A thyroidectomy is the surgical removal of all or some of the thyroid gland. This surgery is used to treat benign thyroid nodules and large goiter (noncancerous enlargement of the thyroid). In most cases, thyroidectomy is the preferred treatment of thyroid cancer. A total thyroidectomy removes the entire thyroid, whereas a hemi-thyroidectomy removes a portion of the gland.

The thyroid gland is located in the front section of the neck. The gland captures iodine that has been absorbed into the blood from food and uses the iodine to produce thyroid hormones. Thyroid hormones play a major role in regulating the body’s metabolism, the body’s process of using food for energy and growth.

A thyroidectomy is the total or partial removal of the thyroid gland. This surgical procedure may be performed to remove all or part of a goiter, which is an enlargement of the thyroid gland. This is especially necessary if the enlargement interferes with respiratory function or swallowing. In addition, thyroidectomy may be used to trat increased thyroid function (hyperthyroidism).

Thyroidectomy also may be used to remove thyroid nodules or cancerous and noncancerous thyroid tumors. It is a common form of treatment in patients who have been diagnosed with thyroid cancer.

Located in the lower part of the thyroid cartilage in the front section of the neck, the thyroid gland is part of the endocrine system, a network of glands that produce and secrete hormones. The thyroid gland is shaped like a butterfly, with two lobes, one on the right side and one on the left side – connected in the center by the thyroid isthmus.

The gland is responsible for absorbing iodine from an individual’s blood and using the iodine to produce thyroid hormones. Thyroid hormones play a major role in regulating the body’s metabolism, the body’s process of using food for energy and growth.

The amount of the thyroid gland removed depends on the reason for the surgery. When cancer has been diagnosed, surgery is typically used to remove as much of the tumor as possible. A thyroidectomy is the most effective way to keep thyroid cancer from spreading further and to prevent it from returning. Thyroidectomies are commonly used to treat cases of two types of thyroid cancer: papillary carcinoma and follicular carcinoma. Options for surgery include:

• Total thyroidectomy. Removes the entire thyroid. It may be recommended in cases where the tumor is located in both lobes of the thyroid gland (multifocal) or when the cancer is aggressive.
  
  
• Near-total thyroidectomy. Leaves a small part of the thyroid intact. The advantage of this procedure is that it leaves small rims of tissue around the parathyroid glands (small glands near the thyroid that help regulate calcium levels), reducing the risk of damage to these glands during surgery. In some cases, professionals distinguish between subtotal thyroidectomy (leaving a small amount of thyroid tissue on each side) and near-total thyroidectomy (leaving a small amount of thyroid tissue on one side).

In addition to near-total or total thyroidectomy, there are other forms of surgery that are sometimes used to treat thyroid cancer. These include:

• Lobectomy. Removes only the side of the thyroid where the cancer is located. It generally is used to treat papillary cancers smaller than a half-inch (1 centimeter) that have not spread beyond the thyroid gland. This procedure is common in cases of thyroid cancer known as medullary thyroid carcinoma and anaplastic carcinoma.
  
  
• Lymph node dissection. Removes lymph nodes in the neck near the thyroid. This procedure is called a central compartment neck dissection and is performed when cancer has spread beyond the thyroid into the lymph nodes. It is often performed when a patient’s tumor is bigger than a half-inch (1.5 centimeters).

In some cases, an endoscopic thyroidectomy may be used instead of more invasive surgery. This procedure uses several small incisions in the neck and special instruments to remove small cysts or benign nodules. However, endoscopic thyroidectomy is not used to treat multiple nodules or thyroid cancer.

Other thyroid cancer treatments that may be used in addition to surgery to reduce the risk of cancer recurrence or to treat metastasized cancer include:

• Radioactive iodine therapy. Used to destroy the remaining thyroid gland tissue after surgery and treat any undetected microscopic cancer remaining in the body.
  
  
• Hormone therapy. Many patients experience hypothyroidism (low levels of thyroid hormones) after surgery and treatment with thyroid hormones helps to replace their loss. Doses are typically high to prevent any recurrence of thyroid cancer cells.
  
  
• Radiation therapy.
  
  
• Chemotherapy.

In preparation for a thyroidectomy, a physician will perform a complete physical examination and take a comprehensive medical history. An EKG, chest x-ray and other heart tests may be performed, especially on patients over age 45 or those with a history of cardiac disease. Blood tests may be performed to check for bleeding disorders.

Patients who have had a change in voice or a previous neck operation will have their vocal cord function evaluated to ensure that the recurrent laryngeal nerve that supplies the vocal cord muscles is functioning normally.

If a rare form of disease known as medullary thyroid cancer has been diagnosed, patients will be evaluated for coexisting tumors of the adrenal gland known as pheochromocytomas, or for the presence of hypercalcemia (high calcium levels in the blood) or hyperparathyroidism (increased secretions of the parathyroid glands).

During the procedure, patients usually are placed under general anesthesia, meaning they are asleep for the procedure. For patients who may be at risk with general anesthesia, the surgery may be performed with intravenous medications under regional anesthesia. The patient remains awake but without pain.

An incision is made in the front of the neck and all or part of the thyroid gland is removed. Surgeons will be careful to avoid any damage to surrounding nerves or blood vessels in the neck. They will also work to preserve the parathyroid glands, two small glands located near the thyroid. After the thyroid gland is removed, the incision will be closed with stitches.

Surgery to treat follicular cancer is slightly more complicated than surgery to treat papillary cancer. Follicular cancer usually cannot be diagnosed until the tissue has been analyzed by a pathologist. A technique known as frozen section is sometimes used during surgery to complete this analysis. It usually takes less than 10 minutes to complete. Once the surgeon knows the results of the tissue analysis based on the pathology report, the surgical procedure can be completed.

The entire surgery usually takes between two and two-and-a-half hours to complete.

Most patients are discharged one to two days following surgery, although some may stay in the hospital for up to a week. Typically, recovery from thyroid surgery is quite rapid. Patients should not participate in vigorous sports or heavy lifting for at least 10 days. They should be able to resume all normal activities within a few weeks.

After thyroidectomy some patients receive radioactive iodine therapy to ensure that any remaining cancer cells are treated. Because one of the functions of the thyroid gland is to absorb iodine, iodine that has been made radioactive is drawn to any remaining thyroid cells. This treatment helps to eradicate any microscopic cancer cells that may not have been identified by other methods. Radioactive iodine after surgery is the standard treatment for follicular thyroid cancer.

Once the thyroid gland has been removed, patients will need to take thyroid hormone replacement pills for the rest of their lives. This medication supplies the body with the thyroid hormone usually produced by the body’s natural thyroid. It also suppresses the pituitary gland’s production of the substance TSH, which signals the thyroid to manufacture hormones. High levels of TSH can stimulate the growth of any remaining cancer cells.

Patients will need blood tests every few months to evaluate thyroid hormone levels. This will help ensure that they are receiving optimal levels of thyroid replacement hormone.

Too much thyroid hormone can produce the following symptoms:

• Weight loss
• Palpitations
• Tremors
• Sensitivity to heat
• Nervousness
• Osteoporosis
• Frequent bowel movements

Too little thyroid hormone can produce the following symptoms:

• Weight gain
• Sensitivity to cold
• Weakness or fatigue
• Joint or muscle pain
• Dry skin and hair

Risks associated with a thyroidectomy include those of surgery (such as bleeding or infection) or anesthesia (reaction to medication, breathing problems).

Other potential side effects or complications associated with thyroid surgery include:

• Swelling or bleeding at the wound site, causing breathing problems
  
  
• Temporary or permanent hoarseness from damage to the recurrent laryngeal nerve
  
  
• Damage to the parathyroid glands (small glands near the thyroid that help regulate calcium levels)
  
  
• Low levels of calcium in the blood (hypocalcemia)
  
  
• Inadequate thyroid function (hypothyroidism)
  
  
• Dysphagia (difficulty swallowing)
  

Complications are more likely in the following circumstances:

• Cancer has spread into the lymph nodes
  
  
• Cancer requires second thyroid surgery
  
  
• Patients have goiters that extend beneath the collarbone

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 thyroidectomy:

1. Is thyroidectomy the most appropriate treatment for my condition?
   
   
2. How many thyroidectomies have you performed?
   
   
3. Which type of thyroidectomy will I need?
   
   
4. What are the preparations before surgery?
   
   
5. What type of anesthesia will be used?
   
   
6. How long will my surgery take?
   
   
7. What are the risks associated with the surgery?
   
   
8. Will you complete a frozen analysis during surgery?
   
   
9. How will my surgery change based on the results of the tissue analysis?
   
   
10. What can I expect in terms of recovery from the surgery?
    
    
11. What signs or symptoms following the surgery indicate a medical emergency?
    
    
12. What type of cancer treatment will I need following the surgery?
    
    
13. What type of medications will I need after thyroidectomy?
    
    
14. What are the chances of my cancer returning if my thyroid gland is removed?