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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")
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
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