Most thyroid cancers are not fatal and can be cured. The most common types, papillary and follicular, can usually be cured [2]; in papillary cancer, almost all patients are alive 5 years later and more than 9 in 10 are alive 20 years later [1]. Medullary cancer has a good outcome if it is found early [6], but anaplastic cancer, which is very rare, grows quickly, is dangerous and needs urgent treatment [7].
Key points
- In the United States, almost all patients with thyroid cancer are alive 5 years later [3].
- In a large study in the United States, more than 8 in 10 thyroid cancers were papillary [11]; this type usually grows slowly, and more than 9 in 10 patients are alive 20 years later [1].
- "Malignant thyroid cancer" simply means thyroid cancer; every cancer is malignant. What determines the chance of cure is the type of cancer, its stage and the patient's age [10, 2].
- Age matters: in people younger than 55, differentiated thyroid cancer is stage 1 even if it has reached the lymph nodes in the neck [4].
- The cancer can come back, mostly in the neck; that is why regular follow-up after treatment matters [1].
- Anaplastic cancer makes up fewer than 2 in 100 thyroid cancers, but it grows very quickly and must be checked and treated urgently [7].
What does "malignant thyroid cancer" mean? Does malignant mean deadly?
"Malignant" means cancerous. A malignant tumour can invade nearby tissues and spread to other parts of the body; a "benign" tumour does not, and after removal it usually does not grow back [10]. So "malignant thyroid cancer" is simply "thyroid cancer"; there is no such thing as a benign cancer.
But malignant does not mean deadly. Most thyroid cancers are "differentiated" (papillary and follicular), and these can usually be cured [2]. What determines the chance of cure is the type of cancer, its size and spread, and the patient's age [2, 4].
If you have only a nodule on ultrasound so far and the biopsy result is not clear yet, most nodules are not cancer; see Thyroid nodule and TI-RADS: when is it cancer? and What is the difference between a benign and a malignant tumour?
Thyroid cancer survival rate and chance of cure by type
| Type | How common | Treatment outcome |
|---|---|---|
| Papillary | The most common; more than 8 in 10 thyroid cancers [11] | Almost all are alive 5 years later and more than 9 in 10 are alive 20 years later [1] |
| Follicular | Less common | Like papillary, it is a differentiated type and can usually be cured [2] |
| Medullary | 1 to 2 in 100 [6] | At 10 years, everyone with stage 1 and more than 9 in 10 with stage 2 are alive; with stage 4, about 2 in 10 [6] |
| Anaplastic | Fewer than 2 in 100 [7] | Grows very quickly and is dangerous; needs urgent treatment [7] |
Your type of cancer is written in your pathology report. These figures are averages from large groups; your own doctor can best explain what they mean for you.
Is papillary thyroid cancer deadly? What does classic papillary mean?
Papillary cancer usually grows slowly and has an excellent outcome with treatment: almost all patients are alive 5 years later, and more than 9 in 10 are alive 10 and 20 years later [1]. The US National Cancer Institute says papillary and follicular cancers can be treated and can usually be cured [2].
The pathology report also gives the subtype of papillary cancer. "Classic" is the usual form of papillary cancer; there are also rarer subtypes, such as "tall cell", "hobnail" and "columnar cell" [1]. The doctor takes the subtype into account, together with the size and spread of the tumour, when estimating the risk of the cancer coming back [1].
A very small papillary cancer (1 cm or less) that has not spread is sometimes followed only with regular ultrasound. At a hospital in Japan, of 1,235 patients who chose monitoring and were followed for about 6 years on average, none developed cancer that spread to distant parts of the body or died of this cancer; of the 191 who later had surgery for various reasons, none died of the cancer either [5]. Read more: Active surveillance for papillary microcarcinoma.
Age and stage: why do younger people do better?
In papillary and follicular cancers, age is one of the most important factors. In current staging, the age cut-off is 55 [4]:
- Younger than 55: if the cancer has not spread to distant parts of the body, it is stage 1 whatever its size and lymph node involvement; only spread to distant parts (for example the lungs) counts as stage 2 [4].
- 55 and older: the stage is set from 1 to 4 by the size of the tumour, lymph node involvement and growth outside the thyroid [4].
As an estimate, 10 years later this many patients have not died of this cancer: almost all with stage 1, about 9 in 10 with stage 2, about 6 to 7 in 10 with stage 3 and fewer than half with stage 4 [4]. For a general explanation of stages, see What are the stages of cancer?
Medullary and anaplastic thyroid cancer
Medullary cancer starts in different cells of the thyroid and makes up 1 to 2 in every 100 thyroid cancers [6]. It is sometimes inherited, so all patients, even those with no family history, are offered a test for the RET gene [6]. The outcome depends on the stage: at 10 years, everyone with stage 1, more than 9 in 10 with stage 2, about 7 in 10 with stage 3 and about 2 in 10 with stage 4 were alive [6]. People whose calcitonin blood test (a marker of this cancer) becomes normal after surgery are almost all alive 10 years later [6].
Anaplastic cancer makes up fewer than 2 in 100 thyroid cancers, but it usually shows up as a lump in the neck that grows very quickly [7]. In the past, only about 2 in 10 patients were alive one year later [7]. Today a test for the BRAF gene should be done very quickly [7]; in patients with this gene change, about half were alive one year later with two targeted tablets in a small study [8].
How likely is thyroid cancer to come back?
In papillary cancer, the disease comes back in some patients (between about 1 in 7 and 1 in 3), most often where the thyroid was or in the lymph nodes of the neck, and rarely in distant parts of the body [1]. If the cancer comes back, there is treatment for that too, such as further surgery or radioactive iodine; the doctor decides based on where it is and how large it is [1].
After surgery, the doctor estimates each patient's risk of the cancer coming back: low, low to intermediate, intermediate to high, or high [1]. This estimate decides whether radioactive iodine is needed and how closely you are followed up [1]. Follow-up is mostly with neck ultrasound and blood tests; see the details in Thyroid hormone, TSH suppression and follow-up.
Life after thyroid surgery
- After the whole thyroid is removed, the body no longer makes thyroid hormone, and you need to take a thyroid hormone tablet every day [2]. With the tablet and regular blood tests, the hormone level is kept right.
- After half of the thyroid is removed, the remaining half makes enough hormone in most people. In a large review, about 1 in 5 people developed an underactive thyroid, mostly mild, and only about 1 in 25 had a clearly underactive thyroid [9].
- Radioactive iodine is not needed for everyone; many low-risk patients do not need it after surgery [1]. For more details and advice about pregnancy, see the Thyroid cancer page.
When should I see a doctor?
Before diagnosis or after treatment, tell your doctor promptly about any of these [2]:
- A new lump or swelling in the neck
- Hoarseness that does not go away
- Difficulty or pain when swallowing
- Difficulty breathing
A lump in the neck that is growing quickly must be checked urgently [7]. Severe shortness of breath or being unable to swallow needs urgent care; call your local emergency number.
Frequently asked questions
What is the life expectancy with thyroid cancer?
Can thyroid cancer that has spread to the lymph nodes in the neck be cured?
What if thyroid cancer has spread to the lungs or bones?
In people younger than 55, this is stage 2, and as an estimate about 9 in 10 have not died of this cancer after 10 years [4]. In people aged 55 or older, the same situation counts as stage 4 [4]. Treatment is with radioactive iodine and, if the disease does not respond to iodine, with targeted tablets [1]; see Thyroid cancer.
Is thyroid cancer hereditary?
Do I need surgery straight away?
Most thyroid cancers grow slowly [1], and there is usually time to discuss the type of surgery with your doctor or get a second opinion. For a very small papillary cancer, regular monitoring without immediate surgery is also possible [5]. The exception is a lump that is growing very quickly; it must be checked urgently [7].
I have a thyroid nodule; does it mean I have cancer?
Very likely not; most thyroid nodules are not cancer [2]. See Thyroid nodule and TI-RADS: when is it cancer? and What are the symptoms of thyroid cancer?
Prognosis, staging and risk of recurrence (for physicians)
For physicians
Differentiated cancer (ATA 2025). PTC is usually indolent; survival 96% at 5 years, 93% at 10 years and more than 90% at 20 years; mortality 1% to 6.5% and overall recurrence 15% to 35%, usually in the thyroid bed or cervical lymph nodes and rarely at distant sites. ATA 2025 recurrence-risk categories: low (<10%), low-intermediate (10% to 15%), intermediate-high (16% to 30%) and high (>30%). An excellent response means no biochemical or structural evidence of persistent disease [1]. In SEER-9 (1974 to 2013, 77,276 patients), PTC was the most common type with 64,625 cases, and incidence-based mortality for distant-stage PTC rose by 2.9% per year [11]. USPSTF (2017): overall 5-year survival for thyroid cancer 98.1% [3].
AJCC 8th edition. The age cut-off rose from 45 to 55 years (in a validation of about 9,500 patients, 12% were downstaged, with 98% 10-year disease-specific survival in the downstaged group). Younger than 55: stage I any T and any N with M0, stage II with M1. 55 and older: I T1–T2 N0/Nx; II T3a (more than 4 cm and confined to the thyroid), T3b (gross extension only into the strap muscles) or N1; III gross extension into major neck structures; IVA extension into the prevertebral fascia or encasement of major vessels; IVB distant metastases. Expected 10-year disease-specific survival: I 98% to 100%, II 85% to 95%, III 60% to 70%, IV (IVA and IVB) less than 50%. Anaplastic cancer: IVA intrathyroidal, IVB with gross extension or cervical nodal metastases, IVC with distant metastases [4].
Active surveillance of microcarcinoma. Ito 2014: 1,235 patients with low-risk PTMC (1993 to 2011, mean follow-up 75 months); progression was more frequent under 40 and less frequent at 60 and older; there were no distant metastases or deaths from PTC; of 191 patients who had surgery after observation, apart from one recurrence in the remnant thyroid, no recurrence was seen [5].
Medullary cancer (ATA 2015). 1% to 2% of thyroid cancers in the United States; 10-year survival for stages I to IV 100%, 93%, 71% and 21%, respectively; patients with a normal basal calcitonin (<10 pg/mL) after complete lymph node dissection are "biochemically cured" and have a 97.7% 10-year survival; germline RET testing is recommended for patients with apparently sporadic MTC [6].
Anaplastic cancer (ATA 2021). 1.7% of thyroid cancers; a rapidly growing tumour; historical median survival about 5 months and 1-year survival 20%; BRAF V600E should be assessed urgently by IHC with molecular confirmation (recommendation 4, strong) [7]. In the ATC cohort of the ROAR trial (36 patients, dabrafenib 150 mg twice daily + trametinib 2 mg once daily), median PFS was 6.7 and OS 14.5 months, with 12-month OS 51.7% and 24-month OS 31.5% [8].
After lobectomy. Meta-analysis of 32 studies: overall risk of hypothyroidism after hemithyroidectomy 22%; in 4 studies that separated them, subclinical hypothyroidism 12% and clinical 4%; positive anti-TPO antibodies before surgery are an important predictor [9].
Related cancer types
Related questions
References
11 referencesShow all references, 6 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2
- 3Screening for Thyroid Cancer: US Preventive Services Task Force Recommendation Statement
- 4
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- 7
- 8Dabrafenib plus trametinib in patients with BRAF V600E-mutant anaplastic thyroid cancer: updated analysis from the phase II ROAR basket study
- 9
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- 11
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