Alternatives tothyroid surgery

There are a number of non-surgical treatments for thyroid problems.

Before deciding on treatment, you’ll need some tests. If you have thyroid nodules, this will probably mean thyroid function tests and a thyroid ultrasound. Depending on the ultrasound results, you may also need a fine needle biopsy. You and your doctor can talk about your test results and treatment alternatives.

Benign thyroid nodules

Most thyroid nodules are benign (not cancerous) but a few – about 5% – are malignant (cancerous). Benign nodules don’t necessarily need treatment unless they’re causing you problems with breathing or swallowing or if you’re bothered by their appearance.

Even if your nodule is cancerous, if it’s less than 10mm in size you may not need surgery as they can be observed safely. Your doctor can discuss options with you.

Aspiration of a liquid nodule

If a thyroid nodule is filled with fluid, the fluid can be drained out with a needle. This can provide temporary relief but the cyst almost always recurs.  

Ethanol ablation                                                                                                          

This is a similar procedure to aspiration and can be used for simple liquid-filled nodules. Using ultrasound to locate the nodule, your doctor inserts a needle to remove fluid from the nodule before replacing it with a sterile ethanol (alcohol) solution. This eventually creates scar tissue and helps reduce the chance the nodule will recur.

Goitre

There are two types of goitre (enlarged thyroid): toxic goitre and nontoxic goitre.

Toxic goitre produces excess thyroid hormone and is associated with hyperthyroidism. Nontoxic goitre doesn’t produce excess hormone. It doesn’t need treatment unless it’s unsightly or causing you problems like compressing your windpipe or voice box, getting bigger or extending into your chest.

Thyroxine

Thyroxine is one of the hormones produced by your thyroid gland, and can be used as a treatment if your thyroid has stopped working. It doesn’t reduce the growth of goitres, and if your thyroid is working normally, it can cause osteoporosis and heart disease.

Radioactive iodine

If you’re too old or sick to tolerate thyroid surgery, and have severe symptoms, your doctor may prescribe a therapy called radioactive iodine.

It’s a single-dose pill which targets your thyroid with radiation. If you have this therapy, you’ll become radioactive for several days and need to keep your distance from other people, especially children or pregnant women. Your doctor can advise how long you need to take these precautions.

Side effects include neck tenderness and swelling, nausea and vomiting, swelling and tenderness of the salivary glands, dry mouth, taste changes and dry eyes.

Women need to avoid getting pregnant for at least 1 year after radioactive iodine therapy as it can affect the foetus. Your fertility (male or female) can be affected, especially if you have multiple treatments.

Many people with nontoxic goitre develop hypothyroidism after radioactive iodine treatment. This may mean you’d need to take thyroid hormone tablets for the rest of your life, as you would if you'd your thyroid gland removed.

Radioactive iodine therapy isn’t generally as effective as surgery for goitre.

Hyperthyroidism (or Graves’ disease)

Graves’ disease is the most common cause of hyperthyroidism in Australia. It’s caused by your immune system attacking your thyroid gland, making it overproduce hormones. There’s no treatment to stop the immune system from attacking your thyroid gland.

Non-surgical treatments for hyperthyroidism either treat the symptoms, stop your thyroid from producing its hormones or destroy thyroid tissue.

Anti-thyroid medications

Medications to block your thyroid gland from producing its hormones include Neo-mercazole® (carbimazole) and PTU (propylthiouracil). These medications are used initially to see if the Graves’ hyperthyroidism goes away by itself rather than being used long term. If they’re needed for more than a year radioactive iodine or surgery is preferred.

Radioactive iodine

Your doctor can prescribe radioactive iodine to treat hyperthyroidism. See details under Alternatives for goitre (above).

Thyroid cancer

A diagnosis of thyroid cancer can be overwhelming and upsetting. Overall, your chance of surviving for 5 years after diagnosis is around 98%. Most thyroid cancers don’t behave aggressively.

Before any thyroid cancer surgery, you should have an ultrasound to see if your lymph nodes are affected. You should ideally be managed by a team of specialist doctors who work together to plan your treatment.

Depending on the size of the tumour your surgeon will recommend removing either half or all of your thyroid gland. Lymph node removal may also be recommended.

If the cancer is small (<10mm) with no risk factors, active surveillance may be the best approach.

Active surveillance

Many thyroid cancers found incidentally by an X-ray, CT or MRI scan would otherwise go undetected and never cause problems. They’re unlikely to grow or spread to other parts of your body. Other thyroid cancers are more likely to grow and spread if they’re not removed. A biopsy to confirm the type of cancer will help determine whether it’s one that’s likely to spread but sometimes it’s hard to tell for sure.

If your cancer is <10mm in size with no sign of local invasion or enlarged lymph nodes,  you and your doctor may decide to take an approach of ‘active surveillance’ with periodic ultrasound to check if the cancer has grown or spread. If you prefer surgery, removing only half the thyroid should be enough. Ask your specialist doctor if this approach may work for you.