How to Treat Thyroid Cancer Without Surgery?

Thyroid cancer treatment often begins with surgery, but this invasive approach can lead to unintended consequences. Removing all or part of the thyroid gland can disrupt critical hormone production, potentially impacting metabolism, energy, mood, and more.

Further, surgery poses risks like vocal cord paralysis and hypoparathyroidism. For some patients, these complications outweigh the benefits of surgery. Fortunately, effective non-surgical alternatives exist.

Reasons to Avoid Surgery for Thyroid Cancer

  • There are some situations where nonsurgical treatment options may be recommended over surgery:
  • If the cancer is very slow-growing or low-risk, like papillary microcarcinoma, doctors may advise monitoring at first before treating it.
  • If the cancer is very advanced or aggressive, like anaplastic thyroid cancer, surgery may not be helpful as it often spreads rapidly.
  • If a patient is at high risk for surgery due to advanced age or other medical issues.
  • If a patient declines surgery – it is ultimately their choice.
  • If thyroid cancer recurs after initial surgical treatment.


Alternative Non-Surgical Thyroid Cancer Treatments

The main nonsurgical treatment options for thyroid cancer include:

Radiofrequency Ablation

  • Uses heat generated by radio waves to destroy thyroid nodules and small tumors.
  • Done as an outpatient procedure under local anesthesia.
  • Less invasive with a lower risk of complications than surgery.
  • Very effective for properly selected patients, with 90-95% success rates.
  • Preserves thyroid function and avoids risks of full thyroid removal.
  • Often, the best nonsurgical option for treating low-risk, early-stage thyroid cancers.

Radioactive Iodine (RAI) Therapy

  • Uses radioactive iodine to destroy cancerous thyroid cells.
  • The RAI is typically swallowed as a pill that goes directly to thyroid tissue.
  • Often used after surgery to kill any remaining cancer cells.
  • It can also be used as primary therapy without surgery.

External Beam Radiation

  • Radiation is directed at the thyroid from outside the body.
  • Typically requires 25-40 treatments over 5-8 weeks.
  • Used if RAI therapy is not effective.

Targeted Therapy Drugs

  • Medications that target specific flaws in cancer cells, like lenvatinib and sorafenib.
  • Block cancer growth and disrupt tumor blood supply.
  • For advanced cancers that don’t respond to RAI or radiation.

Active Surveillance or Watchful Waiting

Watchful waiting or active surveillance for thyroid cancer refers to a management strategy where the progression of the cancer is closely monitored without immediate intervention or treatment. This approach is typically considered for certain low-risk thyroid cancers, such as small, localized papillary thyroid cancers that are not causing symptoms or posing immediate health risks.

The rationale behind watchful waiting or active surveillance is that some thyroid cancers grow very slowly and may not significantly affect a person’s health during their lifetime. Immediate treatment, such as surgery or radioactive iodine therapy, can carry risks and lead to long-term consequences, including the need for lifelong thyroid hormone replacement therapy.

During watchful waiting or active surveillance, patients undergo regular check-ups, which may include ultrasound imaging of the thyroid and neck, blood tests to monitor thyroid function and cancer markers, and possibly biopsy procedures if there is concern about cancer growth or progression. The healthcare provider determines the frequency of these follow-ups based on the specifics of the patient’s condition.

If there are signs that the cancer is growing or spreading, or if the patient prefers to proceed
with treatment, the healthcare team may then recommend starting an active treatment plan.
This approach allows some patients to avoid or delay the potential side effects and
complications of treatment while keeping a close eye on their health.

The concept of active surveillance for thyroid cancer, particularly for low-risk papillary thyroid microcarcinomas, has been advanced and supported by several medical pioneers and institutions around the world.

Key figures and places include:

  1. Dr. Akira Miyauchi – A prominent figure in the field, Dr. Akira Miyauchi of Kuma Hospital in Japan, has conducted extensive research and published numerous studies on the outcomes of active surveillance for patients with small papillary thyroid carcinomas. His work has significantly contributed to accepting and implementing this management strategy in Japan and has influenced its consideration and adoption internationally.
  2. Dr. Yasuhiro Ito – Also associated with Kuma Hospital, Dr. Ito has worked closely with Dr.Miyauchi on research related to thyroid cancer surveillance and has contributed to the body of evidence supporting the safety and efficacy of this approach.
  3. Dr. Iain Ross McDougall – Although not directly associated with the inception of active surveillance, Dr. McDougall has been a significant figure in thyroid cancer treatment and management, including evaluating less aggressive approaches in appropriate patients.
  4. Johns Hopkins Medicine – In the United States, institutions like Johns Hopkins Medicine have been at the forefront of researching and offering active surveillance as a management option for patients with low-risk thyroid cancers. Dr. Julie Ann Sosa and Dr. Ralph P. Tufano, among others, have been involved in studies and guidelines development regarding the approach.
  5. Memorial Sloan Kettering Cancer Center (MSKCC) – MSKCC, particularly through the work of Dr. Luc G.T. Morris and Dr. Michael Tuttle, has contributed significantly to the research and clinical implementation of active surveillance for thyroid cancer. Their work has helped establish guidelines and patient selection criteria for this approach in the United States.

These pioneers, among others, have been instrumental in challenging the traditional paradigm of immediate surgery for all detected thyroid cancers, advocating for a more nuanced approach that considers the disease’s nature and the patient’s overall well-being. Their research and advocacy have led to a broader acceptance of active surveillance as a viable management strategy for certain patients with low-risk thyroid cancer, promoting patient-centered care and avoiding overtreatment.

Non-Surgical Treatment Process of Thyroid

If nonsurgical treatment is pursued, the process usually includes:

  1. Imaging tests like ultrasounds, CT scans, and MRIs to determine the extent of the tumor.
  2. Biopsy to confirm cancer and collect cells for specialized testing. This helps determine the specific variant and mutations present.
  3. Consultation with endocrinologist and oncologist to map out a treatment plan based on all test results and the individual case.
  4. Administration of the chosen nonsurgical treatment – such as swallowing a radioactive iodine pill or 25-35 radiation therapy sessions.
  5. Follow-up scans at 3, 6, and 12 months after finishing treatment to assess response. Blood tests to monitor thyroid hormone levels.
  6. If needed, additional rounds of RAI therapy or a different second-line treatment if the cancer does not sufficiently respond to the initial option.
  7. Long-term monitoring with annual scans for at least 5 years after going into remission to watch for potential recurrence.


Deciding Between Surgical vs Nonsurgical Treatments for Thyroid Cancer

  • Key factors in deciding which route to take include:
  • Type and stage of cancer – RAI works best for early-stage papillary/follicular variants. Advanced tumors often require surgery.
  • Overall health – Surgery may be too risky for some patients due to age or conditions like heart disease.
  • Potential side effects – Both options carry risks that need to be weighed.
  • Treatment goals – Is the aim to cure the cancer or slow progression?
  • Personal preferences – The patient’s desired level of treatment aggressiveness.

Many thyroid cancers are treated with a combination approach, using surgery followed by
RAI therapy or external radiation to maximize outcomes.

Ultimately there is no universal “right choice” – the best treatment path depends on each
patient’s unique case. Seeking multiple opinions can help weigh all options before deciding
on surgery or nonsurgical therapy for thyroid cancer.


Thyroid cancer can be treated without surgery using alternative options like radioactive
iodine and radiation therapy. Careful consideration of risks and goals is needed to determine
if nonsurgical treatment is suitable. While it may not cure advanced cancers, it provides a
viable path for some patients who wish to avoid or cannot undergo surgery.


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