Which operation is performed on a thyroid gland depends upon 2 major factors: The first is the thyroid disease present that is necessitating the operation. The second is the anatomy of the thyroid gland itself as is illustrated below.
Most surgeons and endocrinologists recommend total or near total thyroidectomy in virtually all cases of thyroid carcinoma. In some patients with small papillary carcinomas, a less aggressive approach may be taken (lobectomy with removal of the isthmus). A lymph node dissection within the anterior and lateral neck is indicated in patients with well differentiated (papillary or follicular) thyroid cancer if the lymph nodes can be palpated. This is a more extensive operation than is needed in the majority of thyroid cancer patients. All patients with medullary carcinoma of the thyroid require total thyroidectomy and aggressive lymph node dissection.
Partial Thyroid Lobectomy
Thyroid Lobectomy with Isthmusectomy
The standard neck incision is made typically measuring about 4 to 5 inches in length, although many endocrine surgeons are now performing this operation through an incision as small as 3 inches in thin patients. This incision is made in the lower part of the central neck and usually heals very well. It is almost unheard of to have an infection or other problem with this wound. The surgeon will then typically remove part or all of the thyroid.
As mentioned above, for thyroid cancer, this will usually entail all of the thyroid lobe that harbors the malignancy, the isthmus, and a variable amount of the opposite lobe (ranging from 0% to 100%, depending on the size and aggressive nature of the cancer, the cancer type, and the experience of the surgeon). The surgeon must be careful of the recurrent laryngeal nerves, which are very close to the back side of the thyroid and are responsible for movement of the vocal cords. Damage to this nerve will cause hoarseness of the voice, which is usually temporary but can be permanent. This is an uncommon complication (about 1% to 2% of patients experience this), but it it is serious.
Your surgeon must also be careful to identify the parathyroid glands so their blood supply can be maintained. Another potential complication of thyroid surgery—although incredibly rare is—hypoparathyroidism, which is due to damage to all 4 parathyroid glands. Usually the only thyroid operations that have even a slight chance of this complication is the total or subtotal thyroidectomy. Although these complications can be serious, their risk should not be the sole determinant of whether or not to undergo surgery.
Often, formal thyroid surgery is not needed to determine if a thyroid mass is cancerous. Because these masses can often be felt, a physician can stick a small needle into it to sample cells for malignancy. This is called fine needle aspiration (FNA) biopsy.
Don't be afraid to ask questions if you don't understand something. Your surgeon will walk you through all your thyroid surgery options, including total thyroidectomy.