Thyroid Cancer: Surgery

Types of thyroid cancer surgery

Surgery is often the first and main treatment for almost all thyroid cancers. Your healthcare provider will use tissue removed during surgery to find out the cancer’s type and stage. The type and stage of the cancer helps tell whether you need additional treatment. When you have surgery for thyroid cancer, your surgeon may do one of the following methods:

• Total thyroidectomy. This surgery removes the whole thyroid gland.

• Near-total thyroidectomy or subtotal thyroidectomy. This surgery removes nearly all of the gland, but a very small part is left behind.

• Lobectomy. This surgery may be used for some small cancers. Only the side, or lobe, of the thyroid with the tumor is removed. (The thyroid gland has 2 sides.) This method keeps you from needing to take a thyroid supplement afterward. But having some thyroid left can interfere with some tests that look for cancer that comes back, or recurs, after treatment. 

Surgeons today most often do total or near-total thyroidectomies. 

Your surgeon also may remove the lymph nodes near the thyroid if they are known to have cancer cells in them or if they look abnormal or suspicious. This procedure is called either a central compartment neck dissection or a modified radical neck dissection. It depends on the extent of lymph node removal.

After surgery, you may need treatment with radioactive iodine. This can kill any remaining cancer cells. You may still benefit from additional surgery in the future if the tumor comes back (recurs) either in the area of the original thyroid tumor, or at another site.

Risks of thyroid cancer surgery

All surgery has risks. The risks of thyroid surgery include:

• Bleeding

• Infection

• Damage to the nearby parathyroid glands, which help control calcium levels in the body. (Symptoms of low blood calcium include tingling, muscle spasms, and numbness.)

• Damage to nearby nerves which can affect your voice

Getting ready for your surgery

Your healthcare team will talk with you about the surgery options that are best for you. You may want to bring a family member or close friend with you to appointments. Write down questions you want to ask about your surgery. Make sure to ask about:

• What type of surgery will be done

• What will be done during surgery

• The risks and possible side effects of the surgery

• If you will have thyroid function after surgery or will need to take replacement hormones the rest of your life

• When you can return to your normal activities

• If the surgery will leave scars and what they will look like

Before surgery, tell your healthcare team if you are taking any medicines. This includes over-the-counter medicines, vitamins, herbs, and other supplements. This is to make sure you’re not taking medicines that could affect the surgery. After you have discussed all the details with the surgeon, you will sign a consent form that says that the healthcare provider can do the surgery.

You’ll also meet the anesthesiologist. This is the healthcare provider who will give you general anesthesia. This is the medicine that prevents pain and makes you sleep during surgery. He or she also checks you during surgery to keep you safe. He or she will ask about your medical history and your medicines.

After your surgery

Surgery can cause discomfort and pain at and around the area where the surgical incision (cut) was made. You may be uncomfortable during the first few days after surgery, but pain can be controlled with medicine. Discuss pain relief options with your healthcare provider nurse.

For a while after surgery, you may feel tired or weak. The length of time it takes to recover from surgery will vary.

You may feel like there's a lump in your throat and your voice may sound hoarse, but these get better over time. Sometimes one of the nerves to the muscles of the voicebox may be damaged. This can cause the voice to have a weak, "breathy" quality. In some cases, this requires special treatment.

Follow-up care

You may need more treatment after surgery. Your healthcare provider will talk with you about this.

If most or all of your thyroid has been removed or destroyed during treatment, you will likely need to take a thyroid hormone pill each day to replace the lost hormones. You will do this for the rest of your life. Make sure you understand how to take your hormone therapy and what the dose should be. You will need to have regular blood tests to check your hormone levels so adjustments can be made if needed.

When to call your healthcare provider

Let your healthcare provider know right away if you have any of these problems after surgery:

• Bleeding

• Redness, swelling, or fluid leaking from the incision

• Fever

• Chills

• Breathing or swallowing problems

Be sure you know what to watch for and know how to reach your provider after office hours and on weekends and holidays.