Thyroid Cancer

By Alan Christiansen, NMD

Thyroid cancer is the most common endocrine cancer and fastest increasing type of cancer in the United States.  In some parts of the world, the yearly incidence has doubled in the last decade alone.  The most common type of thyroid cancer is papillary and it has a 10-year survival rate of 90-95%.  The main elements of its treatment include thyroidectomy, post-surgical radioiodine administration (RIA,) and therapeutic thyrotropin suppression for life.

Historically, RIA has relied on inducing a hypothyroid state to maximize radioiodine uptake in cells with thyroid histology.  This causes the need for greater amounts of radiation and the symptoms and complications of being severely hypothyroid following surgery.  Recombinant human thyoritropin (Thyrogen, Genzyme, USA) is a Thyroid hormone-releasing hormone analog that allows patients to achieve a TSH elevation without hypothyroidism.  This also lets less radioiodine be needed and allows it to better target thyroid tissues.

In a recent study fifteen patients with thyroid cancer who were followed for 24 months after treatment with Thyrogen while receiving a lower than typical dose of radioiodine (<100 mCi.)  Their success rate for full ablation (88.2%) was similar to that of higher dose radiation.

The clinical relevance of these findings to Naturopathic Physicians is that it will allow them to better advocates for their patients. Although Thyrogen is available and usually not out of pocket, many oncologists and endocrinologists do not yet routinely offer it.  By encouraging your patients and their other providers to make use of this development, you can prevent many short-term and likely some long team complications of treatment

Reference: Mylonas C, Zwas S, et al. Recombinant human thyroid-stimulating hormone in
radioiodine thyroid remnant ablation.  2014. IMAJ. February.

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