Surgery is the main treatment for thyroid cancer and is used in nearly every case, except perhaps some anaplastic thyroid cancers. If the results of fine needle aspiration (FNA) tests indicate thyroid cancer, surgery to remove the tumor and all or part of the remaining thyroid gland is usually recommended.

Lobectomy

This operation is sometimes used for differentiated thyroid cancers that are small and that show no signs of spread beyond the thyroid gland. The lobe containing the cancer is removed, usually along with the isthmus (the small piece of the gland that acts as a "bridge" between the left and right lobes). Because this surgery leaves part of the gland behind, the patient may not require the lifelong use of thyroid hormone supplements afterward. But having some thyroid left can interfere with some tests to look for cancer recurrence after treatment, such as radioiodine scans and blood tests such as thyroglobulin.

Thyroidectomy

This operation removes all (total thyroidectomy), nearly all (near-total thyroidectomy) or most (subtotal thyroidectomy) of the thyroid gland. It is the most common surgery for thyroid cancer. After a total thyroidectomy and radioablation, your doctor can most often follow you (continue to watch you for disease recurrence) with radioiodine scans and blood tests, e.g., thyroglobulin.

Lymph node removal

When cancer has spread outside the thyroid gland, surgery is always used to remove as much cancer that has invaded the neck as possible, including cancer that has spread to lymph nodes. This is especially true for treatment of medullary thyroid cancer and for anaplastic cancer (when surgery is an option).

For papillary or follicular cancer where only 1 or 2 enlarged lymph nodes are thought to contain cancer, these enlarged nodes may be removed and any small deposits of cancer cells that are left are treated with radioactive iodine (see below). More often, several lymph nodes near the thyroid are removed in an operation called a central compartment neck dissection. Removal of more lymph nodes, including those on the side of the neck, is called a modified radical neck dissection.

Risks and side effects of surgery

Patients who have thyroid surgery are often ready to leave the hospital within a few days after the operation. Potential complications of thyroid surgery include:

• temporary or permanent hoarseness or loss of voice (this can happen if the larynx (voice box) or windpipe is irritated by the breathing tube that was used during surgery or if the nerves to the larynx are damaged during surgery)

• damage to the parathyroid glands (small glands near the thyroid that help regulate blood calcium levels), which can lead to low blood calcium levels, causing muscle spasms and numbness and tingling sensations

• excessive bleeding or formation of a major blood clot in the neck ("hematoma")

• wound infection

Complications are less likely to happen when you have an experienced thyroid surgeon, especially one with specialized training. 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. All patients who have had near-total or total thyroidectomy will need this.

Last Medical Review: 04/28/2009
Last Revised: 05/14/2009