Surgery for Thyroid Nodules & Cancers

Doctors typically recommend surgery to manage a thyroid nodule if a biopsy shows it is cancerous or if genetic testing shows it is likely to be cancerous. Genetic testing of a nodule often allows surgeons to avoid performing surgery if the test shows no mutations or genetic abnormalities.

People with toxic nodules or toxic multinodular goiters that are causing the thyroid to produce high levels of thyroxine—a condition called hyperthyroidism—may also benefit from surgery.

Your NYU Langone endocrinologist and endocrine surgeon determine the most effective and least invasive treatment or type of surgery based on diagnostic test results.

Scar-reducing or scarless surgery may be an option.

The thyroid consists of two lobes, which sit on either side of the windpipe, or trachea. They are joined by a small piece of tissue, called an isthmus. For a thyroid lobectomy, surgeons remove one lobe of the thyroid and the isthmus. A doctor may also use a lobectomy to manage a single toxic nodule that is causing hyperthyroidism. 

A lobectomy is also used to remove a thyroid nodule that might contain a small cancer. Removing one lobe instead of both allows the thyroid to continue producing thyroid hormone, which decreases the likelihood of requiring postoperative thyroid hormone supplementation.

A lobectomy is usually performed with general anesthesia, although local anesthesia with sedation is possible. You and your doctors determine the best option for you. During the procedure, the surgeon makes a small incision and removes the thyroid lobe and isthmus. The incision is often made in the crease of the neck to avoid a visible scar. 

Throughout the lobectomy, a physician monitors important nearby structures, such as the parathyroid glands, which help control the body’s calcium level, and the recurrent laryngeal nerve, which provides movement to the larynx, or voice box, enabling you to speak. 

Once the thyroid lobe and isthmus are removed, the incision is closed with dissolvable stitches.

Thyroidectomy is removal of the entire thyroid gland. It may be recommended for people with toxic multinodular goiters, confirmed thyroid cancer, genetic mutations associated with rapidly growing thyroid cancers, or a higher risk of recurrence. If you have thyroid cancer, your doctor may perform a fine needle aspiration biopsy on the lymph nodes in the neck to determine if they contain cancer. 

At NYU Langone, our doctors are experts in determining whether nearby lymph nodes look suspicious and need to be removed. Some people—such as those with a more aggressive thyroid cancer or a medullary thyroid cancer—are at greater risk of the cancer spreading to the lymph nodes. 

About half of people with papillary thyroid cancers that are larger than 1 centimeter have cancer in the lymph nodes. When doctors identify malignant lymph nodes during surgery, they usually remove them. Smaller lymph nodes that may have evaded detection by fine-needle aspiration or surgery are sometimes treated with radioactive iodine. 

To determine whether you need radioactive iodine therapy after a total thyroidectomy, your doctor considers the type of thyroid cancer you have, the lymph node involvement, and features of the tumor that increase the risk of recurrence. Follicular thyroid cancer rarely spreads to the lymph nodes, though it can spread through the bloodstream more readily than papillary cancer.

To perform a total thyroidectomy, the surgeon makes an incision in the front of the neck along a skin crease, if possible, to avoid creating a visible scar. The entire thyroid is then removed. If the gland cannot be removed—for example, if removing it could damage the nerve that provides movement to the larynx—the procedure is called a near-total thyroidectomy. Surgery is performed using either local or general anesthesia. 

Doctors at NYU Langone may remove all or part of the thyroid using advanced, minimally invasive surgery to reduce scarring. If you are concerned about scarring, please talk to our surgeons about the possibility or using one of these approaches.

Retroauricular Thyroid Surgery

Our surgeons may use a robotic-assisted retroauricular approach to perform a thyroid lobectomy or thyroidectomy. For this approach, we make an incision behind the ear to minimize visible scarring and use a surgical robot to help us with the procedure. Robotic-assisted surgery results in excellent visualization of the thyroid and surrounding structures and gives us the ability to perform the surgery with a hidden incision.

“Scarless” Thyroid Surgery

Our surgeons may perform a “scarless” procedure known as the transoral and submental technique (TOaST) to remove the thyroid. For this procedure, we make a tiny incision hidden in the natural fold under the chin and behind the lower lip area in the mouth to remove thyroid tissue, a method that minimizes visible scarring. The scar in the mouth is not visible, and the incision on the chin is nearly invisible.

People who have a thyroid lobectomy or a total thyroidectomy can often go home the day of surgery, but those who have a total thyroidectomy may need to stay in the hospital overnight. You may experience minor discomfort for a few days, which can be managed with pain medication.

A thyroidectomy stops or decreases production of thyroxine. Your doctor replaces thyroxine with a medication called levothyroxine, taken by mouth daily. This medication helps keep your metabolism functioning properly and prevents hypothyroidism.

If you have thyroid cancer, doctors may prescribe levothyroxine to keep thyroid-stimulating hormone levels on the low side or even fully suppressed to minimize the growth of any remaining thyroid cancer cells.

Some people produce enough thyroxine after a lobectomy and do not need levothyroxine. An NYU Langone endocrinologist assesses your hormone levels after lobectomy to determine whether you need medication.