Medication for Thyroid Nodules & Cancers
NYU Langone doctors prescribe a variety of medications to manage certain types of thyroid nodules, including toxic thyroid nodules, toxic multinodular goiters, and thyroid cancers.
Toxic nodules and multinodular goiters, which cause hyperthyroidism, can often be managed with antithyroid agents before turning to treatments such as radioactive iodine therapy or surgery.
Antithyroid medications, which include methimazole and propylthiouracil, reduce the amount of hormone produced by the thyroid. They control, but do not cure, hyperthyroidism.
Taken by mouth, these medications can be used from several months to years, depending on your doctor’s recommendations.
During treatment, doctors monitor the thyroid hormone levels in your blood to determine whether the medications are working. They also monitor the amount of thyroid-stimulating hormone (TSH). TSH is secreted by the pituitary gland and stimulates the thyroid to produce thyroid hormone.
In addition to antithyroid medications, your doctor may prescribe a class of medications known as beta blockers for toxic nodules and multinodular goiters causing hyperthyroidism. Beta blockers do not change the amount of thyroxine your thyroid produces but rather block the hormone’s effects on your body. The medication can relieve symptoms such as increased heart rate and palpitations within hours to days of taking it.
If the thyroid gland has been surgically removed or destroyed with radioactive iodine therapy, your doctor may prescribe a synthetic thyroid medication called levothyroxine. It is taken by mouth at the same time each day to ensure that you do not develop hypothyroidism, in which thyroid hormone levels are too low.
In some people with thyroid cancer, slightly higher than normal doses of levothyroxine are prescribed to suppress the normal production of thyroid-stimulating hormone by the pituitary. This approach can help block the stimulating effects that the hormone can have on thyroid cancer and prevent a recurrence of follicular or papillary thyroid cancer.
NYU Langone doctors may prescribe chemotherapy, a group of drugs that target cancer cells throughout the body, for people with thyroid cancer that has spread to other parts of the body, such as the liver or lungs.
Most people with papillary carcinoma or follicular carcinoma experience remission after surgery, with or without radioactive iodine therapy, but a small number do not. Also, aggressive thyroid cancers—such as medullary or anaplastic thyroid cancer—do not respond to radioactive iodine therapy and may require chemotherapy or targeted drugs after surgery.
Chemotherapy drugs are often given through a vein with intravenous (IV) infusion or by mouth. While most thyroid cancers are not sensitive to chemotherapy, these drugs may help manage anaplastic thyroid cancer when combined with external beam radiation therapy.
Our doctors usually give chemotherapy a few times each week, every three or four weeks. This cycle may be repeated several times.
NYU Langone doctors may also prescribe targeted drugs to treat thyroid cancer that has spread or returned after treatment. These drugs are designed to destroy cancer cells while sparing healthy cells, which may result in fewer side effects than chemotherapy.
Several targeted medications are available to treat thyroid cancer.
NYU Langone doctors may use a drug called sorafenib to treat advanced papillary carcinoma or follicular carcinoma that has recurred or does not respond to radioactive iodine therapy. Sorafenib blocks certain proteins that “tell” cancer cells to multiply and form new blood vessels. Sorafenib is taken daily by mouth.
Another targeted drug, vandetanib, works like sorafenib but is approved to treat medullary thyroid cancers that cannot be removed with surgery, have spread to other parts of the body such as the lungs or liver, or are worsening. This drug is taken daily by mouth.
People with advanced medullary thyroid cancer may benefit from cabozantinib, which blocks proteins that help cancer cells survive.
Managing Side Effects
Thyroid hormone is well tolerated, although the compounds used to create the pills may rarely cause allergies. Beta blockers can cause fatigue, cold hands, and headache, and antithyroid agents may lead to joint aches, nausea, changes in liver function, and lower levels of white blood cells, which can increase the risk of infection.
Chemotherapy drugs may cause nausea, vomiting, and diarrhea. Although targeted drugs are less likely to cause side effects, they may result in constipation, stomach pain, high blood pressure, rash, fatigue, and headache.
If you are experiencing any side effects, tell your NYU Langone doctor, who can adjust the dose of the drug, prescribe another, and refer you to specialists who provide support services and integrative therapies.
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