Surgery for Thyroid Cancer

Surgery is the main treatment in nearly every case of thyroid cancer, 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.

Lobectomy

A lobectomy is an operation that removes the lobe containing the cancer, usually along with the isthmus (the small piece of the gland that acts as a bridge between the left and right lobes). It 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 (see Tests for Thyroid Cancer).

An advantage of this surgery 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 interfere with some tests that look for cancer recurrence after treatment, such as radioiodine scans and thyroglobulin blood tests.

Thyroidectomy

Thyroidectomy is surgery to remove the thyroid gland. It is the most common surgery for thyroid cancer. As with lobectomy, this is typically done through an incision 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.

If the entire thyroid gland is removed, it 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. But one advantage of this surgery over lobectomy is that your doctor will be able to check for recurrence (cancer coming back) afterward using radioiodine scans and thyroglobulin 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. This is especially important 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, the enlarged nodes may be removed and any small deposits of cancer cells that may be left are then treated with radioactive iodine. (See Radioactive Iodine [Radioiodine] Therapy.) More often, several lymph nodes near the thyroid are removed in an operation called a central compartment neck dissection. Removal of even more lymph nodes, including those on the side of the neck, is called a modified radical neck dissection.

Risks and side effects of thyroid surgery

Complications are less likely to happen when your operation is done by an experienced thyroid surgeon. Patients who have thyroid surgery are often ready to leave the hospital within a day 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. It may also occur if the nerves to the larynx (or vocal cords) are damaged during surgery. The doctor should examine your vocal cords before surgery to see if they move normally. (See Tests for Thyroid Cancer.)
• Damage to the parathyroid glands (small glands behind the thyroid that help regulate calcium levels). This can lead to low blood calcium levels, causing muscle spasms and feelings of numbness and tingling.
• Excessive bleeding or formation of a major blood clot in the neck (called a hematoma)
• Infection