Thyroid cancer is the most common cancer of the hormone glands, and most types are highly curable. The main types are papillary, the most common by far, follicular, medullary and the rare but aggressive anaplastic thyroid cancer. For many people, the biggest change in recent years is not more treatment but less: research from Japan, the United Kingdom and France shows that many low-risk thyroid cancers can be safely watched or treated with less surgery and without radioactive iodine. For advanced thyroid cancer, targeted drugs have transformed the outlook. This article explains the options at each stage.
Small Papillary Cancers: Active Surveillance From Japan
Since 1993, Kuma Hospital in Kobe, Japan, has offered people with very small papillary cancers, one centimeter or less, the choice of careful monitoring with regular ultrasound instead of immediate surgery. Over ten years, fewer than one in ten of these small cancers grew, and those that did could still be removed successfully, with no deaths from thyroid cancer in the people who chose monitoring.1 Active surveillance is now accepted in international guidelines for carefully selected patients.
Surgery
Most thyroid cancers are treated with surgery. For low-risk cancers, removing only the affected half of the thyroid, called a lobectomy, is often enough and may allow the remaining thyroid to keep making its own hormone. Larger or higher-risk cancers are treated by removing the whole gland, sometimes with nearby lymph nodes.
Radioactive Iodine: Often Not Needed for Low-Risk Cancer
For decades, most people had radioactive iodine after thyroid surgery to destroy any remaining thyroid tissue. Two randomized trials have now shown that many low-risk patients can safely skip it. In the UK IoN trial of 504 people, published in The Lancet in 2025, about 98 percent of those who did not receive radioactive iodine were free of cancer after five years, compared with about 96 percent of those who did.2 The French ESTIMABL2 trial reached the same conclusion.3 Avoiding radioactive iodine spares people its side effects, which can include dry mouth, changes in taste and damage to the salivary glands.
Advanced Thyroid Cancer
When radioactive iodine stops working. In the SELECT trial, led from Gustave Roussy in France, lenvatinib extended the time before the cancer grew to 18.3 months, compared with 3.6 months with placebo.4 In some patients, drugs that block the MAPK growth pathway can restore the cancer’s ability to absorb radioactive iodine, making it treatable again.5
Medullary thyroid cancer. Many medullary cancers carry a RET mutation. In the LIBRETTO-531 trial, also led from Gustave Roussy, the RET-blocking drug selpercatinib controlled the cancer far longer than older drugs.6 In China, anlotinib is approved for advanced medullary thyroid cancer.
Anaplastic thyroid cancer. This rare, fast-growing cancer once had almost no effective treatment. For anaplastic cancers with a BRAF V600E mutation, the combination of dabrafenib and trametinib shrank tumors in about seven in ten patients,7 and it is now used to shrink tumors enough for surgery.
Testing the Tumor
Molecular testing for BRAF, RAS and RET mutations and for gene fusions such as NTRK and ALK guides treatment of advanced thyroid cancer and can open targeted options. See our articles on tumor DNA and RNA sequencing, cancer driver pathways and head and neck cancer.
How Cancer Expert MD Helps
Cancer Expert MD provides education and consultation for people with every type and stage of cancer, and specializes in Stage IV and metastatic cancer. Our guide to what to do when treatment stops working explains re-testing and the next steps, and our book, The New Reality of Cancer, covers testing and treatment across all cancers.
Frequently Asked Questions
Is thyroid cancer curable?
Most thyroid cancers are highly curable, especially papillary and follicular types found early.
Do small thyroid cancers need surgery right away?
Not always. Japan’s Kuma Hospital has shown that very small papillary cancers can be safely watched with regular ultrasound, and fewer than one in ten grew over ten years.
Do I need radioactive iodine after thyroid surgery?
Many people with low-risk cancer do not. The UK IoN and French ESTIMABL2 trials found that skipping it worked just as well for low-risk cancer.
What treatments exist for advanced thyroid cancer?
Targeted drugs such as lenvatinib, selpercatinib for RET-mutated cancers, and dabrafenib with trametinib for BRAF-mutated anaplastic cancer.
About the author. Dr. Silver, MD, graduated from Temple University School of Medicine, trained as an interventional cardiologist, and has practiced medicine for nearly fifty years. A lymphoma survivor of about twenty-five years, he is co-author, with Dr. Lindmeier, DHSc, of The New Reality of Cancer: The Science of Recovery. Read more about Dr. Silver, MD.
Research by Dr. Lindmeier, DHSc, cancer educator and co-author of The New Reality of Cancer.
This article is for general education only and is not individual medical advice. Always consult your own doctor before making any changes to your care.
© 2026 Cancer Expert MD, Dr. Silver, MD, and Dr. Lindmeier, DHSc. All rights reserved. This article draws on the research in The New Reality of Cancer and may not be copied, republished or distributed without written permission.
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References
- Ito Y, Miyauchi A, Kihara M, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014;24(1):27–34.
- Mallick U, et al. Thyroidectomy with or without postoperative radioiodine for patients with low-risk differentiated thyroid cancer in the UK (IoN): a randomised, multicentre, non-inferiority trial. The Lancet. 2025;406(10498):52–62.
- Leboulleux S, Bournaud C, Chougnet CN, et al. Thyroidectomy without radioiodine in patients with low-risk thyroid cancer (ESTIMABL2). New England Journal of Medicine. 2022;386(10):923–932.
- Schlumberger M, Tahara M, Wirth LJ, et al. Lenvatinib versus placebo in radioiodine-refractory thyroid cancer (SELECT). New England Journal of Medicine. 2015;372(7):621–630.
- Ho AL, Grewal RK, Leboeuf R, et al. Selumetinib-enhanced radioiodine uptake in advanced thyroid cancer. New England Journal of Medicine. 2013;368(7):623–632.
- Hadoux J, Elisei R, Brose MS, et al. Phase 3 trial of selpercatinib in advanced RET-mutant medullary thyroid cancer (LIBRETTO-531). New England Journal of Medicine. 2023;389(20):1851–1861.
- Subbiah V, Kreitman RJ, Wainberg ZA, et al. Dabrafenib and trametinib treatment in patients with locally advanced or metastatic BRAF V600-mutant anaplastic thyroid cancer. Journal of Clinical Oncology. 2018;36(1):7–13.
This article is for education only. It is not medical advice and does not diagnose or treat any condition. Cancer Expert MD has no financial relationship with any laboratory, drug maker, supplement company, clinic or hospital.
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