The main treatment for follicular and papillary thyroid cancer and for medullary thyroid cancer is surgery. This can be used sometimes to treat anaplastic thyroid cancer as well. During surgery, part or all of the thyroid gland is removed. This is called thyroidectomy.
The type of operation you have will depend on the size of the cancer and your general health. Your surgeon or specialist nurse can talk to you about what to expect before and after your operation.
In this operation, the surgeon removes the whole thyroid gland. It is the most common surgery for thyroid cancer. If it is not possible to remove the whole thyroid gland, the surgeon will remove most of it. This is called a near-total thyroidectomy.
If the cancer has started to spread outside the thyroid gland, the surgeon may need to remove some of the tissue in the area around it. They may also remove some of the nearby lymph nodes. Your doctor will discuss this with you before the operation.
In this operation, the surgeon removes the lobe of the thyroid gland that contains the cancer. The isthmus may also be removed.
Sometimes, if the FNA result is not clear, a lobectomy is used to diagnose thyroid cancer. Your doctor or specialist nurse will discuss this with you. If a cancer is found, your doctor may then suggest you have another operation to remove the remaining lobe of the thyroid gland.
Your surgeon may remove the lymph nodes in the front, or the front and side, of your neck. This is called a neck dissection. It is done to:
- remove suspicious or cancerous lymph nodes
- reduce the risk of the cancer coming back.
Removing the lymph nodes will also give your doctor information to help them plan further treatment.
If you have all of your thyroid gland removed, your body will no longer produce thyroid hormones. You will need to replace them by taking tablets for the rest of your life.
If you have had a lobectomy, you may also need to take thyroid hormones, but this is unlikely. Your doctor or specialist nurse can tell you whether you will need to.
The thyroid gland is close to the nerves that control your vocal cords. Occasionally, these nerves can be bruised or damaged during surgery. This can make your voice sound hoarse and weak. Your doctor may check your vocal cords before and after your surgery.
A hoarse, weak voice is usually a temporary problem, but may be permanent in a very small number of people. You may be referred to a speech and language therapist for specialist advice.
Change in calcium levels
There is a small risk that surgery to remove the thyroid gland will damage the parathyroid glands. These are four very small glands behind the thyroid gland. They make parathyroid hormone, which helps to control the level of calcium in your blood.
If your parathyroid glands are damaged, the level of calcium in your blood may become low (hypoparathyroidism). This can cause:
- tingling in your hands or feet, or around your mouth
- unusual muscle movements, such as jerking, twitching, spasms or muscle cramps.
Your doctor or nurse will check the calcium level in your blood after your operation. If your calcium level is low, they will give you calcium either as a tablet or through a drip in your arm. They will check your calcium levels every day until they improve.
Your doctor will prescribe calcium, and possibly vitamin D supplements, for you to take at home. They will arrange for you to have regular blood tests to check your calcium levels. You should take the calcium tablets at least four hours before or after taking thyroid hormone replacement tablets.
You will often only need these supplements for a short time. Your doctor will tell you how long you need to take them for. If the calcium level in your blood continues to be low, one of your doctors will monitor it regularly. This will often be an endocrinologist or your GP.
After your operation, you will have a small scar at the level of your collar line on the front of your neck. The scar will usually be in one of your natural skin folds, and it will fade as it heals. If you have more extensive surgery to remove lymph nodes, you may have a bigger scar.
We have more information about covering scars.
Your neck may feel stiff and uncomfortable after surgery. This usually gets better after a few weeks. But it may continue for longer if you have had more extensive surgery to remove some of your lymph nodes. Your doctor will prescribe painkillers to help and may refer you to a physiotherapist.
Tiredness and mixed emotions
It is normal to feel tired for a 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 adjusts to the effects of the surgery.