Thyroid surgery is typically performed for thyroid cancer, a nodule (mass) present in the thyroid that is suspicious for cancer, an enlarged thyroid (goiter) causing compressive symptoms such as difficulty swallowing or breathing, and in some cases of hyperthyroidism.
We can use several different surgical approaches to perform these procedures. The traditional "open" method uses a 6-8 cm horizontal incision in the lower neck to expose the thyroid and surrounding structures. A "minimally invasive" approach with or without an endoscope can be performed in selected cases to reduce the incision size to between 2-4 cm. Finally, in selected patients, we can completely eliminate neck incisions using the da Vinci Surgical System to perform robot-assisted endoscopic thyroid surgery.
The most common procedures performed include:
Thyroid lobectomy, the removal of half of the thyroid gland. Typically this is performed to determine if an exisiting nodule is cancerous, or if enlargement of the thyroid is confined to one side. If cancer is found in the lobe of the thyroid, the other side may need to be removed (completion thyroidectomy) depending on the size of the cancer.
The potential risks of thyroid lobectomy include:
- Injury to the recurrent and superior laryngeal nerve, which may cause voice change, hoarseness, and swallowing problems. This may be a temporary or permanent problem.
- Bleeding which could cause airway compression.
- About 20% of patients may become hypothyroid. This may not become apparent for six months to two years after surgery and will require the need to take life-long thyroid replacement medication.
Total thyroidectomy, the removal of both lobes (the entire) thyroid gland. This is typically performed for known cancer, compressive goiter, or suspicious nodules on both sides. All patients that have a total thyroidectomy will require life-long thyroid replacement medications.
The potential risks of total thyroidectomy are the same as the risks for thyroid lobectomy, and also include:
- Temporary or permanent hypocalcemia (low calcium levels), related to injury to the parathyroid glands. This may require a patient to take calcium and vitamin D supplements to maintain their calcium levels.
- Since the recurrent and superior laryngeal nerves on both sides are in the surgical field, there is a risk of bilateral vocal cord paralysis causing airway obstruction.
In some cases of cancer, a neck dissection needs to be performed to remove lymph nodes surrounding the thyroid gland to determine if the cancer has spread and to remove any cancer cells may be contained in these lymph nodes.
Dr. deJong, Dr. Woong Youn Chung, and Dr. Kuppersmith
at the Severance Hospital, Yonsei University College of Medicine
in Seoul, Korea