1231 116th Avenue NE, Suite 915
Phone: (425) 454 - 3938
Typically, surgery such as a thyroid lobectomy or total thyroidectomy is recommended in patients diagnosed with thyroid cancer or in patients with high clinical suspicion for thyroid cancer. In addition, thyroid surgery is also indicated in patients with large thyroid nodule (> 4 cm), non-diagnostic thyroid nodule with high-risk features, poorly controlled hyperthyroidism (e.g. Grave’s disease), and enlarged goiter causing compressive symptoms or cosmetic deformity. However, other factors such as the patient’s co-morbidities, age, and goal of care may guide the decision between observation and surgery. Patients with thyroid cancer who are at high risk for regional metastasis to lymph nodes in the neck or have evidence of nodal metastasis will usually need a concurrent neck dissection (removal of lymph nodes).
Figure 1. Common indications for thyroid surgery include thyroid cancer (left) and thyroid goiter (right).
The decision to proceed with a thyroid lobectomy (removal of half the thyroid gland) or total thyroidectomy (complete removal of the thyroid gland) is based on the underlying pathology and goal of care. The approaches to the surgeries are the same.
A horizontal skin incision is made at the midline of the neck over the thyroid gland. The thyroid gland is identified under the muscles in the neck. The gland is then carefully separated from the underlying structures in the neck. The parathyroid glands (responsible for calcium regulation) and the recurrent laryngeal nerves (responsible for voice and breathing function) are often identified and preserved. Often, the recurrent laryngeal nerve is monitored (neuro-monitoring) to aid in the surgery while reducing the risk of injury to the nerve.
Figure 2. Illustration of skin incision and removal of the thyroid gland. Source: uptodate.com
The lymph nodes may be removed (central neck dissection) at the same time if there is evidence of cancer spreading to the nodes or if the risk of nodal metastasis is high. This is performed by removing fatty and lymphatic tissue in the area over the trachea, between the recurrent laryngeal nerves.
Figure 3. Central neck nodes are removed after removal of the thyroid gland. Source: uptodate.com
Your surgical team will include your surgeon, a surgical assistant, an anesthesiologist, a scrub nurse, a circulating nurse, and additional supporting staff dedicated to ensuring that your surgery is safe. Thyroid surgery is performed under general anesthesia and will usually last about 2-3 hours; however, the duration will vary depending on your underlying pathology. Blood loss from thyroid surgery is usually minimal. Your surgeon may choose to monitor the recurrent laryngeal nerve during the surgery by using a special intubation tube. At the end of the surgery, the incision is usually closed using sutures and a temporary drain may be placed to remove excess fluid until it is removed the next day.
Figure 4. Neuromonitoring during thyroid surgery. Source: Butterworth et. al. Morgan & Mikhail's Clinical Anesthesiology, 5th Ed
As with any surgical procedure, a thyroidectomy has associated risks. With meticulous planning and appropriate precautions, complications from thyroid surgery are very rare. Although the chance of a complication occurring is very small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have. These risks may include:
Your surgeon is committed to providing you with the highest level of care in a comfortable and caring environment. We want you to have all of your questions answered and provide you with a complete understanding of your condition and treatment plan related your thyroid surgery. Please feel free to ask questions about any aspect of your care. Learn more about thyroid nodule, thyroid cancer, and post-operative care after thyroid surgery.