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Treatments and drugs
By Mayo Clinic staff
Several approaches are available to treat Hurthle cell cancer:
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Surgery. Surgery is the best treatment for Hurthle cell cancer. During this operation all or nearly all of the thyroid gland is removed, in a procedure is called a near total thyroidectomy. The surgeon leaves tiny edges of thyroid tissue near the adjacent parathyroid glands to lower the likelihood of parathyroid injury. These small parathyroid glands regulate your body's calcium level. Surrounding lymph nodes are removed to determine if the cancer has spread to them.
Before the surgery, your doctor will conduct a complete physical exam, including a heart evaluation to determine the risk of cardiac complications during the operation. Blood tests can reveal if you have a bleeding disorder that could become problematic. You'll be asked to avoid eating and drinking, beginning the night before the operation.
The greatest risk associated with the operation is unintended injury to the recurrent laryngeal nerve, which could cause temporary or permanent hoarseness or a loss of your voice. Other complications include damage to the parathyroid, excessive bleeding and infection. You'll probably need to stay in the hospital for a day or two after the operation to ensure that post-surgical bleeding hasn't occurred and that you're able to breathe normally.
- Thyroid hormone medication. After surgery for Hurthle cell cancer, your doctor will prescribe the synthetic drug levothyroxine (Levoxyl, Synthroid, Levothroid), which replaces the hormones no longer being produced because of the absence of the thyroid. You'll need to take these synthetic hormones for the rest of your life. These medications are safe, and blood tests help determine the correct dose, which minimizes the risk of side effects.
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Radioactive iodine therapy. Radiation therapy using a capsule containing radioactive iodine 131 is often prescribed as an adjunct to surgery for Hurthle cell cancer. It can be used to destroy any microscopic thyroid tissue remaining after the operation, using a modest dose of radiation in a procedure called "remnant ablation." At times, a higher dose of radioiodine can be used to eliminate any malignant cells that have spread to other parts of the body, such as the lungs and bones.
Radioactive iodine therapy is typically administered about six weeks after surgery, generally as an outpatient procedure.
In rare cases, radioiodine therapy can cause temporary side effects including sore throat, dry mouth, decrease in taste sensations, neck tenderness, nausea and vomiting. Nearly all traces of the radioactive iodine are excreted from the body within about two days after the start of treatment. Doctors avoid this form of treatment in pregnant and breast-feeding women because of risks to the fetus and newborn. Women are advised to wait at least six months before attempting to conceive, and men are advised to wait several months before attempting conception.
- External beam radiation. This approach delivers radiation treatment to attack malignant cells. It's sometimes an option for people in whom radioiodine therapy hasn't been successful. It uses a special X-ray machine called a linear accelerator to deliver radiation to cancer cells. This treatment can target specific areas where cancer cells are present, minimizing damage to nearby healthy tissue. Side effects may include fatigue and a temporary reddening and sensitivity of the skin.
