Surgery

Surgery is generally the first and most common treatment for thyroid cancer. Sometimes it is the only treatment.

A surgeon will remove as much of the thyroid cancer as possible through one of the following operations:

• Lobectomy: Removal of the lobe in which thyroid cancer is found. Biopsies of lymph nodes in the area may be done to see if they contain cancer.
• Near-total thyroidectomy: Removal of all but a very small part of the thyroid.
• Total thyroidectomy: Removal of the whole thyroid.
• Lymphadenectomy or neck dissection: Removal of lymph nodes in the neck that contain thyroid cancer. This is generally separated into central lymph node dissection and lateral lymph node dissection.

Points to keep in mind:

• The best outcomes and fewest complications are achieved when surgery is performed by a very experienced thyroid surgeon. For adults, this means a surgeon who does 100 or more thyroid surgeries per year.
• When you meet with the surgeon, ask how often he or she performs thyroid surgery, and more specifically how often he or she performs thyroid cancer surgery.
• The initial surgery is the most important part of your treatment.

Surgery for Differentiated Thyroid Cancer (Papillary and Follicular)

• Prior to surgery, the American Thyroid Association (ATA) and European Thyroid Association (ETA) Guidelines advise neck ultrasonography, in both adults and children, to carefully inspect the lymph node compartments in the lateral and central neck for metastases. Some surgeons also use other imaging such as CT scans.
• Treatment for differentiated thyroid cancer that is over a very small size usually begins with a total thyroidectomy or near- total thyroidectomy. For a smaller papillary tumor or an indeterminate solitary nodule, a lobectomy may be sufficient.
• In addition, at surgery the surgeon normally inspects the neck for enlarged lymph nodes.
• The surgeon may alter the extent of the initial surgery, depending on the tumor size and whether or not there are lymph node metastases and/or tumor in nearby neck tissues. Tumor in the soft tissues of the neck can usually be removed without injuring neck muscles or the recurrent laryngeal nerve, which powers the vocal cords.
• The surgeon removes abnormal-appearing or biopsy-proven metastatic lymph nodes. Both the ATA and ETA Guidelines suggest total removal of entire groups of lymph nodes within one or another neck compartment if at least one malignant lymph node is found.
• Some surgeons prophylactically remove all the lymph nodes in the central neck when the patient has a very aggressive tumor.

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After Surgery— Possible Risks
The more experienced a surgeon is at performing thyroid surgery, the lower the risk of complications. However, complications can occur even for the most experienced surgeon.

Some Risks:

• Temporary or permanent hoarseness or loss of voice, resulting from damage to the laryngeal nerve, a nerve that is located next to the thyroid gland.
• A change in the voice quality is usually temporary. In rare cases it is permanent.
• A number of corrective measures are possible if the nerve is damaged.
• If both nerves are injured, some patients will have breathing problems and require a tracheotomy, although this is rare.
• Low calcium levels in the blood due to damage to the parathyroid glands.
• There are 4 parathyroid glands that are located on the back portion of the thyroid gland. During thyroidectomy, the surgeon will carefully locate the glands and try to leave them in place without damaging them.
• Symptoms of low calcium levels are muscle spasms as well as tingling and numbness, especially in your hands or feet. Damage to the parathyroid glands results in a condition called hypoparathyroidism.
• Decreased function of the parathyroid glands (hypoparathyroidism) is treated with calcium and a special form of vitamin D called calcitriol.
• Most frequently, the condition is temporary (transient) and treatment with calcium and calcitriol is often only needed for a period of 2 to 4 weeks.
• However, in a small percentage of patients, surgery can result in lifelong hypoparathyroidism and the lifelong need for calcium and calcitriol replacement
• Infection. This is a very rare complication. It is treated with antibiotics.
• Bleeding. This is rare and is controlled at the time of the operation or afterward.
• As with all surgical procedures, it is ideal to find a surgeon who specializes in this area to help reduce the risks and ensure the best outcome.

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Recovery from Surgery

• Most thyroid surgery requires only one night’s stay in the hospital.
• Your doctor will give you instructions for care of your incision, as well as what activities are appropriate and when you can resume your normal activities.
• Your doctor will also give instructions for when you should call. You should be given the time and date of your post-surgery appointment before you leave the hospital.
• Pillows in the hospital, during your ride home, and at home will aid your comfort.
• Rest, good nutrition, enough fluids, and brief walking times will also aid your recovery.
• For more information about surgery, visit www.thyca.org. Also, the reference book Thyroid Cancer: A Guide for Patients, has chapters by two thyroid surgeons on thyroid surgery and re-operative thyroid surgery.
• ThyCa’s free support groups and one-to-one support are helpful resources for discussing experiences and tips for coping before and after your surgery. Support is available both one-to-one and in groups —in person, by phone, and online.

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For more about Surgery, see

• Treating Recurrent or Persistent Disease
• Types, Staging, Treatments
• Surgery for Papillary and Follicular Thyroid Cancer

Last updated: May 21, 2013