Surgery for thyroid cancer
Surgery is usually the first treatment for thyroid cancer.
If the cancer is detected and removed early, most people have a very good chance of being cured. Your surgeon will explain the type of surgery that you need.
If the cancer has spread beyond the thyroid gland, surgery alone may not cure the cancer and you’ll often need a combination of treatments. Your surgeon may still recommend that the thyroid gland is removed as this can help to control symptoms.
It isn’t 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. This means that treatment with radioactive iodine is then possible.
Most people have all of the thyroid gland removed (total thyroidectomy). But some people who have stage 1 papillary or follicular thyroid cancer, which affects only one lobe of the thyroid gland, may have an operation to remove only the affected lobe (partial thyroidectomy or lobectomy).
The surgeon will remove the lymph nodes near the thyroid gland if tests show there are cancer cells in them.
The surgeon may also remove some of the lymph nodes close to the thyroid gland and in the neck if there is a high risk of the cancer coming back. This is called a prophylactic lymph node dissection. Your doctor will discuss with you if this is appropriate and what the possible side effects are.
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 the gland into surrounding tissue (locally advanced cancer)
you have anaplastic thyroid cancer, as this type can spread more quickly.
In most cases, the surgeon will try to remove as much of the cancer as possible without damaging any of the nerves in the neck. If the cancer can’t be completely removed with surgery, it will be treated with external beam radiotherapy and/or radioactive iodine.
Very occasionally, the surgeon will have to remove part of the trachea (the tube you breathe through). Sometimes surgery is the only treatment needed for thyroid cancer, but 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.
The nurses on the ward will help you to lie in a fairly upright position. This is to reduce swelling in the neck area.
You’ll be encouraged to start moving about as soon as possible. This is an essential part of your recovery. Most people can go home 1-3 days after thyroid surgery. If you have to stay in bed, the nurses will encourage you to do regular leg movements and deep breathing exercises. A physiotherapist or nurse will explain these exercises to you.
The nurses or surgeon will also show you some neck exercises to reduce stiffness in your neck.
Drips and drains
You will have a drip (intravenous infusion) to replace your body’s fluids until you’re able to eat and drink again, which is usually within 24 hours. One or two tubes (drains) will drain fluid from your wounds. These are usually removed within 24-48 hours.
If clips are used instead of stitches to close the wound, these will be removed before you go home.
Pain and discomfort
You’ll probably have some pain or discomfort after your operation, and your doctor will prescribe painkillers for you.
If you find they’re not helping, let your nurse know as soon as possible so that the drugs can be changed.
The skin on your neck up to your jawline might feel numb for the first 24 hours after surgery. This is from the local anaesthetic that is used during the surgery.
Eating and drinking
You should be able to swallow fluids an hour or so after your operation. However, you may find it painful to swallow solid foods for the first three days after surgery. You may need to start with soft foods. Once swallowing is easier, you can start eating solid foods. The nurses or a dietitian will discuss this with you before you go home. It’s important to maintain a balanced diet. If you’re finding it difficult to eat, nutritious drinks are a good way to supplement your diet.
Our section on eating problems and cancer has details of different nutritious drinks and supplements.
Most people are ready to go home about 1-3 days after their operation. If you think that you might have problems when you go home (for example, if you live alone or you have several flights of stairs to climb), let your nurse or the social worker know when you’re admitted to the ward. They can arrange help before you leave the 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. Our cancer support specialists can talk to you, and tell you how to contact a counsellor or local cancer support group.
Before you leave hospital, you’ll be given an appointment to attend an outpatient clinic for a post-operative check-up and to discuss if you need any further treatment. This is also a good time to discuss any concerns you may have.
You may have to let your insurance company know when you have thyroid surgery as many companies will not cover you in the weeks after surgery.
Once you get back to driving, you should make sure that you are free from any side effects of painkillers. You should also make sure you’re able to turn your neck in all directions.
Getting back to work
Everyone recovers at their own pace. People whose work involves heavy lifting, standing for long periods or walking around a lot may need more time before they are be able to return to work.
Usually, most people can return to work within two weeks of having thyroid surgery. It can help to speak to the occupational health nurse or your GP if you are uncertain when to go back.
Side effects of surgery
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Thyroid hormone replacement
Once your thyroid gland is removed, your body will no longer produce thyroid hormones. You’ll need to replace them by taking tablets for the rest of your life.
Occasionally, because of the position of the thyroid, the operation may affect the nerves close to the voicebox (larynx). This can make your voice sound hoarse and weak. This is usually a temporary problem, but it may be permanent in a very small number of people. You’re likely to have a vocal cord check after your surgery. You may be referred to a speech and language therapist.
Change in calcium levels
With a thyroidectomy, there’s a small risk (2 out of every 100 people) of damage to the parathyroid glands. These are four very small glands behind the thyroid. They produce parathyroid hormone, which helps to control the level of calcium in the blood.
If the parathyroid glands are damaged, the level of calcium in the blood may become low (hypoparathyroidism). The most common symptoms are:
tingling in the hands or feet, or around the mouth
unusual muscle movements such as jerking, twitching, or spasms
The calcium level in your blood will be checked within 24 hours after surgery. If your calcium level is low, it will be checked daily. Your doctor will prescribe calcium, and possibly vitamin D, supplements. Often these are only needed for a short time as the hypoparathyroidism can be temporary. Your doctor will tell you how long you need to take them for.
If the calcium level in your blood is found to be low in the long term, an endocrinologist or your GP will monitor it regularly.
After the operation, you’ll have a scar of about 5-7cm (2-3 in) at the level of your collar line on your neck. The scar will usually be in one of the natural skin folds, and it will fade as it heals.
It’s normal to feel tired a for few weeks after your thyroid gland has been removed. Many people also find that they experience a mixture of emotions after surgery. This is natural as your body is adjusting to the effects of the surgery.
Our section on fatigue has information on how to deal with tiredness.