Surgery for thyroid cancer

Surgery is the main treatment for nearly every case of thyroid cancer, except for some anaplastic thyroid cancers. If thyroid cancer is found by a biopsy (fine needle aspiration), surgery to remove the tumor and all or part of the rest of the thyroid gland is most often done.

Lobectomy

This operation is sometimes used to treat papillary or follicular thyroid cancers that are small and that show no signs of spreading beyond the thyroid gland. It is also sometimes used to diagnose thyroid cancer if a needle biopsy result doesn’t provide a clear diagnosis.

First, the surgeon makes an incision (cut) a few inches long across the front of the neck to reach the thyroid. The lobe with the cancer is then removed, usually along with the small piece of the gland that acts as a bridge between the left and right lobes (the isthmus).

An advantage of this surgery, if it can be done, is that some patients might not need to take thyroid hormone pills afterward because it leaves part of the gland behind. But having some thyroid left can cause problems with some tests to look for the cancer coming back (recurrence) after treatment.

Thyroidectomy

Surgery to remove the thyroid gland is called thyroidectomy. This is the most common surgery for thyroid cancer. The whole thyroid, or a large part of it, may be removed. This is done through an incision a few inches long across the front of the neck.

After a thyroidectomy you will need to take thyroid hormone pills every day. But one plus of this surgery over lobectomy is that your doctor can most often watch for the disease coming back by using radioiodine scans and certain blood tests.

Lymph node removal

If cancer has spread to nearby lymph nodes in the neck, these will be removed at the same time surgery is done on the thyroid.

For papillary or follicular cancer where only 1 or 2 enlarged lymph nodes are thought to contain cancer, the enlarged nodes may be removed and radioactive iodine (see below) is used to treat any cancer cells that may be left. More often, several lymph nodes near the thyroid are removed.

Risks and side effects of surgery

Patients who have thyroid surgery are often ready to leave the hospital the next day. Possible problems from thyroid surgery include:

• Hoarseness or loss of voice that may be short term or permanent. This can happen if the voice box or windpipe is irritated by the breathing tube that was used during surgery. It may also occur if nerves to the larynx (or vocal cords) are damaged during surgery. The doctor should check your vocal cords before surgery to see how well they are moving.
• Damage to the parathyroid glands (small glands near the thyroid that help control blood calcium levels). This can lead to low blood calcium levels, causing muscle spasms and numbness and tingling feelings.
• A lot of bleeding or a major blood clot in the neck
• Wound infection

You will have a small scar across the front of your neck after surgery. This should become less visible over time as it heals.

Problems are less likely to happen when you have an experienced thyroid surgeon. Most doctors recommend that the operation be done by a surgeon experienced in treating thyroid cancer.

If most or all of your thyroid gland is removed, you will need to take daily thyroid hormone replacement pills.

For more about cancer surgery in general, see our document, Understanding Cancer Surgery: A Guide for Patients and Families.