The thyroid is a butterfly-shaped gland located in your neck, near your windpipe. Each of the two butterfly "wings" is known as a lobe. The lobes are connected by a part of the thyroid known as the isthmus.
Reasons for thyroidectomy
Thyroid surgery — known as a thyroidectomy — removes all or part of your thyroid gland, and is performed to treat a number of thyroid conditions.
Thyroid cancer: If you have thyroid cancer — confirmed from a positive fine needle aspiration (FNA) biopsy — you almost always will require a thyroidectomy. The only exception is very small, non-aggressive papillary thyroid cancer known as a microcarcinoma. Some doctors now recommend "watchful waiting" and periodic monitoring for those cancers.
Goiter: An enlarged thyroid, a goiter is frequently treated with thyroidectomy in three situations:
When the goiter is so large that it is cosmetically unsightly
When the goiter is affecting your ability to breathe
When the goiter is affecting your ability to swallow
Thyroid nodules: Thyroidectomy may be recommended for certain nodules, particularly:
- When the nodule is so large that it is externally visible and cosmetically unsightly
- When the nodule or nodules are “hot” or “toxic,” meaning that they are producing excess thyroid hormone and making you hyperthyroid
Hyperthyroidism: Thyroidectomy is sometimes performed as a treatment for hyperthyroidism, particularly:
When a woman is in her second trimester of pregnancy and has not responded sufficiently to antithyroid drugs
When a woman is in her second trimester of pregnancy, and the antithyroid drugs are affecting fetal health or development
When a woman is in her second trimester of pregnancy and has adverse reactions or significant side effects from antithyroid drugs
When someone with hyperthyroidism can’t or won’t take antithyroid drugs, and refuses radioactive iodine (RAI) ablation
When a woman of child-bearing age does not want to wait up to a year after RAI before it’s considered safe to get pregnant
Outside the United States, surgery is sometimes recommended for children with hyperthyroidism, rather than RAI, due to concerns about the long-term effects of radiation exposure.
The different types of surgery
There are many different types of thyroidectomy surgeries.
Total or full thyroidectomy: A total thyroidectomy — also called a full thyroidectomy — is the most frequently performed type of thyroid surgery. This surgery involves removal of the entire thyroid gland, including both lobes and the isthmus.
Subtotal or partial thyroidectomy: A subtotal thyroidectomy — also known as a partial thyroidectomy, or near-total thyroidectomy — removes only part of the thyroid gland.
Isthmusectomy: When a small nodule or tumor is located in the isthmus between the lobes of the thyroid, an isthmusectomy — sometimes called an isthmectomy — may be performed.
Thyroid lobectomy: Also known as a hemi-thyroidectomy, this procedure involves removal of one lobe, or side, of the thyroid gland. A lobectomy can be performed with or out without an isthmusectomy.
According to the University of California San Francisco’s surgical center, if you have suspected but unconfirmed thyroid cancer, your surgeon may take what are known as “frozen sections” of your thyroid or lymph nodes during your surgery. These are tissue samples that are sent for pathology assessment. If cancer is found, a second thyroid surgery may be needed.
According to the American Thyroid Association, your condition will dictate the extent of the thyroid surgery recommended for you.
Thyroid surgical methods
Traditional thyroid surgery involves a 3- to 5-inch incision in the neck, which is then closed with sutures, staples, or both.
In an axillary thyroidectomy, the thyroid is accessed through the underarm. This surgery leaves a scar under the arm.
In scarless transoral thyroidectomy, the thyroid is removed via small incisions in your mouth, eliminating any scars.
In endoscopic thyroid surgery, two small incisions — usually less than an inch in length — are made in the neck. A camera is inserted through one incision, and a scalpel is inserted through the second incision.
Thyroid surgery typically takes from 45 minutes to several hours, depending on the extent of the surgery. If you are having lymph nodes removed — known as neck dissection — the surgery may require more time.
You will most often be admitted to the hospital and stay one to two nights after thyroidectomy. There is an increasing trend toward outpatient thyroid surgery, where you spend some time in recovery and are released, usually within 24 hours of your surgery. Outpatient thyroidectomy is controversial, however. Some studies show that outpatient surgery is as safe and effective as inpatient thyroidectomy. Other studies suggest that it poses greater risks, especially if you have post-surgical bleeding.
Types of anesthesia
Because the thyroid is adjacent to your windpipe, most thyroid surgery is performed while you are under a general anesthetic, with a breathing tube inserted to help you breathe. In a small percentage of cases, you may have the option to have your surgery using local anesthesia. In that case, you would be given a sedating medication, along with a numbing medication, followed by local anesthesia. Note that few surgeons are trained in doing thyroidectomy with local anesthesia. If you choose this option, you need to be sure your surgeon has performed a substantial number of thyroid surgeries using local anesthesia.
Complications after thyroid surgery
Normal side effects after thyroidectomy include some pain and stiffness in the neck, and a sore throat, usually treatable with over-the-counter pain medication. Temporary impairment of your parathyroid glands can cause low calcium levels, which can cause tingling and numbness in your mouth, lips, and extremities. This is treated with calcium and vitamin D supplements.
More significant, but far less common, risks include:
Damage to your laryngeal nerve, which controls your vocal cords. You can have a weak and/or hoarse voice. This condition usually resolves, but a small percentage of patients have permanent hoarseness.
Hypoparathyroidism/hypocalcemia: The parathyroid glands can be injured, or sometimes need to be removed, during surgery. These glands control your body’s calcium levels. Around 5 percent of patients have temporary hypocalcemia — low calcium levels — after thyroidectomy, and 1 percent have permanent hypocalcemia. In both cases, the treatment is calcium and vitamin D supplementation.
Complications are more common if you have invasive thyroid tumors, advanced disease, extensive involvement of your lymph nodes, or are having a repeat thyroid surgery.
The risks of significant complications are also directly correlated to the experience of your surgeon.
While thyroid surgery is often performed by general surgeons and head/neck surgeons, you are likely to have the best outcome and a significantly lower risk of complications if you work with an experienced or expert thyroid surgeon. The New York Thyroid Center at Columbia University Medical Center defines an experienced thyroid surgeon as one who has performed more than 500 thyroidectomies, and experts have performed more than 1,000 thyroidectomies.