Thyroid surgery removes part or all of your thyroid gland.
Your thyroid gland has two lobes, left and right.
- Total thyroidectomy removes both lobes of your thyroid gland.
- Hemithyroidectomy removes half of your thyroid gland.
- Thyroid nodulectomy removes a thyroid nodule and leaves the rest of your thyroid gland intact. This works best if the nodule is in the centre of the thyroid.
If you have all or most of your thyroid gland removed, you’ll need to take thyroid hormone tablets daily for the rest of your life. If you have half the gland removed, you may or may not need thyroid hormone replacement.
Open thyroid surgery is by far the most common type in Australia, and is safe and effective. The scar is in a natural skin crease on the front of your neck, and the cosmetic result is usually excellent. Your surgeon will make the incision and remove part or all of your thyroid. The incision is between 4 and 7 cm or longer, depending on the size of your thyroid, and your neck.
Keyhole (endoscopic) surgery
This surgery is done using several smaller incisions, usually between 2 and 2.5 cm. Your surgeon uses an endoscope (a tube with a light and camera on the tip) to view your thyroid nodule and removes it by inserting instruments through the incision.
Keyhole surgery usually takes longer than open surgery and may have increased risks. You’ll need to find an endocrine surgeon who’s skilled in keyhole techniques.
If you’re having keyhole surgery, be aware that if your surgeon has difficulties with the procedure they may need to change to an open surgery.
If you have small thyroid nodules, you may be offered robotic assisted surgery. Miniature robotic arms controlled by your surgeon are inserted through incisions made in the back of your neck, under your hairline, in your chest or your armpit – which means you won’t have a scar on the front of your neck.
While not having a scar may be appealing, there are drawbacks: It’s a more extensive procedure than open surgery as the surgeon has to tunnel through from a distant site. It’s also a lot more expensive, with a longer hospital stay and a more uncomfortable recovery period.
At the moment there are very few Australian surgeons doing robotic thyroid surgery, and experience is very limited. This type of thyroid surgery has been abandoned in the USA for safety concerns but remains popular in Asia.
Surgery for thyroid cancer
Following a diagnosis of thyroid cancer, there are several surgical options, depending on the type of cancer. If your thyroid cancer is less than 2cm diameter, hasn’t spread to surrounding tissue or your lymph nodes, you may have only half the thyroid removed (hemithyroidectomy).
If the tumour is larger, or if you and your surgeon are concerned for other reasons your surgeon may recommend removing the whole thyroid plus or minus the nearby lymph nodes. Removing the lymph nodes can reduce the risk of cancer reappearing in the area. The approach your surgeon recommends will depend on the stage and type of cancer.
Following total thyroidectomy surgery, your surgeon may recommend radioactive iodine treatment, depending on the risk level of the cancer. Radioactive iodine will destroy any remaining remnants of your thyroid.
In very rare cases, thyroid cancer may spread to other parts of your body, and if that happens, radioactive iodine can treat that too. More advanced cases of thyroid cancer are rare, but occasionally, your doctor may discuss other treatments such as external beam radiation, chemotherapy and/or targeted drug therapy. Learn more. <link to Thyroid cancer staging and treatments page>
If you’re pregnant
Because of the possible risks to your foetus from general anaesthesia, your doctor may recommend delaying thyroid surgery until after you’ve had your baby. The exceptions would be if you have thyroid nodules that are restricting your breathing, or if you have a large or invasive thyroid cancer. If you to need to have thyroid surgery while you’re pregnant, the best time to have it is during the second trimester.
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