Surgery for Thyroid Nodules & Cancers

NYU Langone doctors may recommend surgery to manage a thyroid nodule if a biopsy shows it’s cancerous or if genetic testing shows it’s likely to be cancerous.

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 have surgery, but doctors typically recommend using medications or radioactive iodine therapy first because these treatments can be effective and are less invasive.

Your NYU Langone endocrinologist and endocrine surgeon determine the extent of the surgery based on diagnostic test results.

Thyroid Lobectomy

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 cancer. Removing one lobe instead of two often allows the thyroid to continue producing enough thyroid hormone. If the nodule is confirmed to be cancerous, the rest of the thyroid is usually removed in a second, later procedure.

Genetic testing of a nodule often allows surgeons to avoid performing a lobectomy to confirm a diagnosis of thyroid cancer. If testing shows that cancer is likely, surgeons can perform a thyroidectomy, the removal of the entire thyroid, as the first and only procedure.

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

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.

What to Expect After Surgery

People who have a lobectomy can often go home the day of surgery, but those who have a total thyroidectomy usually 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 synthetic hormone 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.