The first line of treatment for papillary thyroid cancer, also known as papillary thyroid carcinoma, is to eliminate the cancer cells by surgically removing the thyroid. This procedure is known as a thyroidectomy.
There are 2 types of thyroidectomy procedures—total and partial. A total thyroidectomy is a procedure that removes your entire thyroid gland. Total thyroidectomies are more common than their partial counterparts. That's because total thyroidectomies provide a greater guarantee of removing the entire papillary thyroid cancer.
Total thyroidectomy procedures can take a long time to perform—3 to 4 hours, in most cases. Your surgeon makes a small incision in the front of the neck, and he or she must carefully work around vital structures, such as the vocal nerves. A small amount of thyroid tissue near the recurrent laryngeal nerve (the nerve that is important for the voice) may be left behind.
Because the thyroid gland is removed, this procedure causes hypothyroidism. Without the thyroid gland, no thyroid hormone is released. To compensate, you'll need to take thyroid hormone replacement therapy. This will ensure that your body has healthy levels of thyroid hormones.
For patients with small papillary tumors located in only one lobe of the thyroid gland and whose cancer hasn't spread outside the thyroid, a partial thyroidectomy (also known as a lobectomy) may be enough to remove the cancer.
The thyroid cancers that may be treated with a partial thyroidectomy are smaller than 1 cm and are called microscopic papillary thyroid cancer. In the absence of extension outside the thyroid capsule, removing the other thyroid lobe (if that lobe is entirely normal without nodules) is not necessary.
In a partial thyroidectomy, only the cancerous thyroid lobe is removed. This surgery typically takes 1.5 to 2 hours to perform. Unlike a total thyroidectomy, this procedure won't result in hypothyroidism. Though one lobe is removed, the remaining lobe can still produce healthy amounts of thyroid hormone. However, depending on the pathology and your thyroid function tests, you might still need to take thyroid hormone medication to suppress the remaining thyroid lobe.
After the Procedure
Though a thyroidectomy is an extensive procedure, the recovery time is typically very short. Plus, most patients report very little discomfort after surgery.
Immediately after surgery, you'll be able to function normally. And even though the incision site is in the front of the neck, you'll be able to eat and talk.
You may need to stay in the hospital overnight if you have a total thyroidectomy, though most patients who have partial thyroidectomies may be discharged within a few hours of their operation.
Potential Risks and Complications
A thyroidectomy is a safe surgical procedure with relatively few risks. But because it involves an incision in the neck, there is a small chance that a vocal cord nerve may be damaged. If this occurs, your voice will sound permanently hoarse or scratchy.
Sometimes, despite the nerve being not damaged, voice can be changes can occur after surgery. This is due to swelling around the voice box and trauma from the tube placed in the air pipe during the surgery. If the nerve is intact, the voice changes frequently recover within 3 to 6 months. If the voice changes persist beyond 6 months, then certain procedures and rehabilitation can be done by ENT doctors and speech therapists to improve the voice. The risk of a permanent injury to the nerve is about 1%.
Your parathyroid glands are located behind your thyroid, so they also carry a small risk of injury. The surgeon must carefully identify the parathyroid glands to prevent damaging them during the thyroidectomy.
The parathyroid glands regulate calcium levels. If one or more of those glands are damaged, then hypoparathyroidism can result. This may eventually trigger hypocalcemia, which is a condition of abnormally low levels of blood calcium. If hypocalcemia occurs, then it can be easily treated with calcium and vitamin D supplements.
About a third of patients can experience temporary hypocalcemia, which manifests as numbness and tingling involving the finger tips and the lips. This condition responds well to calcium ingestion. A permanent problem with hypocalcemia is possible, but occurs in less than 1% of the patients.
As with all surgical procedures, a thyroidectomy does have some risks. However, these risks are very rare. Thyroid surgery is a generally safe and effective surgical procedure for the treatment of papillary thyroid carcinoma. If you have been diagnosed with papillary thyroid cancer and have questions about surgery, don't hesitate to ask your doctor.