A thyroidectomy is surgery to remove half (thyroid lobectomy) or your entire (total thyroidectomy) thyroid gland.

Research has proven that the chance of having a safe and successful thyroid surgery depends on the experience of the surgeon.

Most patients are candidates for minimally invasive thyroid surgery (ie, a very small incision) to remove the thyroid gland.

Many patients can have an outpatient procedure and go home the same day of surgery. Surgery is performed under general anesthesia.

All patients will have a pre-operative thyroid ultrasound and possibly a thyroid biopsy, performed by Dr. Goldfarb to determine the extent of surgery. A small group of patients may also require evaluation of their vocal cords before their thyroidectomy.

two surgeons in an operating room

Types of Thyroid Surgery

The extent of thyroid surgery depends on your diagnosis as well as the state of your entire thyroid gland.

There are only a few possible surgeries that your surgeon should perform.

Unilateral Thyroid lobectomy and isthmusectomy

Half of the thyroid (or one lobe) is removed along with the middle part of the thyroid that connects the two lobes (the isthmus). This type of thyroid surgery is generally performed for a benign thyroid nodule, thyroid cyst, or unilateral goiter that is causing symptoms, for a thyroid nodule with an “indeterminate” biopsy or a low-risk mutation, or a small low-risk thyroid cancer.

Total Thyroidectomy

The entire thyroid gland is removed. This type of thyroid surgery is performed for patients with larger (>2cm) known thyroid papillary or follicular cancers, all medullary thyroid cancers, Graves’ disease , a multinodular toxic goiter, an indeterminate lesion with a high-risk mutation, or when nodules >1cm are in both lobes and the decision for surgery has been made for one of the above reasons.

Re-operative thyroid surgery

Occasionally, patients with thyroid cancer will need to have a repeat thyroid surgery at some future time to remove recurrent or residual thyroid tissue/cancer.

  • In general, any re-operative surgery has a greater risk of complications because you are entering an area with a lot of scar tissue and sometimes the normal anatomy looks different. For re-operative thyroid surgery, there is slightly higher rate of nerve injury and hypocalcemia. You should discuss this with your surgeon.
  • An ultrasound will be used in the operating room to identify and confirm the thyroid tissue and/or lymph nodes that are to be removed.
  • Sometimes, dye or a radio-labeled isotope will be used to help identify the recurrent lymph node that was planned for removal.

Total thyroidectomy with central neck dissection

A central neck dissection is when the lymph nodes closest to your thyroid in the central part of your neck are removed during your thyroidectomy.

This is done whenever abnormal lymph nodes are identified on ultrasound before surgery. Sometimes, for patients with larger and/or more extensive papillary thyroid cancer and for all medullary thyroid cancer, this lymph node surgery will be done prophylactically.

What to Expect the Day of Surgery – Commonly Asked Questions

  • A thyroidectomy can take anywhere from one to six hours once you are asleep depending on the type of surgery you are having.

  • Most patients that undergo a total thyroidectomy will go home that same day after spending 5-6 hours in the recovery room.
  • Patients with Graves’ disease, multiple medical problems, live far away, or are having a lateral neck dissection will spend one night in the hospital.

  • One of the rare side effects of thyroid surgery is injury to one of the recurrent laryngeal nerve that controls your voice. This complication occurs permanently in about 0.5-1% of patients.
  • It is not uncommon to experience some temporary hoarseness after surgery.

.

  • Yes. A nerve monitor is used during your entire thyroid operation. This allows the surgeon to confirm that the recurrent laryngeal nerve (the one that controls your voice) is working at the end of the case.

 

After Thyroid Surgery

(For more information please refer to Thyroidectomy What to Expect)

  • Everyone can eat, drink, and talk that same day right after surgery.
  • While you may feel some fatigue for 2-3 days (general anesthesia), you will be able to perform your normal activities.
  • Most people only take a few days off from work.

  • After Thyroid lobectomy: Approximately 50-75% of patients will not need hormone replacement. However, there are no accurate predictors of who will need medication and who will not. Your thyroid function will be tested about six weeks after surgery and a determination will be made at that time.
  • After Total thyroidectomy: You will need to take thyroid hormone replacement for the remainder of your life. It is a small pill that you take once a day (either first thing in the morning or before bedtime) on an empty stomach. You will be started on a weight-based dose and titrated as needed.

  • Most patients heal very well from surgery and have minimal residual thyroid surgery scar at 6 months.
  • The size of the incision will somewhat depend on how large your thyroid gland is. If you have a normal size thyroid gland, your thyroidectomy incision will generally be 3-4.5cm in length; for patients with large goiters (or very large nodules), your incision may be up to 6cm in size. If you have a neck crease, we try to hide the thyroidectomy scar in that line. All sutures are dissolvable.
  • It is important to apply suntan lotion to the surgical site for up to one year after surgery to prevent darkening of any scar.