Thyroidectomy

If you have thyroid cancer or tumors of your thyroid, your care team is likely to recommend surgery. A thyroidectomy, which involves removing part or all of the thyroid, is one of several procedures available.

There are two types of thyroidectomy.

Near-total thyroidectomy: This surgery removes all but a very tiny part of the thyroid gland, and possibly nearby lymph nodes to check them for signs of cancer. This surgery also may be called a subtotal or partial thyroidectomy.

Total thyroidectomy: This surgery extracts the entire thyroid, and may or may not involve removing nearby lymph nodes for analysis.

There are different partial surgeries as well.

Hemi-thyroidectomy: One lobe, or one-half of the thyroid, is removed.

Isthmusectomy: The bridge of the thyroid tissue, which is located between the two lobes, is removed. This may be an option if a small tumor is located there.

Your age, tumor type and thyroid cancer stage when diagnosed help determine which surgery is right for you.

Your care team is likely to recommend a thyroidectomy if you have:

• Stage 1, stage 2 or stage 3 papillary and follicular thyroid cancer
• Stage 4 papillary and follicular thyroid cancer that has spread
• Recurrent papillary and follicular thyroid cancer
• Medullary thyroid cancer
• Anaplastic thyroid cancer

A total thyroidectomy is often recommended to reduce the risk of recurrence, as 5 percent to 10 percent of relapses are found in the lobe on the opposite side of the tumor, according to an American Health & Drug Benefits study.

Preventative thyroidectomy

Some families carry genes that make members susceptible to thyroid cancer. A genetic test may show whether your family is at risk. Some family members, including children, may wish to undergo a thyroidectomy to reduce their chances of developing this type of cancer.

How to prepare for surgery

If you have a large tumor, your surgeon may recommend external beam radiation to help shrink it before surgery.

Your doctor may prescribe oral supplements one to two weeks before the procedure to prevent hypoparathyroidism (a lack of parathyroid hormone) or hypocalcemia (low calcium levels in the blood). He or she may also order these in the weeks leading up to your procedure:

• An ultrasound, computed tomography (CT) scan or other imaging tests to locate an abnormal thyroid growth so the surgeon can remove it during the procedure
• A fine-needle aspiration to determine whether the growth is cancerous
• Tests of your vocal chord function

With today’s advances, many thyroidectomies may be performed safely as outpatient surgery. In some cases, a thyroidectomy may require a hospital stay for observation afterward.

Here’s what you need to do before surgery:

• Arrange for someone to take you to and from the hospital or surgery center. You cannot drive after having anesthesia.
• Speak with your doctor about the surgery you’re undergoing and what to expect.
• Tell your care team about any medications you are taking, especially blood thinners. Ask which, if any, of your medications you should take on the day of your procedure.
• Make sure the hospital and doctors have a copy of your advance care plan. If you don’t have an advance care plan, you may wish to write one.
• Shower or bathe before your procedure, but don’t apply lotions or perfumes to your skin.
• Remove nail polish.
• Don’t wear jewelry or body piercings.
• Bring photo identification with you.
• Don’t have anything to eat or drink after midnight prior to your surgery.

What to expect during surgery

The procedure may take as long as four hours, perhaps less if you’re having a partial or near-total thyroidectomy.

• You’ll be placed on the operating table with your neck slightly hyperextended. Your surgeon may opt to secure your head to the table with tape and padding.
• A special roll or cushion is placed behind your neck so that your shoulders fall backward.
• You’ll receive general anesthesia, so you won’t feel any pain. In rare cases, your surgery may be done with a local anesthetic and medication to relax you, in which case you’ll be awake but feel no pain.
• Your surgeon examines your neck to identify the location of your thyroid and makes an incision through your skin. Incisions typically measure 4 cm to 6 cm but may be longer if your lobes are larger. Through this incision (located in the front of your neck and above your collarbones), your surgeon removes all or part of the thyroid, depending on the type of surgery you’re having.
• You may need a drain (catheter) in the neck area to prevent blood and other fluids from building up. It should be removed in one to two days after your surgery.
• Your surgeon closes the incision with sutures.
• Once surgery is complete, you’ll be taken to recovery. Once you’re awake, you’ll be given something to eat and drink.

New techniques may make it possible for your surgeon to make a smaller incision near your thyroid or elsewhere to remove it. Robotic thyroidectomy is becoming available in more settings as well, and involves the use of computerized robotic arms to help perform the surgery. Some surgeons offer robotic thyroidectomy, but it must be performed by those experienced in this technique.

Recovering from surgery

You may be able to go home even if your drain hasn’t been removed. If you have a drain, you should empty it twice a day. Keep a record of the amount of fluid you remove each time. Speak with your care team about when and how it’ll be removed.

Below is what to expect post-surgery.

• Your neck may be sore, and you may have some pain when swallowing at first.
• You should rest and limit extreme physical activities for a few days/weeks after your surgery. Rest lowers your risk of developing a postoperative neck blood clot (hematoma) or opening your stitches.
• For the first week, keep your head raised while you sleep.
• Avoid heavy lifting for about 10 days to two weeks.
• Begin your normal activities when you’re feeling better.
• Ask your doctor about a prescription pain medication if you feel you need one.
• Over-the-counter pain medicines—such as Advil^® (ibuprofen), Motrin® (ibuprofen) or Tylenol^® (acetaminophen)—may help as well. Be aware that some pain medications may cause constipation. A stool softener and a high-fiber diet may help.
• Icing your incision for 15 minutes at a time also may help ease pain and swelling. Be sure to wrap the ice in a towel or compress so it doesn’t come in direct contact with your skin. You need to keep the area dry.
• There’s no need for a special diet during your recovery.

Your doctor may prescribe medicine to replace your thyroid hormone. You may need to take this medicine to replace the natural thyroid hormone for as long as you live. If you have surgery because of thyroid cancer, you may not start on replacement therapy immediately.

You’ll likely have a follow-up appointment with your surgeon about two weeks after surgery.

Potential risks

Complications are rare. The overall risk of serious complications from thyroid surgery is estimated to be less than 2 percent, according to the American Thyroid Association.

Possible risks include:

• Bleeding within hours of surgery that may lead to breathing problems
• Injury to a laryngeal nerve—which may be temporary or permanent—that may cause hoarseness (though highly unlikely, if both laryngeal nerves are damaged, it may lead to acute respiratory distress)
• Damage to the parathyroid gland that may cause hypoparathyroidism or hypocalcemia (both may cause tingling, muscle cramps and seizures)

Complications are more likely if:

• Your tumor is invasive
• This is your second thyroid surgery
• You have a large goiter that goes into your upper chest

Call your doctor if you have any of these signs of an infection or complication.

• Incision that’s red, swollen, painful or bleeding
• Fever of 100.5°F or higher
• Chest discomfort or pain
• Weak voice
• Eating difficulties
• Excessive coughing
• Numbness or tingling of face or lips

Contraindications

Thyroid cancer is a progressive but slow disease in most cases. The risks and benefits of this type of surgery change the older you are. Speak with your doctor about whether thyroidectomy is right for you.

There are few reasons, if any, that you cannot undergo a thyroidectomy. Surgery is more likely if you don’t have metastasis.

If you’ve noticed your voice has changed, or had previous surgery on your neck (such as parathyroid surgery, spine surgery or carotid artery surgery), your laryngeal nerves, which control the muscles of your vocal cords, should be evaluated before surgery to be sure they are functioning normally.

Also, if you have medullary thyroid cancer, you should be evaluated for endocrine tumors, such as adrenal and parathyroid tumors.

Follow-up care

Depending on the cancer type and location—and on the success of your surgery—your care team may recommend additional treatments for your thyroid cancer, such as external beam radiation, chemotherapy and targeted therapy.

As a first-line treatment, a total thyroidectomy has been shown to increase survival and decrease recurrence in tumor cells that look like normal cells. You likely will need thyroid replacement therapy, and may need treatment with radioactive iodine.

You should be able to resume your normal activities once you’re fully recovered from surgery.