Treatment of Recurrent Thyroid Cancer

This article discusses the treatment options for recurrent thyroid cancer, focusing on surgery and radioiodine therapy. It explores the effectiveness of these treatments and addresses controversies surrounding them. The article also highlights the importance of patient education and the socioeconomic factors that can impact treatment.

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Name of the student:
Name of the university:
Author note:

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Reviews topic and explains rationale for its selection in the context of client care:
Article 1
The thyroid cancer is one of the utmost common cancer and it frequently reoccurs in the
lymph node region of the neck. There are several cases where it has been seen that the tumour
is unable to detect during the surgery or ultrasound process. In this article it is discussed
about several reports have been evolved that supports ethanol and radiofrequency ablation.
And both the methods have shown advantages and disadvantages and it the ethanol ablation
is proved to be cheaper and less painful than radiofrequency process (Lee et al., 2014).
Article 2
In the second article it discusses about the various methods of treatment of thyroid cancer and
its reoccurrence. It uses surgical treatment, radioiodine therapy and L-thyroxine treatment.
And it also aims to analyse the chances of occurrence of the disease and treatment to reduce
the chances of its reoccurrence (Mihailovic, Nikoletic, & Srbovan, 2014).
Research findings into the decision-making for this client’s treatment
According to the Article 1 research finding, Ethanol ablation, radiofrequency ablation can be
mostly considered as treatment for recurrent thyroid cancer patients with high surgical threat.
RFA is superior on behave of treatment to ethanol ablation and less amount of treatment
periods is the benefit of RFA, on comparison to ethanol ablation. And the usage of ethanol
ablation is followed by radiofrequency treatment (Lee et al., 2014).
In the second article, the research findings reflect the usage of surgery and radiation with
another method where L- thyroxine treatment is used and followed by radioimmunoassay.
Recurrent thyroid cancer disease must be treated with the use of surgery or radioiodine

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management until reduction. Both the action with radioiodine and retreatment with
radioiodine are better and safe for the management of recurrent thyroid cancer, with no
adversative effects. It helps the patients to choose better treatment option that will reduce the
life risk and cure the disease (Mihailovic, Nikoletic, & Srbovan, 2014).
Compare and contrast or discussion of the treatment process.
In the article 1, the researcher focuses on the thyroid cancer treatment using Radiofrequency
ablation and ethanol ablation. And it is considered according to the research, a better non-
surgical treatment process for a patient with high risk of surgery. And it has been observed
that is has reduced the chances of recurrence of thyroid cancer, and reduces the risk of spread
to the other organs (Lee et al., 2014).
In article 2, it research was performed using various methods such a surgical treatment,
radioactive iodine ablation usage of L-thyroxine treatment at very suppressive amount which
was further followed by radioimmunoassay. And according to the study it was observed that
the patients who underwent radioactive iodine treatment and other treatments in the initial
stage has lesser chances of recurrent thyroid cancer then those who were treated with surgery.
In contrast, focusing on both of the articles, it can be stated that the treatment with the use of
radioactive iodine has better effective result then that of surgery. Many of the surgery cannot
be performed to every patient, as age is major factor in surgical treatments. And it induces
risk factor in the surgical process as it includes removal of the portion of the thyroid gland
(Mihailovic, Nikoletic, & Srbovan, 2014).
Key concepts related to the topic
In the first research article, the key concept is the treatment of thyroid cancer and the
recurrent thyroid cancer condition in patients using radioactive iodine treatment and ethanol
ablation. In the study, they treated 32 patients with recurrent thyroid cancer out of 35. They

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used regular follow-up ultrasound techniques to detect recurrent thyroid cancer. And
maximum patients had high surgical risk so they avoided the use of surgical treatment (Lee et
al., 2014).
In the second research proposal, they focused on the treatment of patients with thyroid cancer
using both surgical method as well as radioactive laser treatment. the researcher practiced on
51 patients from which 46 patients were treated with both thyroidectomy and radioactive
iodine treatment, 3 patients went through total thyroidectomy and rest 3 received subtotal
surgery of thyroid. Out of 51 patients 36 witnessed complete remission of the cancer, 14
patients from the rest were partially recovered and only one out of the 51 patients suffered
from advanced disease (Mihailovic, Nikoletic, & Srbovan, 2014).
Cultural, spiritual, and socioeconomic issues as applicable.
There are various in-built culturally rooted fears and misconception of thyroid treatment
using radioactive iodine and surgery. There are issues in the population concerning about the
word “radioactive” which raise up descriptions of hair loss and birth imperfections. It is
important for the patients to be educated enough about the disease in order to understand the
concept of treatment and the better outcome. Lack of education leads to wrong beliefs which
keeps the patients devoid of treatment that further leads to serious condition or sometimes
leads to death.
Scientists initiate that a person with lesser average domestic income is connected with a
better advanced phase of thyroid cancer at analysis. In count, they also observed that
progressive age is also related to a better progressive stage while diagnosis. Finally, with
analysis, they discovered that the chances of being analysed at an advanced stage drop by
~4% per year, signifying that thyroid cancer is being diagnosed former over time.

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The socioeconomic factor is one of the major issues in the treatment process, the cost of
treatment and medication sometimes become unaffordable by the patients that leads to
increase of the risk in the patient suffering from thyroid cancer.
Controversy related to recurrent thyroid cancer treatment
Recurrent thyroid cancer is often occurred after several years after the primary treatment of
the thyroid disease. The patient suffering from recurrent thyroid disease undergoes different
treatment such as, Surgical, Radiography and L-thyroxine treatment (Fagin & Wells, 2016).
These treatments are associated with various ethical and controversial issue. Radiography is
used in the medical examination by the use of radiographs. Radiography is done by emitting
radiation which can give rise to mutations at genetic level. In the case of thyroid cancer, it is
treated with radioiodine ablation, which is a radiation therapy used to destroy remaining
thyroid tissue after thyroidectomy. These mutations occurred due to radiography can either
give rise to other varieties of cancer or increases the risk of cancer in an individual suffering
from thyroid cancer (Dehbi, et al., 2019). Due to these, many people and general practitioner
try to avoid radiography to prevent future complications. Hence the use of radiography is a
controversial issue. If the surgery of the thyroid cancer fails or not up to the expectation, it
can give rise to recurrent thyroid cancer. Although the chances are extremely less but still it is
a controversial issue.
Soundness of research
The research proposals in both the topics has been proved to effective for the treatment of the
thyroid cancer and its recurrence. Patients were observed to have beneficial result and the
treatment process was easily accessible. The research has proved that the usage of radioactive
iodine for thyroid cancer and its recurrence is more effective then that od surgery, as in

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surgical treatment the risk factor is high and the chances of the cancer to occur again remains.
The radioactive iodine treatment has proved to be more effective and it reduces the cancer
occurrence and cures it to a better level focusing on the age group of the patient and other risk
factor. And it has also been seen that it is easily available and cost effective for patients with
low domestic income (Momesso et al., 2016).

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Protocol
1. Rationale
To estimate the effectiveness of radioiodine therapy, surgery and medication in the treatment
of recurrent thyroid cancer (Thyroidectomy). The protocol is designed for the treatment process
and contains all the principles of standardized procedure.
2. Definition
Thyroid cancer is an acute health disorder where cancer develops from the thyroid gland
tissues and it has potential to spread and effect other parts of the body. The treatment options
for thyroid cancer can be surgery, radiation treatment which includes radioactive iodine. But
there is chance where the thyroid cancer can re occur even after the treatment. the recurrent
thyroid cancer can occur after several years of the treatment process (Cabanillas, McFadden,
& Durante, 2016). It basically arises in the neck region such as lymph nodes, and is called
regional recurrence. In many cases the patients suffer distant metastases and the cancer
spreads to other regions of the body. These recurrences normally happen in the lungs and
bones (Lamartina et al., 2017).
3. Epidemiology
Thyroid cancer is one of the most common acute disease and has relatively good diagnosis. It
is found to recurs at the lymph nodes or distant organs. It repetition and mortality rate due to
thyroid cancer are around 20.5% and 8.5% in a period of 11 years. The surgical treatment
with the use of radioactive iodine is commended for recurrent thyroid cancer (Lamartina et
al., 2017). There are some recurrent cancers that cannot be detected during the surgery
without pre-surgical supervision or ultrasound. There are non-surgical methods that can

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eradicate these recurrences in the patients and can eliminate the need for operation and other
related difficulties. The recurrence of thyroid cancer depends on the patients age and the
tumour size.
4. Physical exam
In the early stage of recurrent thyroid cancer, very few symptoms or no symptoms are
observed. The major symptom of such cancer is formation of lump or swelling in the front
portion of the neck and it also effects the lymph nodes in your neck region which becomes
swollen. There are other physical exams for the recurrent thyroid cancer such as impenetrable
hoarseness that turns worse after a few days and the neck region starts paining.
5. Diagnostic tests
The recurrent thyroid cancer can be managed successfully with the use of surgical and
radioiodine treatment methods on the early stage of the disease and operative methods for the
recognition of the disease are very critical. The observation methods for the recurrent thyroid
cancer includes radioiodine scanning of the entire body and serum thyroglobulin
measurement. The lymph node metastases can be recognized using ultrasonography,
computed tomography and magnetic resonance imaging.
A new methodology has been induced where the circulating thyroid cells can be detected
using PCR-assay for thyroglobulin mRNA in the blood. This method can be used in the
diagnosis of recurrent thyroid cancer (Lamartina et al., 2017).
Another method is PET/CT scanning which is carried out in the region that has experienced
surgery.

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6. Management
In order to improve the quality of life of the patients distress from recurrent thyroid cancer,
three concerns are needed. At first it is the sufficient helpful care for the toxicities, then is the
patient instruction, because it is important to have early interaction with medical workers
which is necessary for early acknowledgement, which leads to optimum management. Last is
the structure of the medical organization, because it is essential to admit calls from patients
24 hours, every day.
Patients medication and therapy sessions should be revised accordingly, the improvement or
the adverse effect of the medication should be monitored in order to avoid any further risk
(Bibbins et al., 2017).
Patients education is an important part of the management process in recurrent thyroid
cancer. As cancer cannot be neglected and it requires early assistance by the medical facilities
in order to get effective cure. And for this education is important in the patient and that
should start former to the treatment session and should be continued throughout the session.
The patient should be informed about the adverse effect to the disease (Haugen et al., 2016).
A multidisciplinary team should be prepared by the medical organization in order to provide
better treatment to the patient that has the chances of recurrent thyroid cancer.
7. Treatment
The treatment of recurrent thyroid cancer is dependent on various factors that includes earlier
treatment process. It includes focusing on the cell type that has converted to cancerous and
understand whether the cell can retort to radioactive iodine usages, the location of the cancer
recurrence and other considerations (Lee et al., 2014). The iodine is used by the thyroid gland
to secret thyroid hormones. And the radioactive form of these iodine is collected in the same
way as natural iodine. The iodine is only utilized by the thyroid and no other parts of the

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body. And the excessive radioactive iodine is released out of the body via urine. Hence, it
becomes the safest way to diagnose and treat the recurrent thyroid cancer (Momesso et al.,
2016).
Another process of treatment is surgery, which is a key component in the treatment of thyroid
recurrence which followed by repeated treatment using radioiodine. In the surgery treatment,
the patient suffering from recurrent thyroid cancer has already remove a part of their thyroid
and the rest will be removed by a full thyroidectomy and to remove cancer present in any
other portion of the neck.
L-thyroxine treatment can be performed by providing small dosage to the patient, and this
treatment includes further ultrasonography and test centre testing for thyroglobulin, Tgb
antibodies and thyroid stimulating hormones level in blood. After which the
electrochemiluminescence immunoassay is performed and the whole body is scanned with
111MBq. And it has been observed that the patient is witnessed with complete remission of
the thyroid cancer (Mihailovic, Nikoletic, & Srbovan, 2014).
VEGFR-targeted TKIs for recurrent thyroid cancer, including RAI-refractory DTC and MTC.
This treatment process includes oral medication, such as uptake of Sorafenib, Lenvatinib,
Vandetanib and Cabozantinib. These oral kinase inhibitors are used to inhibit VEGFR and
has shown effective result in recurrent thyroid cancer.
Kinase inhibitors
8. Prevention
Thyroid cancer has a greater chance to reoccur. And to reduce the chances of the recurrent
thyroid cancer to evolve, few common risk factors needs to be avoided;

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 Avoid radiation exposure: The primary risk factor due to which the chances to thyroid
cancer to re occur is radiation. As the cells have already been through treatment and
thyroidectomy, so the cells at that region become more sensitive to radiations
(Kitahara, & Sosa, 2016).
 Appropriate amount of iodine uptake: Iodine deficiency is the one of the reason
behind thyroid malfunction and increase the risk of cancer reoccurrence. In order to
avoid recurrent thyroid cancer, appropriate amount of iodine needs to be supplied to
the gland.
 Regular thyroid cancer screening: Even though, the surgery removes the cancer cells
from the thyroid, there are chances for the thyroid cancer to re occur (Bibbins et al.,
2017). So a routine screening should be done, so that if any chances of cancer is
observed, it can be treated in the primary level.
 Radiotherapy: If recurrent thyroid cancer is diagnosed in primary stage, radiotherapy
should be provided as early as possible to avoid spread of the cancer to other part of
the body.
 Surgery: Removal of the thyroid region where the cancer is observed to be
generating, in order to reduce the risk of the spread (Kitahara, & Sosa, 2016).
9. Development and approval of standardized procedure
 The standardized procedure was developed by the direct supervisor or the clinical
physician and the nurse practitioners.
 The standardized procedure was developed and approved by the organization higher
authority and would be reviewed annually as and when required.
Review Date______________

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10. The developed standardized procedure was approved by the oncology
department chief, the director of nursing practice, Supervising physician
and medical group administrator.
Interdisciplinary Committee.
_______________________________ Date_______________________
Oncology Department Chief
_______________________________ Date_______________________
Supervising Physician
_______________________________ Date_______________________
Medical group Administrator
_______________________________ Date_______________________

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Reference
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Doubeni, C. A., ... & Landefeld, C. S. (2017). Screening for thyroid cancer: US
Preventive Services Task Force recommendation statement. Jama, 317(18), 1882-
1887.doi:10.1001/jama.2017.4011
Cabanillas, M. E., McFadden, D. G., & Durante, C. (2016). Thyroid cancer. The Lancet,
388(10061), 2783-2795. https://doi.org/10.1016/S0140-6736(16)30172-6
Dehbi, H. M., Mallick, U., Wadsley, J., Newbold, K., Harmer, C., & Hackshaw, A. (2019).
Recurrence after low-dose radioiodine ablation and recombinant human thyroid-
stimulating hormone for differentiated thyroid cancer (HiLo): long-term results of an
open-label, non-inferiority randomised controlled trial. The Lancet Diabetes &
Endocrinology, 7(1), 44-51.https://doi.org/10.1016/S2213-8587(18)30306-1
Fagin, J. A., & Wells Jr, S. A. (2016). Biologic and clinical perspectives on thyroid cancer.
New England Journal of Medicine, 375(11), 1054-1067. DOI:
10.1056/NEJMra1501993
Haugen, B. R., Alexander, E. K., Bible, K. C., Doherty, G. M., Mandel, S. J., Nikiforov, Y.
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https://doi.org/10.1089/thy.2015.0020
Kitahara, C. M., & Sosa, J. A. (2016). The changing incidence of thyroid cancer. Nature
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Lamartina, L., Borget, I., Mirghani, H., Al Ghuzlan, A., Berdelou, A., Bidault, F., ... & Hartl,
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