Thyroid Cancer Treatment in Sydney

Thyroid cancer is the most common endocrine malignancy in Australia, with over 3,000 new cases diagnosed each year. It typically presents as a thyroid nodule or neck lump and has an excellent prognosis when detected early, with five-year survival rates exceeding 95 percent for the most common types. Treatment centres on surgical removal of the thyroid gland, often followed by radioactive iodine therapy and long-term hormone management.

Types of Thyroid Cancer

Thyroid cancer is classified into several types based on the cell of origin, each with different behaviour and prognosis:

Papillary thyroid cancer (PTC): the most common type, accounting for approximately 80 percent of cases. It tends to grow slowly and often spreads to cervical lymph nodes but has an excellent prognosis
Follicular thyroid cancer (FTC): accounts for 10 to 15 percent of cases. It may spread via the bloodstream to distant sites such as bone and lungs but generally carries a good prognosis
Medullary thyroid cancer (MTC): arises from parafollicular C cells and accounts for 3 to 5 percent of thyroid cancers. It can be sporadic or hereditary (associated with MEN2 syndrome) and produces calcitonin, which serves as a useful tumour marker
Anaplastic thyroid cancer (ATC): rare (less than 2 percent) but highly aggressive. It typically presents in older patients with a rapidly enlarging neck mass and requires urgent multidisciplinary management
Thyroid lymphoma: rare, usually arising on a background of Hashimoto's thyroiditis

Symptoms of Thyroid Cancer

Many thyroid cancers are asymptomatic and discovered incidentally. When symptoms occur, they may include:

A new or growing lump in the front of the neck
Enlarged, firm lymph nodes in the neck
Hoarseness or voice changes that persist beyond two weeks
Difficulty swallowing or a sensation of something stuck in the throat
Neck pain or discomfort radiating to the ears
Breathing difficulty (with advanced disease)
A rapidly enlarging neck mass (concerning for anaplastic thyroid cancer)

Risk Factors

Radiation exposure: previous radiation to the head and neck region, particularly during childhood, is the strongest known risk factor
Family history: first-degree relatives of thyroid cancer patients have an increased risk. MEN2 syndrome (hereditary medullary thyroid cancer) requires genetic screening
Sex and age: thyroid cancer is three times more common in women and typically diagnosed between ages 25 and 65
Iodine status: iodine deficiency increases the risk of follicular thyroid cancer
Pre-existing thyroid disease: Hashimoto's thyroiditis is associated with thyroid lymphoma
Genetic syndromes: familial adenomatous polyposis, Cowden syndrome and Carney complex carry increased thyroid cancer risk

Diagnosis

At Central Sydney ENT, thyroid cancer is diagnosed through a structured pathway:

Clinical assessment: Thorough neck examination including palpation of the thyroid and cervical lymph nodes. A fixed, hard nodule or palpable lymph nodes raise clinical suspicion.

Ultrasound-guided fine needle aspiration (FNA): The cornerstone of thyroid cancer diagnosis. Suspicious features on ultrasound (irregular margins, microcalcifications, taller-than-wide shape, extrathyroidal extension) prompt FNA biopsy. Results are classified using the Bethesda reporting system.

CT or MRI: Cross-sectional imaging may be required to assess the extent of disease, particularly for larger tumours, suspected invasion of adjacent structures, or evaluation of deep cervical lymph nodes not well visualised on ultrasound.

Laryngoscopy: Flexible laryngoscopy is performed pre-operatively to assess vocal cord function, particularly if there is hoarseness or if the tumour is close to the recurrent laryngeal nerve.

Genetic testing: For medullary thyroid cancer, RET proto-oncogene testing is essential to identify hereditary cases (MEN2A and MEN2B) and guide family screening.

Treatment Options

Surgery

Surgery is the primary treatment for thyroid cancer. The extent of surgery depends on the type, size and stage of the cancer:

Total thyroidectomy: removal of the entire thyroid gland. Standard treatment for most thyroid cancers over 1 cm or with concerning features
Hemithyroidectomy: removal of one thyroid lobe. May be sufficient for small (under 1 cm), low-risk papillary thyroid cancers without lymph node involvement
Central neck dissection: removal of lymph nodes in the central compartment of the neck (level VI). Performed when lymph node involvement is confirmed or suspected
Lateral neck dissection: removal of lymph nodes in the lateral neck (levels II-V). Required when lateral lymph node metastases are identified

Our head and neck surgeons: including Dr Alexander Zhang, Dr Rahuram Sivasubramaniam and Dr Jareen Ebenezer: perform thyroid cancer surgery with intraoperative nerve monitoring to protect the recurrent laryngeal nerves and careful preservation of parathyroid glands.

Radioactive Iodine (RAI) Therapy

Following total thyroidectomy for differentiated thyroid cancer (papillary and follicular), radioactive iodine therapy may be administered to destroy any remaining thyroid tissue and microscopic disease. This treatment is coordinated with nuclear medicine specialists and is typically given 4 to 6 weeks after surgery.

TSH Suppression and Hormone Replacement

After total thyroidectomy, patients take levothyroxine (thyroid hormone replacement) for life. In thyroid cancer patients, the dose is often adjusted to suppress TSH to a level appropriate for their risk category, reducing the stimulus for any remaining cancer cells to grow.

When to See an ENT Specialist

You should seek urgent referral to an ENT or head and neck specialist if:

A thyroid nodule biopsy has returned a suspicious or malignant result
You have a thyroid nodule with associated hoarseness
You have a rapidly enlarging neck mass
You have a thyroid nodule with enlarged neck lymph nodes
You have a family history of thyroid cancer or MEN2 syndrome
You have had previous head and neck radiation

Related Conditions

Thyroid cancer is closely linked to several other conditions treated at Central Sydney ENT:

Thyroid Nodules: the most common presentation leading to thyroid cancer diagnosis
Parathyroid Disease: parathyroid glands are carefully preserved during thyroid surgery
Hoarse Voice: voice changes may indicate nerve involvement by thyroid cancer

Common Questions

Thyroid Cancer FAQ

What is the survival rate for thyroid cancer? +

The prognosis for thyroid cancer is generally excellent. Papillary thyroid cancer, which accounts for approximately 80 percent of cases, has a five-year survival rate exceeding 98 percent when treated appropriately. Follicular thyroid cancer also has a very good prognosis. Less common types such as medullary and anaplastic thyroid cancer have more variable outcomes.

What are the different types of thyroid cancer? +

The main types are papillary thyroid cancer (most common, approximately 80 percent of cases), follicular thyroid cancer (10 to 15 percent), medullary thyroid cancer (3 to 5 percent, arising from calcitonin-producing C cells), and anaplastic thyroid cancer (rare but aggressive). Papillary and follicular types are classified as differentiated thyroid cancers and generally have excellent prognoses.

Will I need radioactive iodine after thyroid surgery? +

Not all thyroid cancer patients require radioactive iodine (RAI) therapy. It is typically recommended for intermediate or high-risk differentiated thyroid cancers to destroy any remaining thyroid tissue and reduce the risk of recurrence. Low-risk papillary thyroid cancers treated with surgery alone often do not require RAI. Your specialist team will discuss whether RAI is recommended based on the final pathology.

What follow-up is needed after thyroid cancer treatment? +

Long-term follow-up is essential and typically includes regular blood tests for thyroglobulin (a tumour marker) and thyroid function, periodic neck ultrasound to monitor for recurrence, and clinical examinations. Follow-up frequency depends on risk stratification but is usually every 6 to 12 months initially, extending to annual reviews for low-risk patients.

Does Central Sydney ENT treat thyroid cancer? +

Yes. Central Sydney ENT has fellowship-trained head and neck surgeons with subspecialty expertise in thyroid cancer surgery. We work within multidisciplinary teams including endocrinologists, nuclear medicine physicians and oncologists to provide comprehensive thyroid cancer care. Surgery is performed across our seven Sydney locations.