Thyroid surgery is sometimes used to treat conditions that affect the thyroid gland. It most often is recommended for patients with thyroid cancer or conditions that fail to respond to antithyroid medications, including some cases of thyroid nodules, some types of thyroiditis and certain cases of goiter caused by hyperthyroidism or hypothyroidism.

There are various types of thyroid surgery that may be performed, depending on the nature of a patient’s illness. In some cases, surgery consists of a biopsy in which a tissue sample is removed for analysis. In other cases, part or all of the thyroid may be removed.

Before thyroid surgery, various tests may be performed to ensure that a patient is a good candidate for the procedure. In the 24 hours prior to the procedure, patients are urged to follow any preparatory recommendations made by their physician. These may include changes to diet or medication regimen.

In most cases, thyroid surgery is performed in a hospital while the patient is under general anesthesia. This means that the patient is not conscious and does not experience pain. During the procedure, the physician makes an incision in the front of a patient’s neck and removes some or all of the thyroid gland.

In most cases, patients who have thyroid surgery are discharged from the hospital within one to three days. After they are fully recovered, most patients do not experience any long-term limitations in their daily lives and routines. However, patients who have their entire thyroid removed will be required to take thyroid medications such as a hormone replacement pill daily for the rest of their lives.

Thyroid surgery is sometimes used to treat conditions that affect the thyroid gland. Physicians typically prefer to avoid treating thyroid conditions with surgery whenever possible. However, surgery is usually necessary in patients with thyroid cancer and for patients whose thyroid condition fails to respond to other treatment methods.

The thyroid is a butterfly-shaped gland that sits just below the Adam’s apple in the neck. It secretes hormones that regulate a person’s metabolism, the physical and chemical processes necessary for the maintenance of life. Various disorders may affect the thyroid and prevent or cause excessive release of these hormones. This alters a person’s metabolism and may lead to significant health problems.

Surgery may be used to treat various cancerous (malignant) and noncancerous (benign) thyroid conditions. Most often, it is used to treat growths of cells in the thyroid that form a lump (thyroid nodules). Surgery is typically recommended if cancer is discovered and is usually recommended if cancer is suspected. Additional options for cancer  after surgery is performed include thyroid hormone therapy, radioactive iodine therapy, external-beam radiation therapy or chemotherapy.  

If analysis reveals that the nodule tissue is noncancerous (benign), experts generally recommend alternative therapies such as antithyroid medications or no treatment. However, surgery sometimes is performed if the benign nodule continues to grow larger or if it causes pain, swallowing problems or other significant symptoms.

Other thyroid conditions that may require surgery include:

• Enlarged thyroid (goiter). This can be felt or even seen as a swelling at the base of the neck. It often results from hyperthyroidism (overactive thyroid gland) or hypothyroidism (underactive thyroid gland). Surgery is usually used for this condition if the goiter becomes so large that it impairs a patient’s ability to breathe, or if it impinges upon the esophagus or blood vessels. Surgery may also be recommended if other treatments, such as medications, fail to work.
  
  
• Hyperthyroidism. Hyperthyroidism is a condition in which overactivity of the thyroid gland causes too much thyroid hormone to build up in the bloodstream. As a result, processes in the body speed up. Left untreated, hyperthyroidism can have serious health consequences.
  
  
• Thyroiditis. Inflammation of the thyroid requires surgery only in unusual cases. For example, a rare condition called Riedel’s thyroiditis can spread in the neck and impede swallowing or breathing, necessitating surgery to remove all or part of the inflamed thyroid.

Surgery may also be recommended if the patient’s thyroid disorder cannot be controlled with medication because of pregnancy or other conditions.

There are various types of thyroid surgery that may be performed. The type of surgery chosen depends on the nature of a patient’s illness. Surgical options include:

• Biopsy or lumpectomy. A small part of the thyroid gland is removed. It usually is performed to obtain a small piece of tissue that can be analyzed in a laboratory. Surgical biopsy is sometimes needed to follow up a simpler procedure called fine-needle aspiration biopsy, in which a tissue sample is removed with a very fine needle. A fine-needle aspiration biopsy can generally be performed in the physician’s office.
  
  
• Lobectomy. Removal of half the thyroid gland.
  
  
• Subtotal thyroidectomy. Removal of all but a small amount of tissue on each side of the thyroid.
  
  
• Near-total thyroidectomy. Removal of nearly all the thyroid, with just 1 centimeter of tissue left on one side.
  
  
• Total thyroidectomy. Removal of the entire thyroid.

In addition, some patients with Graves’ disease, a common type of hyperthyroidism may have a severe form of an eye condition called Graves’ ophthalmopathy. These patients may be advised to undergo surgery on the eye muscles, eyelids or skull.

Prior to thyroid surgery, various tests may be performed to ensure that a patient is a good candidate for the procedure. The physician typically begins by reviewing the medical history and performing a physical examination. Patients who are older than 45 or who have a history of heart disease may be evaluated with tests such as an electrocardiogram (EKG) and a chest x-ray. For thyroid nodules, a fine-needle aspiration biopsy is the primary means of distinguishing cancerous growths from benign ones.

Other tests that may be performed prior to the procedure include:

• Evaluation of vocal cord function. This may be recommended for patients who have experienced a change in their voice or who have had a previous neck operation. Such testing may include indirect laryngoscopy (simple examination involving mirrors and a bright light) or direct laryngoscopy (insertion of a flexible fiber-optic scope into the throat). In addition, laryngeal nerve function may be assessed with tests such as electromyography or a nerve conduction velocity test.
  
  
• Blood tests. These may be performed for various reasons, such as checking for the presence of a bleeding disorder, or screening for hypercalcemia due to parathyroid disease (which is sometimes present in people with thyroid disorders).
  
  
• Tests for coexisting conditions. Patients who have conditions such as medullary thyroid cancer (rare cancer often associated with other endocrine problems) may undergo testing for other conditions such as coexisting adrenal tumors (pheochromocytomas), hypercalcemia and hyperparathyroidism.

In most cases, thyroid surgery is performed in a hospital while the patient is under general anesthesia. This means that the patient is not conscious and does not experience pain. The physician makes an incision (typically several inches long) in the front of a patient’s neck and removes part or all of the thyroid gland.

The amount of thyroid removed depends upon the specific procedure that is being performed. In some cases, the physician will obtain a sample of thyroid that will be instantly analyzed with a microscope. This can help the physician determine whether or not additional thyroid tissue should be removed.

The amount of time needed to complete thyroid surgery varies depending on the nature of the procedure. In some cases, it can take up to two or three hours to complete.

Surgeons have developed minimally invasive techniques that may be suitable for some patients. These methods feature smaller incisions and faster recoveries. One such technique involves use of an ultrasonic scalpel guided by a miniature video camera that is built into the instrument. However, some conditions, such as large goiters, rule out use of these techniques.

Following surgery, patients will be moved into a recovery room. Pockets of fluid (seromas) may form but usually resolve on their own. A surgical drain may be placed in the neck to remove fluids resulting from the procedure. This usually is removed within 24 hours of the surgery. Some patients may experience a sore throat following surgery as a result of the breathing tube that was placed in the throat during the procedure.

In most cases, patients who have thyroid surgery are discharged from the hospital within one to three days of the procedure. Patients can usually return to their everyday routine within days, although others may require weeks to fully recover. Strenuous activity and heavy lifting should be avoided according to the physician’s instructions, generally for 10 days or more. Patients are urged to consult with their physician about any other advisable restrictions in the immediate postoperative period.

After they are fully recovered, most patients do not experience any long-term limitations in their daily life and routines. However, patients who have their entire thyroid removed will be required to take a daily thyroid hormone replacement pill for the rest of their life. This supplement is necessary when surgery renders the thyroid unable to produce natural thyroid hormones.

Regular monitoring, such as thyroid blood tests, is often recommended for patients who have undergone thyroid surgery.

Thyroid surgery can offer significant health benefits. However, it also involves some risks of which patients should be aware. Less than 2 percent of people who undergo thyroid surgery experience these complications, according to the American Thyroid Association.  

Thyroid surgery includes risk of damage to the recurrent and external laryngeal nerves that control the vocal cords. This can result in hoarseness or a weakening of the voice.

Surgery also can damage the parathyroid glands, which control the level of calcium in the blood. Damage to the parathyroid glands may require the patient to take calcium medication to ensure that levels of calcium in the bloodstream remain normal. Patients are urged to contact their physician if they experience tingling or twitching after the operation. This reaction can indicate that a person’s calcium level is low, which may occur if the parathyroid gland is damaged.

In some cases, bleeding occurs that may lead to acute respiratory distress. Rarely, postoperative bleeding can cause an expanding hematoma (swelling of blood) that may constrict the airway. Sudden swelling in the wound area may indicate bleeding.

Surgery may result in a visible scar on the neck. In addition, thyroid surgery involves all of the usual risks involved with any surgery, including infection and adverse reaction to anesthesia. Redness and drainage from the wound area may indicate infection.

Certain patients are at increased risk for side effects or complications if the following factors are present:

• Presence of invasive tumors and major involvement of the lymph nodes
  
  
• Previous thyroid surgery
  
  
• Presence of large goiter that extends below the collarbone
  
  
• Presence of a condition, such as diabetes, that hinders recovery from surgeries.

Because of the potential risks, surgery for noncancerous thyroid conditions is seldom recommended for older patients and others at higher risk for complications.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about thyroid surgery:

1. Why are you recommending thyroid surgery instead of medication or other treatment methods?
   
   
2. What type of thyroid surgery do you recommend for me? Why?
   
   
3. What risks can this surgery have for me?
   
   
4. How should I prepare for the surgery?
   
   
5. How much of my thyroid gland will be removed?
   
   
6. How long will it be before I fully recover?
   
   
7. What are the signs that my parathyroid glands have been damaged?
   
   
8. What can be done if I experience hoarseness following my surgery?
   
   
9. Will I need to take thyroid medication following my surgery?
   
   
10. What is my long-term prognosis?