Thyroid Surgery

Surgery Overview

Thyroid surgery takes out part or all of your thyroid gland. The gland makes hormones that control how your body makes and uses energy (metabolism).

A doctor may take out part or all of the gland when it gets too big, doesn't work right, or has a growth. Most growths or lumps in this gland are benign. This means they aren't cancer.

This surgery may be needed for problems such as thyroid nodules, thyroid cancer, and hyperthyroidism.

During your surgery, your doctor may take out a lump or nodule. A doctor will look at the tissue under a microscope.

• If the sample gives a clear answer for your problem, your doctor may leave the rest of your thyroid. Or you may have all of it removed.
• If the answer isn't clear, your doctor may leave the thyroid. More tests may be done on the tissue. When the test results come back, you may need surgery to take out the rest of your thyroid.

The doctor will take out the tissue, lump, or tumor through a cut (incision) in the front of your neck. You will likely have a tube, called a drain, in your neck. It lets fluid out of the cut. The drain is most often taken out before you go home.

You may go home on the same day. Or you may stay one or more nights in the hospital after surgery. You may return to work or your normal routine in 1 to 2 weeks. This depends on whether you need more treatment and how you feel. It may also depend on the kind of work you do.

Your doctor will check your incision in about a week. You may need to take thyroid medicine. If you have thyroid cancer, you may need to have radioactive iodine therapy. Your doctor will talk to you about what happens next.

Types of surgery

Types of thyroid surgery include:

Total thyroidectomy.

Your surgeon will remove the entire gland and the lymph nodes surrounding the gland. Both sections (lobes) of the thyroid gland are usually removed. If you have thyroid cancer, other treatments with thyroid-stimulating hormone (TSH) suppression and radioactive iodine work best when as much of the thyroid is removed as possible.

Thyroid lobectomy with or without an isthmectomy.

If your thyroid nodules are located in one lobe, your surgeon will remove only that lobe (lobectomy). With an isthmectomy, the narrow band of tissue (isthmus) that connects the two lobes also is removed. After the surgery, your nodule will be examined under a microscope to see if there are any cancer cells. If there are cancer cells, your surgeon may perform a complete thyroidectomy.

Subtotal (near-total) thyroidectomy.

Your surgeon will remove one complete lobe, the isthmus, and part of the other lobe. This is used for hyperthyroidism caused by Graves' disease.

What To Expect

Many people leave the hospital a day or two after surgery. How much time you spend in the hospital and how fast you recover depend on your age and general health, the extent of the surgery, and whether cancer is present.

Why It Is Done

Surgery is used to treat thyroid problems if:

• Thyroid cancer is present or is suspected.
• A noncancerous (benign) nodule is large enough to cause problems with breathing or swallowing.
• A fluid-filled (cystic) nodule returns after being drained once or twice.
• Hyperthyroidism can't be treated with medicines or radioactive iodine.

Surgery is rarely used to treat hyperthyroidism. It may be used if the thyroid gland is so big that it makes it hard to swallow or breathe or if thyroid cancer has been diagnosed or is suspected. Surgery also may be done if you are pregnant or can't tolerate antithyroid medicines.

You may have all or part of your thyroid gland removed, depending on the reason for the surgery.

Some surgeons are now doing endoscopic thyroidectomies. These are done with several small incisions through which a tiny camera and surgical tools are passed.

How Well It Works

Success of a thyroidectomy to remove thyroid cancer depends on the type of cancer and whether it has spread (metastasized) to other parts of the body. You may need follow-up treatment to help prevent the cancer from returning or to treat cancer that has spread.

If a large noncancerous (benign) nodule causes symptoms, such as pain or problems breathing or swallowing, surgery may help relieve symptoms. All or part of the thyroid gland may be removed. Surgery may also help relieve symptoms if other treatments, such as draining a cyst (a noncancerous nodule filled with fluid), have not worked. Surgery may also be an effective treatment if you have a thyroid nodule that makes too much thyroid hormone.

Risks

Thyroid surgery is generally a safe surgery. But there is a risk of complications, including:

• Hoarseness and change of voice. The nerves that control your voice can be damaged during thyroid surgery. This is less common if your surgeon has a lot of experience or if you are having a lobectomy rather than a total thyroidectomy.
• Hypoparathyroidism. Hypoparathyroidism can occur if the parathyroid glands are mistakenly removed or damaged during a total thyroidectomy. This is not as common if you have a lobectomy.