Surgery for thyroid cancer

How surgery is carried out Back to top

It is not always possible for the doctors to make a diagnosis of cancer before surgery. In this situation, the surgeon will remove the affected lobe of the thyroid gland so that it can be examined under a microscope. If the diagnosis of cancer is confirmed, the remaining lobe will often be removed as well, during a second operation.

In people who have stage 1| papillary or follicular thyroid cancer it may be possible to remove only the affected lobe of the thyroid (partial or hemi-thyroidectomy); however, it is far more common for the surgeon to remove the whole gland (total thyroidectomy). The reason for this extra surgery is to make sure that as much of the cancer is removed as possible and to examine the thyroid very carefully in case cancer cells are present in other parts of the gland. It also means that treatment with radioactive iodine| is then possible.

Sometimes the surgeon removes and examines some, or all, of the lymph nodes close to the thyroid gland, to see whether the cancer has spread into them. This can help to reduce the risk of the cancer coming back after surgery.

Occasionally, it may be necessary for the surgeon to remove some of the tissues in the area around the thyroid gland. This may be done if:

• the cancer has begun to spread outside of the gland (locally advanced cancer)
• you have anaplastic thyroid cancer, as this type often spreads more quickly.

Sometimes the surgeon will have to remove part of the tube through which you breathe (trachea) and make an opening in the throat to allow you to breathe (tracheostomy).

Sometimes surgery is the only treatment needed for thyroid cancer, however your doctor may also recommend radioactive iodine| or external radiotherapy|. Radiotherapy aims to destroy any cancer cells that may be left, or to treat any cancer that has spread to other parts of the body.

After your operation Back to top

You will be encouraged to start moving about as soon as possible after your operation. This is an essential part of your recovery and, even if you have to stay in bed, it is important to do regular leg movements and deep breathing exercises. The physiotherapist will help you with these.

To ensure that you can breathe easily after the operation, the nurses will make sure that you are lying in a semi-upright position.

Drips and drains

You will have a drip (intravenous infusion) to replace your body's fluids until you are able to eat and drink again – usually within 24 hours. One or two tubes (drains) will drain fluid from your wound. These are usually removed within 48 hours. If clips are used instead of stitches to close the wound, these will be removed before you go home.

Pain and discomfort

You will probably have some pain or discomfort after your operation and your doctor will prescribe painkillers for you. If you find the painkillers are not helping, let your nurse know as soon as possible so that the drugs can be changed.

Eating and drinking

You may find it painful to swallow for a short time and you may need to eat soft food. The nurses, or a dietitian, will discuss this with you before you go home. It is important to maintain a balanced diet. If you are finding it difficult to eat, nutritious drinks are a good way of supplementing your diet. Our eating well| section has details of different nutritious drinks and supplements.

Going home

Most people are ready to go home about 3–5 days after their operation. If you think that you might have problems when you go home (for example, if you live alone or have several flights of stairs to climb) let your nurse or the social worker know when you are admitted to the ward. They can arrange help before you leave hospital.

Some people take longer than others to recover from their operation. If you have any problems, you may find it helpful to talk to someone who is not directly involved with your illness. The nurses in our cancer support service| can talk to you, and tell you how to contact a counsellor or local cancer support group.

Thyroid hormone replacement Back to top

You will need to take hormones| to replace those normally produced by the thyroid gland.

Radioactive iodine scans and treatment Back to top

If you have an operation for papillary or follicular thyroid cancer, you are likely to have a scan| or treatment using radioactive iodine in the weeks following the surgery. Your doctor may delay starting thyroid hormone replacement therapy until this has been done.

Hoarse voice Back to top

Occasionally, because of the position of the thyroid, the operation may affect the nerves supplying the voice box (larynx). This can make your voice sound hoarse and weak for some time after the operation. This is usually a temporary problem, but in a very small number of people may be permanent.

Change in calcium levels Back to top

With a thyroidectomy there may also be some damage to the parathyroid glands (tiny glands behind the thyroid). Their function is to control the level of calcium in the blood and, if damaged, this may become low. If necessary, your doctor will prescribe calcium supplements for you. Often these are only needed for a short time, but your doctor will let you know how long you need to take them for.

Tiredness Back to top

It is perfectly normal to feel a little tired| for the first few weeks after removal of the thyroid gland, especially if you have to wait before starting thyroid hormone replacement therapy.

Scar Back to top

You will have a scar across the front of your neck just above the collar bones. The scar will look red or dark initially but it should fade with time.

Appointment Back to top

Before you leave hospital you will be given an appointment to attend an outpatient clinic for a post-operative check. This is a good time to discuss any concerns you may have.