Treatments – Follow-Up
Follow-up is a critical component of thyroid cancer management. This includes:
- Routine blood tests
- Regular check-ups, including examination of the neck
- Ultrasounds or whole-body scans for a more detailed view of the body (to detect for cancer recurrence)
What do blood tests monitor?
Blood tests are needed to monitor Thyroid Stimulating Hormone (TSH) levels, which tells your doctor about your hormone levels. Blood tests also measure a substance called thyroglobulin (Tg), which is only produced by thyroid cells.
A person who had their thyroid gland removed should have very low or undetectable Tg levels. If too much Tg is detected, it may be a sign of cancer recurrence. In this case, Radioactive Iodine Treatment (RAI) treatment may be prescribed, or in rare cases, radiation therapy. Tg is tested regularly as part of your follow-up.
Recovering from thyroid cancer and adjusting to life after treatment is different for each person. Recovery depends on the stage of the cancer, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A person who has been treated for thyroid cancer may have concerns about the following.
Hypothyroidism means there is not enough thyroid hormone in the blood to keep the body working properly. It develops when all or part of the thyroid is removed or thyroid tissue is destroyed by radioactive iodine therapy.
Hypothyroidism can cause:
- dry skin
- weight gain
- feeling cold
Hypothyroidism is treated with thyroid hormone therapy using levothyroxine (Synthroid®, Eltroxin®). This drug replaces thyroxine, which is the hormone normally made by the thyroid. You will need to take it for the rest of your life. It may take some time to find the right dose for you so you don’t have symptoms of hypothyroidism. Doctors will adjust the dose of levothyroxine based on blood test results.
Radioactive iodine therapy can make the salivary glands inflamed, which may lower the amount of saliva, or spit, they make. This can lead to dry mouth and sometimes changes in taste. It may take several weeks after treatment for dry mouth to get better. Some people may have long-term problems with dry mouth.
To help keep your mouth moist, drink water and other fluids often throughout the day. Some people use an artificial saliva product to help moisten the mouth. Ask your healthcare team to recommend a product.
Voice changes may happen after surgery for thyroid cancer. The larynx, or voice box, is close to the thyroid. The larynx and nerves in the throat may be damaged during surgery to remove the thyroid. This can cause the voice to sound different. Your voice may be hoarse and sound breathy. You may have problems making high-pitched sounds. A hoarse voice usually gets better in a few weeks after surgery. Some people find that it takes longer for their singing voice to get better. In rare cases, there can be permanent changes to the voice.
If the voice changes seem to be a long-term problem, speech therapy can help improve the quality of your voice.
Hypocalcemia means there is not enough calcium in the blood. It can happen when the parathyroid glands are removed or damaged during surgery.
The parathyroid glands make a hormone called parathyroid hormone (PTH). It helps control the level of calcium in the blood. When blood calcium levels are low, the parathyroid gland releases PTH. If the parathyroid glands have been removed or damaged, they will not be able to make PTH (called hypoparathyroidism).
Hypocalcemia can cause:
- muscle cramps in the back and legs
- dry skin and brittle nails
- tingling and numbness in the lips, tongue, fingers and feet
- confusion, memory loss and depression
- abnormal heartbeat
Hypocalcemia is usually treated with calcium pills (called supplements). Sometimes vitamin D pills are given as well. How long calcium and vitamin D supplements are taken depends on when or if the parathyroid glands recover and function normally. Some people need to take these supplements for the rest of their life so they don’t have symptoms of hypocalcemia.