Which surgery for thyroid cancer?

Surgery is the treatment most often used for follicular, papillary and medullary thyroid cancers. You may have

• All of your thyroid removed (total thyroidectomy)
• Part of your thyroid removed (lobectomy or partial thyroidectomy)

Below are diagrams to show these two types of surgery.

Total thyroidectomy

Lobectomy or partial thyroidectomy

Both partial and total thyroidectomy are big operations. Your doctor must be sure you are fit enough to get through a long operation and anaesthetic, and make a good recovery afterwards. The operations are carried out under general anaesthetic. During the operation your doctor may remove some of the lymph nodes close to the thyroid to see if the cancer has spread into them. You can usually go home 1 or 2 days after the surgery.

If you have the abnormal gene for medullary thyroid cancer, you will be offered a total thyroidectomy to prevent a cancer from developing. The whole gland needs to be removed because cancer could develop in any thyroid tissue left behind.

After your surgery, your doctor may recommend that you have radioactive iodine treatment if they think that 

• Some cancer may have been left behind or
• Some cancer cells might have spread elsewhere in your body

During your operation you may have some lymph nodes removed. If your surgeon knows before the operation that you have cancer in some lymph nodes, they may remove all the nodes on that side of your neck or in the centre of your neck.

If you have surgery for medullary thyroid cancer, you will have the lymph nodes in the central area of your neck removed during the operation. This is because they may contain cancer cells.

Before you have your operation, your doctor and clinical nurse specialist will talk to you about the risks and possible complications of the surgery. You will be asked to sign a consent form to say that you have been told about these risks and you understand what you have been told. Signing the form means that you agree to go ahead with the operation. It is important to ask your surgeon or specialist nurse any questions you have at this point. You are likely to worry less if you have had the risks and benefits of the treatment properly explained to you.

Some possible problems are common to nearly all operations, such as numbness over the area, a wound infection or a blood clot. There is information about the possible complications of surgery in the about cancer treatment section of CancerHelp UK.

After thyroid surgery you may

• Need thyroid hormone replacement if your thyroid has been completely removed
• Need calcium replacement for a while if your parathyroid glands are removed or damaged – this occurs in 1 in 20 people
• Need to go back to the operating theatre if you have a lot of bleeding – this occurs in 1 in 80 people
• Have a hoarse voice if the nerve that supplies your voice box is damaged – this occurs in 1 in 400 people

Usually, the hoarse voice gets better on its own. In a very small number of people who have total thyroidectomy, both vocal cords are paralysed for a while and you need a tracheostomy. A tracheostomy is a small hole made in your neck so that you can breathe. This is only temporary and hardly ever happens. But if you are worried, do ask your surgeon about it.