Thyroid Surgery

The thyroid gland, located in the neck just below the larynx, regulates the body’s energy levels, releasing hormones to regulate metabolism. Thyroid hormones influence virtually every system in the body, regulating the rate at which organs function, as well as the body’s consumption of oxygen and production of heat. When hyperthyroidism, the production of too much thyroid hormone, occurs, and cannot be adequately controlled with medication or other treatment, thyroid surgery is necessary.

Reasons For Thyroid Surgery

Thyroid surgery is used to treat a variety of thyroid conditions such as thyroid cancer, thyroid nodules, or Graves’ disease, an immune disorder that results in hyperactivity of the gland. When the thyroid gland produces too much thyroid hormone for any reason, the condition is called hyperthyroidism. Hyperthyroidism results in the speeding up of the body’s metabolism. This increased metabolic rate can have serious medical consequences, resulting in any or all of the following symptoms:

Surgery is rarely necessary to treat hyperthyroidism unless there is either a suspicion of cancer, a benign nodule that has grown large enough to interfere with swallowing or breathing, a cyst on the gland that refills after drainage, or if hyperthyroidism treatment with medication or radioactive iodine alone is not effective. Another reason for surgery is pregnancy, since it may not be safe for a pregnant woman to take the necessary medications or treatment.

Thyroid Surgery Procedures

There are several types of thyroid surgery, all involving partial or total removal of the gland. Which surgery is performed depends on the reasons for the procedure. The types of surgery for thyroid disease include:

• Biopsy, removal of a tissue sample for microscopic examination
• Lumpectomy, removal of a small diseased part of the thyroid gland
• Lobectomy, removal of one lobe and the isthmus which connects the lobes
• Subtotal thyroidectomy, removal of one lobe, the isthmus, and part of the second lobe
• Total thyroidectomy, removal of the entire gland and the surrounding lymph nodes

Depending on several factors, especially how extensive the necessary procedure will be, the operation may be performed traditionally or with a minimally invasive video-assisted, sometimes robotic, procedure. The patient will have a breathing tube in the throat during surgery and a drain may remain in the neck for 12 hours after the procedure. The length of the surgery depends on how much needs to accomplished. Minimal operations may be performed outpatient, while for more complex surgeries the patient may be hospitalized for a night or two.

Recovery From Thyroid Surgery

After the operation, the patient’s throat will be sore due to the breathing tube inserted during surgery. While most patients are able to return to their normal activities in one day or several, depending on the extent of the surgery, strenuous activities, such as heavy lifting or vigorous sports, must be avoided for at least 10 days after the operation.



Most thyroid surgeries are very successful, but the majority of patients develop hypothyroidism as a consequence of the procedure. This will require ongoing treatment with hormone therapy, but is not usually problematic. The patient may also need follow-up treatment with radioactive iodine to shrink thyroid tissue either because hyperactivity of the gland continues to be an issue or in order to stem the growth of a thyroid cancer.

Risks Of Thyroid Surgery

Thyroid surgery is generally a safe procedure, but complications may occur. In a very small number of cases, the nerves controlling the vocal cords may be damaged, resulting in hoarseness or other changes in voice quality. Laryngeal monitoring of the vocal cord nerves, however, enables the surgeon to be in careful control of the situation. Another possible cause for concern is that the parathyroid glands, which are tiny and difficult to differentiate from other tissue on the thyroid gland, may be inadvertently damaged during surgery.



Other risks are the risks inherent in any surgical procedure. These include: excessive bleeding, abnormal blood clots, adverse reaction to anesthesia or medication, infection, or breathing problems.

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Thyroid Nodules

Thyroid nodules are abnormal growths on the thyroid gland that may be solid or filled with fluid. The majority of thyroid nodules do not cause any symptoms and only a small percentage are cancerous, but because the thyroid gland is located at the base of the neck, large nodules can sometimes interfere with normal breathing or swallowing. Also, thyroid nodules sometimes affect hormone secretion which may result in other medical problems.

Causes Of Thyroid Nodules

Thyroid nodules may appear as cysts, which are fluid-filled, or as solid masses, and may present as a singular nodule or as a multinodular goiter. They may be the result of:

• Iodine deficiency
• Overgrowth of normal thyroid tissue
• Thyroiditis, an inflammation of the gland
• Thyroid cancer

Few thyroid nodules are cancerous, but it may be difficult to ascertain whether a malignancy exists without a fine needle biopsy of thyroid tissue. Neither size nor symptoms alone are indications that a cancer is present, although malignant tumors on the gland frequently enlarge more quickly than benign growths.

Risk Factors For Thyroid Nodules

While the development of thyroid nodules is much more common in women than in men, when men develop thyroid cancer, the disease tends to be more aggressive. Risk factors for thyroid nodules may include a family history of thyroid disease, radiation exposure, especially to the head or neck.

Symptoms Of Thyroid Nodules

Many patients with thyroid nodules are asymptomatic, unaware that there is a problem until their doctor discovers them during a routine physical examination. If the nodules enlarge, however, they may exert pressure on the windpipe or on the esophagus, interfering with swallowing or breathing. If thyroid nodules affect hormone production, patients may experience a variety of symptoms of either hyperthyroidism or hypothyroidism.

Symptoms of hyperthyroidism include:

• Weight loss
• Nervousness or irritability
• Rapid heartbeat
• Sleep disturbances
• Muscle weakness
• Intolerance to heat

Symptoms of hypothyroidism include

• Weight gain
• Hair loss
• Dry skin
• Fatigue
• Constipation
• Intolerance to cold

Treatment Of Thyroid Nodules

Treatment of thyroid nodules depends on the type. Often, all that may be required for a benign nodule is watchful waiting. If the nodule has enlarged to the point that it interferes with breathing or swallowing, it will usually require suppressive hormone treatment or surgery. If the patient is experiencing symptoms of hyperthyroidism, radioactive iodine may be administered.



If a thyroid nodule proves to be cancerous, surgery is usually required to remove some or all of the gland. Radioactive iodine may also be prescribed. If a patient has a large part of the thyroid gland removed, hormone replacement will have to be taken for the remainder of the patient’s life. This usually presents no problem. Thyroid cancer patients have a very high rate of complete recovery.

Risks Of Thyroid Nodules

The most immediately life-threatening risk of thyroiditis resulting from thyroid nodules is thyrotoxic crisis, a sudden and potentially life-threatening intensification of symptoms that requires emergency care. There is also a risk that hyperthyroidism may result in heart problems or osteoporosis. While there is a risk that thyroid nodules may be cancerous, since malignancies of the thyroid gland are usually found in their early stages, they respond well to treatment. Patients with thyroid cancer almost always have a good prognosis.

Thyroid Cancer

The thyroid is a small, butterfly-shaped gland in the throat that controls the body’s heart rate, temperature and metabolism. Cancer of the thyroid gland can interrupt those vital functions, and lead to other complications. Fortunately, thyroid cancer can usually be successfully treated through minimally invasive methods. Thyroid tumors are somewhat common, and most are not cancerous. Cancer may develop as a result of age, exposure to radiation or a family history of goiters, cancer or other diseases. The thyroid is made up of follicular cells and C cells, either of which may develop cancer.

Risks Factors For Thyroid Cancer

The following may increase the risk of getting certain types of thyroid cancer:

• Being between 25 and 65 years old
• Being female
• Being Asian or Caucasian
• Having a family history of thyroid disease
• Having a family history of precancerous polyps in the colon
• Carrying an abnormal RET oncogene
• Having had radiation treatments to the head or neck
• Having a diet low in iodine

Types Of Thyroid Cancer

There are four types of cancer that develop in the thyroid gland, and one that develops in glands in the neck.

Symptoms Of Thyroid Cancer

Symptoms or signs of thyroid cancer may include:

• A bump or lump, or swelling, in the neck that may grow rapidly
• Pain in the front of the neck that may run up to the ears
• Hoarseness or other voice changes that do not go away
• Difficulty swallowing
• Wheezing or difficulty breathing
• A constant cough that is not due to a cold

Diagnosis Of Thyroid Cancer

Thyroid cancer can be diagnosed through a series of tests. Once diagnosed, further testing can help determine the disease’s stage and whether or not it has spread. Diagnostic tests include:

• Surgical biopsy
• Ultrasound exam
• CT or CAT scan
• Laryngoscopy
• Blood tests
• Fine-needle-aspiration biopsy

Treatment Of Thyroid Cancer

Surgery is the most common treatment for thyroid cancer. It is the only way to ensure a complete removal of all cancer cells, and greatly reduce the risk of recurrence. Types of surgery may include:

• Lobectomy, removal of the lobe in which the cancer is found
• Near-total thyroidectomy, removal of all but a very small portion of the thyroid
• Total thyroidectomy, removal of the entire thyroid
• Lymphadenectomy, removal of any cancerous lymph nodes from the neck

Additional standard treatments may include radiation therapy, chemotherapy, thyroid hormone therapy and targeted therapy. Thyroid cancer may be slow-growing enough to allow treatment to be delayed. Those who choose to postpone treatment should be closely monitored by a physician.

Surgical Intervention