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.
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.
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.