Surgery for Thyroid Cancer

Surgery is part of the treatment for nearly all thyroid cancers, except for some anaplastic thyroid cancers. If thyroid cancer is diagnosed by a fine needle aspiration (FNA) biopsy, surgery to remove the tumor and all or part of the remaining thyroid gland is usually recommended.

Different types of thyroid surgery might be done, depending on the situation.

Most often, thyroid surgery is done while you are under general anesthesia (in a deep sleep). The operation is done through an incision (cut) a few inches long across the front of the neck. You will have a small scar across the front of your neck after surgery, but this should become less noticeable over time.

Thyroidectomy

Thyroidectomy is surgery to remove the thyroid gland. This is the most common surgery for thyroid cancer, especially for larger tumors or for cancers with higher-risk features.

If the entire thyroid gland is removed, this is called a total thyroidectomy. Sometimes the surgeon may not be able to remove the entire thyroid. If nearly all of the gland is removed, it is called a near-total thyroidectomy.

After a near-total or total thyroidectomy, you will need to take daily thyroid hormone (levothyroxine) pills to replace the hormones your thyroid was making.

One advantage of this surgery over a lobectomy is that your doctor will be able to check for recurrence (cancer coming back) afterward using radioiodine scans and thyroglobulin blood tests. (See Tests for Thyroid Cancer.)

Lobectomy

In a lobectomy, the surgeon only removes the lobe of the thyroid (left or right) that contains the cancer. The isthmus is usually also removed during this surgery. (The isthmus is the small piece of the gland that acts as a bridge between the lobes.)

Lobectomy is sometimes used to treat differentiated (papillary or follicular) thyroid cancers that are small and show no signs of spread beyond the thyroid gland. It is also sometimes used to diagnose thyroid cancer if an FNA biopsy result doesn’t provide a clear diagnosis.

An advantage of this surgery is that you might not need to take thyroid hormone pills afterward because part of the gland is left behind. But having some thyroid left can interfere with certain tests that look for cancer recurrence after treatment, such as radioiodine scans and thyroglobulin blood tests. 

Lymph node removal

When thyroid cancer spreads, most often it goes first to nearby lymph nodes in the neck. If thyroid cancer appears to have spread to these lymph nodes, the nodes will be removed. This is often done at the same time surgery is done on the thyroid, although it might also be done as a separate operation.

In some situations, lymph nodes in the neck might be removed even if it’s not clear that the cancer has spread to them. This is especially important for larger thyroid tumors or for those that have grown outside the thyroid, as well as for medullary thyroid cancer or anaplastic thyroid cancer (when surgery is an option), because these cancers are more likely to have spread. 

Usually, several lymph nodes in the middle of the neck near the thyroid are removed. This is called a central neck dissection. Removal of even more lymph nodes, including nodes on the side of the neck, is called a modified radical neck dissection.

Risks and side effects of thyroid surgery

The short-term risks of any type of surgery include reactions to anesthesia, bleeding (which might require blood transfusions), blood clots, and infections. Most people will have at least some pain after the operation. This can usually be helped with pain medicines, if needed.

Potential complications of thyroid surgery in particular can include:

• Temporary or permanent hoarseness or loss of voice. This can happen if your larynx (voice box) or windpipe is irritated by the breathing tube that was used during surgery. It can also happen if the nerves to the larynx (or vocal cords) are damaged during surgery. The doctor will examine your vocal cords before surgery to see if they move normally. (See Tests for Thyroid Cancer.)
• Damage to the parathyroid glands. The parathyroid glands are small glands behind the thyroid that help regulate calcium levels. Damage to these glands can lead to low blood calcium levels, causing muscle spasms and feelings of numbness and tingling in different parts of the body.

Complications are less likely to happen when your operation is done by an experienced thyroid surgeon. People who have thyroid surgery are often ready to leave the hospital within a day after the operation.

As noted above, removing the entire thyroid gland (or nearly all of it) means your body will no longer be able to make thyroid hormones, so you’ll need to take thyroid hormone pills for the rest of your life.