Thyroid Cancer Diagnosis and Treatment
At the OHSU Knight Cancer Institute, a team of specialists will make sure you receive the best possible care. We offer you:
- Highly trained doctors and other experts who specialize in thyroid treatment.
- Oregon’s most experienced thyroid cancer surgeons.
- Advanced testing to spare some patients from unneeded surgery.
- The latest radiation therapy technology, plus targeted therapy for rare cancers.
- Complete rehabilitation care and support services.
See the bottom of our Understanding Thyroid Cancer page to learn about treatment for rare parathyroid cancer.
See our Doernbecher Children’s Hospital pages to learn about expert care for children with thyroid tumors.
Diagnosing thyroid cancer
We provide the most advanced diagnostic procedures in the Northwest, including molecular testing that helps some patients avoid surgery.
Tests for thyroid cancer
Ultrasound exam: High-energy sound waves are bounced off tissues to form a picture. This can show the size of a thyroid nodule and whether it is solid or fluid-filled. At OHSU, this test is done by a highly trained thyroid expert.
Fine-needle aspiration biopsy: A needle is used to extract tissue for analysis. At OHSU, samples are examined by a type of doctor called a pathologist who is also a thyroid expert.
Surgical biopsy: A nodule or one lobe of the thyroid is removed and examined for signs of cancer.
Blood test: The level of hormones or substances such as calcium in your blood can indicate thyroid cancer.
CT scan: A computed tomography scan produces three-dimensional X-rays of the neck.
MRI scan: A magnetic resonance imaging scan uses a powerful magnetic field and radio waves to generate detailed computer images of tissues inside the body.
PET scan: Positron emission tomography uses a special camera and small amounts of radioactive material. The material is injected, swallowed or inhaled. The scan can detect medullary thyroid cancer and cancer that has spread outside the thyroid.
Radioiodine scan: A small amount of radioactive iodine is swallowed or injected. Then a special camera is used to detect potentially cancerous cells.
We offer a sophisticated diagnostic approach when ultrasound and biopsy results can’t confirm a diagnosis.
At other hospitals, it’s common to remove all or part of the thyroid to be safe, and then to test it for cancer. This means that some patients learn they don’t have cancer only after they’ve had surgery. Others learn they do have cancer and need a second surgery to remove the rest of the thyroid.
At OHSU, your care team does a detailed analysis of your results, family history and medical history. If this shows a lower risk of thyroid cancer, your team may give you the option of having a second fine-needle biopsy. The biopsy sample is then examined for molecular markers to confirm your diagnosis.
Thyroid cancer treatments
The type and stage of your cancer will guide treatment recommendations. In most cases, patients have surgery to remove the cancer. Then the care team assesses whether you would benefit from additional treatment such as radiation therapy to lower the risk of cancer coming back.
Dr. Maisie Shindo, surgical director of OHSU's Thyroid and Parathyroid Center, is nationally recognized for expertise in thyroid and parathyroid surgery.
Thyroid cancer surgery
Surgery is the most common treatment for thyroid cancer. Your surgeon will make an incision in the front of your neck and may also remove lymph nodes to check for signs of cancer.Surgery types:
- Lobectomy: The surgeon removes one of the thyroid’s two lobes and often the strip of tissue (isthmus) that connects them.
- Near-total thyroidectomy: All but a tiny section of the thyroid is removed.
- Total thyroidectomy: The thyroid is removed. This is the most common surgery.
Our thyroid surgeons are the most experienced in the state, each performing hundreds of surgeries a year. Precision is especially important because the thyroid is near the vocal cords and other sensitive tissues. We’re proud of our high success rate in protecting them.
We also offer techniques that minimize scarring and shorten recovery times. Most lobectomy patients go home the same day. Patients with full removal usually stay one night. Techniques include:
- Minimally invasive surgery that often requires only a 1-inch incision.
- Video-assisted technology.
- A device that monitors your vocal cord nerves during surgery to preserve your voice.
Radiation therapy is often used after surgery to eliminate any cancer cells that were left behind. For thyroid cancer, the types are:
Radioiodine therapy: The patient swallows radioactive iodine, which destroys thyroid tissue, including thyroid cancer cells elsewhere in the body. Because only thyroid tissues collect iodine, other tissues are left alone. In addition, we use a technique in giving this therapy that avoids the risk of hypothyroidism (an underactive thyroid, resulting in too little thyroid hormone).
External beam radiation therapy: This type may be used for medullary or anaplastic thyroid cancer because their cells don’t absorb iodine. This uses a machine outside the body to pinpoint an area with high-energy X-rays. We use state-of-the-art equipment that is faster and more precise.
This therapy is used only for aggressive or advanced thyroid cancers. Medications that kill cancer cells are given intravenously.
As the region’s leading hospital for difficult-to-treat thyroid cancers, we often see rare cases. The cancer may be advanced, for example, or it may not respond to surgery or radioactive iodine. For these, we can often use pills that kill cancer cells by targeting abnormal proteins while mostly leaving normal cells alone.
We monitor hundreds of cancer patients through the OHSU Thyroid and Parathyroid Center. You'll receive complete and continuing follow-up care.
If your thyroid is removed as part of cancer treatment, you will most likely need daily hormone-replacement pills to maintain proper metabolism. You also may need additional treatment, such as radioiodine therapy, to lower the risk of cancer coming back. After active cancer treatment, we offer:
- A discussion of all aspects of your case with an endocrinologist who specializes in thyroid cancer.
- A full medical evaluation and possibly more imaging.
- Thyroid hormone replacement therapy, if needed.
- Bone tests to check for hyperparathyroidism (overactive parathyroid resulting in too much parathyroid hormone) and the risk of bone loss in older patients.
- Lab tests to monitor your thyroid hormone levels. We'll also check for signs of cancer after three, six and 12 months, then yearly or as needed.
- Ultrasound scans and doctor visits after six and 12 months, or as needed. Then you'll probably have scans yearly for at least five years.
Rehabilitation and support services
OHSU provides complete rehabilitation and support services for your health and well-being.
Voice and swallowing: Thyroid cancer surgery may harm surrounding tissue, such as the voice box, windpipe and neck muscles. We offer rehabilitation services at our Northwest Clinic for Voice and Swallowing.
Physical therapy: Specialists at the OHSU rehabilitation clinic provide physical therapy and other services to help cancer patients reach their full potential.
Support for young adults: OHSU’s Adolescent and Young Adult Oncology Program provides Oregon’s only specialized services for cancer patients ages 15 to 39.
Survivorship services: We offer services to help patients transition to life after cancer.
Support services: Offerings to help you and your family include:
- Cancer social workers to help you cope and to address financial, transportation or other issues.
- Complementary therapies such as acupuncture.
- Fertility services for patients who need radiation therapy or chemotherapy.