Surgery for thyroid cancer
Most people with thyroid cancer will have surgery. The type of surgery you have depends mainly on the type and stage of the cancer. It also depends on the risk group for differentiated thyroid cancer. When planning surgery, your healthcare team will also consider other factors, such as your age and overall health.
Surgery may be done for different reasons. You may have surgery to:
- completely remove the tumour
- remove lymph nodes
- remove as much of the tumour as possible (called debulking)
- relieve pain or other symptoms (called palliative surgery)
The following types of surgery are used to treat thyroid cancer. You may also have other treatments before or after surgery.
A lobectomy is surgery to remove one side, or lobe, of the thyroid. A lobectomy is also called a partial thyroidectomy, or hemi-thyroidectomy.
During a lobectomy, the surgeon makes a cut, or incision, in the front of the neck. Through the opening in the neck, the surgeon removes the lobe of the thyroid that contains the tumour along with the part of the thyroid that connects the 2 lobes (called the isthmus).
A lobectomy may be done to treat low-risk differentiated thyroid cancer. It is usually the only treatment needed if the tumour is 1 cm or smaller and only in one place in the thyroid (called unifocal cancer). A lobectomy may also be done if the tumour is 1–4 cm in size and only in the thyroid.
Sometimes cells collected from a lump in the thyroid during a fine needle aspiration look a lot like normal thyroid cells (they are well-differentiated). Doctors can’t tell if the lump is a benign thyroid nodule or a cancerous tumour. When this happens, doctors do a lobectomy to help make a diagnosis.
A total thyroidectomy is surgery to completely remove the thyroid. It is the most common type of surgery done for thyroid cancer.
During a total thyroidectomy, the surgeon makes a cut, or incision, in the front of the neck. The surgeon then removes the thyroid through this opening. Sometimes the surgeon can’t remove all of the thyroid. If most of the thyroid is removed, the surgery is called a near-total, or subtotal, thyroidectomy.
A total thyroidectomy can be done for differentiated thyroid cancer in any risk group, especially if the doctor plans to use radioactive iodine (I-131) therapy. It is also the first treatment for most poorly differentiated carcinomas and medullary carcinomas. A total thyroidectomy may be done for rare cases of anaplastic carcinoma.
A neck dissection is surgery to remove several lymph nodes from the neck. The surgeon may also remove other tissues around the thyroid. It is often done at the same time as a thyroidectomy.
A neck dissection is usually done when:
- the doctor thinks there is cancer in the lymph nodes in the neck based on the results of an ultrasound
- a biopsy shows there is differentiated thyroid cancer in the lymph nodes
- the differentiated thyroid cancer is classified as intermediate risk or high risk
- the primary cancer is poorly differentiated carcinoma and the lymph nodes are enlarged
- the primary cancer is medullary carcinoma
- the primary cancer is anaplastic carcinoma that can be removed with surgery (it is resectable)
The type of neck dissection done depends on the size of the tumour and which lymph nodes in the neck the doctors think have cancer in them. The most common type of neck dissection for thyroid cancer is a central neck dissection. This surgery removes lymph nodes from the front of the neck near the thyroid. Doctors may also do a functional neck dissection or modified radical neck dissection if they need to remove more lymph nodes from the sides of the neck.
Find out more about neck dissection.
Surgery for advanced thyroid cancer
The following types of surgery are used to remove as much cancer as possible and relieve symptoms of advanced thyroid cancer.
En bloc resection may be done to remove the tumour, surrounding tissues, lymph nodes and structures in the neck as one piece (en bloc). This surgery may be done for anaplastic carcinoma that has spread outside of the thyroid to tissues and structures in the neck.
Surgery for metastasis may be used to remove thyroid cancer that has spread, or metastasized, to distant organs such as the lungs, brain or liver. Find out more about metastatic cancer.
Palliative surgery may be done if a large tumour causes symptoms or blocks an airway or the esophagus. The surgeon will remove all of the cancer or as much of it as possible (called debulking).
Tracheostomy is a surgical procedure to create an opening (called a stoma) in the trachea (windpipe) through the neck so air can reach the lungs. It is needed when a tumour presses on or blocks the trachea and makes it difficult to breathe. Find out more about living with a tracheostomy.
Side effects can happen with any type of treatment for thyroid cancer, but everyone’s experience is different. Some people have many side effects. Other people have only a few side effects.
Side effects can develop any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.
Side effects of surgery will depend mainly on the type of surgery and your overall health. A thyroidectomy, lobectomy and neck dissection may cause these side effects:
- hoarseness or other voice changes
- numbness and tingling feelings (often in the face) and muscle spasms caused by low levels of calcium in the blood (called hypocalcemia) and damage to the parathyroid gland
- wound infection
- neck and shoulder weakness after a neck dissection
- difficulty swallowing
- difficulty breathing
Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.
Questions to ask about surgery
One of 4 small glands attached to the thyroid in the neck that make and release the parathyroid hormone, which helps regulate calcium, magnesium and phosphorus levels in the blood.
Great progress has been made
Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.