

Some patients and doctors view thyroid cancer differently than other cancers because they're treated and handled fairly differently than other cancers. For example, chemotherapy is rarely used as a treatment for thyroid cancer. Generally, surgery is the most common treatment. Usually a fairly short surgery, (unless lymph nodes are also involved) it is sometimes even done as a day surgery, or with just one night in the hospital. General anesthesia is usually used, however, there are some surgeons who will perform thyroid surgery with local anesthetics.

Thyroid surgery is not very risky. The main concern is potential damage to the vocal cords or voice box--but this is rare. During surgery, either part or all of the thyroid gland is removed depending upon the level of abnormality.

After surgery, most patients will receive Radioactive Iodine (RAI) treatment. This involves consumption of radioactive iodine, which concentrates in any remaining thyroid tissue, and kills that tissue, targeting the cancer specifically. External radiation therapy is not as common as RAI, and is used when the cancer cannot be totally removed.

Followup

Even after removal of the thyroid gland, in whole or in part, or other types of treatment, most patients will then be classified as hypothyroid, and will need to take prescription thyroid hormone replacement drugs for the remainder of their lives. Most physicians will administer sufficient thyroid hormone so as to suppress the TSH level so that it is nearly undetectable (in the hyperthyroid range), close to 0. This suppression of TSH helps to prevent cancer recurrence.

Many physicians also ask patients to go off thyroid hormone annually and undergo a scan for any recurrence. In some cases, the thyroid drug Cytomel (trioiodothyronine or T3) can be given for part of the time to minimize hypothyroidism symptoms, but in some cases, a patient has to go completely off all thyroid hormone and become hypothyroid, until the scan is completed and evaluated. Frequently, doctors will also recommend those patients go on what's known as the low-iodine diet, a diet that helps ensure the highest possible accuracy of the scan.

Some thyroid cancer survivors who are scheduled for a scan may be eligible to use a drug called Thyrogen, which prevents the symptoms and effects of hypothyroidism, but allows for a scan for recurrence. Thyrogen scans are not considered quite as accurate as full withdrawal from thyroid hormone, but some doctors will perform them for someone who has had several clean scans in a row and who is at lower risk of recurrence.

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Mary Shomon is a nationally-known thyroid patient advocate and best-selling author of numerous books on thyroid disease, including the New York Times best-seller The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss, Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know Living Well With Graves' Disease and Hyperthyroidism, and the Thyroid Guide to Fertility, Pregnancy and Breastfeeding Success. She is also editor of the long-running Sticking Out Our Necks Thyroid Newsletter.