What is thyroid cancer?
What is thyroid cancer?Thyroid cancer is caused by the growth of malignant cells in the tissue of your thyroid, the butterfly-shaped gland at the front base of your neck. Surgery is common in treating thyroid cancer. The type of surgery depends on several factors, such as the patient’s overall health and the stage of cancer.
Thyroidectomy: A surgical procedure that removes all (total thyroidectomy) or most (near-total thyroidectomy) of your thyroid. It is the most common surgery for thyroid cancer, especially for large tumors.
Lobectomy: A surgical procedure that removes the lobe containing the tumor. It is most effective for treating small or slow-growing tumors that are isolated to one part of the thyroid. It is sometimes combined with an isthmectomy (removal of the connective tissue between the two lobes of the thyroid gland).
Lymph node dissection (lymphadenectomy): Removal of nearby lymph nodes to evaluate whether cancer has spread and to help guide staging and treatment.
What to Expect:
- Anesthesia: At NewYork-Presbyterian, patients are given the option of local or regional anesthesia, which induces sedation, or general anesthesia, which allows you to be fully asleep during surgery.
- Surgery: Surgeons traditionally access the thyroid through a small incision in the neck. For many patients, scar-minimizing alternatives are also available.
- Duration of Surgery: A thyroidectomy typically takes one to three hours, while a lobectomy usually takes less than two. The exact duration depends on the extent of the surgery.
- Outpatient vs Inpatient: Some patients may return home on the same day, while others stay in the hospital overnight. Temporary symptoms, such as a weak or hoarse voice, are common post-surgery.
When is surgery recommended?
When is surgery recommended?Surgery is common in the treatment of most thyroid cancers. Thyroid cancer surgery involves the removal of all or part of the thyroid and, in some cases, the removal of nearby lymph nodes to evaluate for cancer spread. Surgery is effective at removing cancerous tissue, reducing the likelihood of recurrence, and, in many cases, leading to a cure. It can be combined with additional treatment, such as radioactive iodine (RAI) therapy or clinical trials.
There are a number of factors that influence how thyroid cancer is treated.
Your team will consider:
- Tumor Size: The size of the tumor and whether or not it has grown beyond the thyroid help determine the extent of surgery and need for additional treatment.
- Type of Tumor: The type of tumor depends on which cells the cancer originated in, and treatment varies based on type. Papillary and follicular cancers are the most common and easiest to cure, while oncocytic, medullary, and anaplastic cancers are more rare and aggressive.
- Spread: Your doctor will determine if the cancer is contained in the thyroid or if it has spread to nearby lymph nodes or distant organs, bones, etc. (metastasis).
- Genetic Factors: Certain genetic conditions are associated with a higher risk of thyroid cancer. These include Cowden syndrome (also known as Cowden disease), familial adenomatous polyposis (FAP), and multiple endocrine neoplasia (MEN), which is linked to mutations in the RET gene. Family history of thyroid cancer is also a risk factor. Genetic factors can be identified through molecular testing and used to help catch tumors early and guide treatment decisions.
- Patient Factors: Your age, overall health, pre-existing conditions, and personal preferences all play a role in determining the most appropriate treatment plan.
What are the different types of thyroid surgery?
Types of thyroid surgeryLobectomy
What is it? A lobectomy is a surgical procedure that removes half the thyroid—the lobe in which the cancer is found. It is sometimes combined with an isthmectomy, which is the removal of the narrow band of tissue (the isthmus) that connects the two lobes of the thyroid gland.
When is it used? Lobectomies are most effective at treating small or slow-growing tumors that are found in one lobe and have not spread beyond the thyroid.
Thyroidectomy (total or near-total)
What is it? A thyroidectomy is a surgical procedure that removes all or most of your thyroid. A total thyroidectomy is the removal of the entire thyroid, while a near-total thyroidectomy is the removal of most of the thyroid. It is the most common type of thyroid cancer surgery.
When is it used? Thyroidectomies are most effective at treating large and advanced tumors. In these cases, a total thyroidectomy is often ideal and can improve the efficacy of additional treatments, such as radioactive iodine therapy. Near-total thyroidectomies are common in patients with Grave’s disease, when the thyroid is enlarged.
Completion Thyroidectomy
What is it? A completion thyroidectomy is a surgical procedure that removes the rest of the thyroid after a lobectomy.
When is it used? It is often performed when additional treatment is needed based on pathology results such as evidence of spread, or to allow for additional treatments like radioactive iodine.
Lymph Node Dissection (lymphadenectomy)
What is it? Lymph node dissection is the surgical removal of lymph nodes near the thyroid.
When is it used? Lymphadenectomy prevents cancer spread and minimizes the likelihood of recurrence. It is typically part of a total thyroidectomy and is often done during a near-total thyroidectomy or a lobectomy, especially when an ultrasound reveals suspicious nodes prior to surgery.
Planning your surgery
Planning your surgeryImaging & Biopsy
Thyroid cancer is often detected during a regular check-up or when a patient experiences swelling or a lump in the neck that causes them to visit the doctor. After getting your medical history and conducting a physical exam to identify risk factors and rule out other conditions, your doctor may order a thyroid ultrasound (USG) and a blood test.
When thyroid cancer is suspected, your doctor will perform a fine needle aspiration (FNA) biopsy to remove cells from your thyroid nodules for analysis under a microscope. After a cancer diagnosis, doctors often use MRIs or CT scans to determine if the cancer has spread. These findings help your care team determine the extent of surgery, including whether a lobectomy or total thyroidectomy is most appropriate.
Thyroid Cancer Staging
Doctors use the TNM system to determine the stage of thyroid cancer. “T” refers to the size of the tumor, “N” represents spread to nearby lymph nodes, and “M” describes spread to distant organs (metastasis).
Age also plays a role. With a few exceptions, patients 55 and younger are diagnosed with Stage I or Stage II, while patients older than 55 can be diagnosed with Stage I through IV. Stage I is the least advanced form of cancer, while stage IV is the most advanced.
Anaplastic thyroid cancer, while rare, is always considered Stage IV. In addition, medullary thyroid cancer staging does not depend on age—all patients can be diagnosed with stages I through IV.
Molecular Testing
NewYork-Presbyterian offers molecular testing to look for specific DNA mutations and gene expressions associated with a higher risk of thyroid cancer. These tests are particularly useful for individuals with a family history of thyroid cancer, especially medullary thyroid cancer.
If certain genetic mutations are identified, your doctor may recommend regular screenings or, in some cases, prophylactic thyroid surgery. It is important to remember that having a genetic predisposition does not mean you will develop thyroid cancer. It just means extra precautions may be necessary.
How the care team coordinates
At NewYork-Presbyterian, multidisciplinary teams of endocrine surgeons, endocrinologists, radiologists, pathologists, oncologists, and other specialists evaluate each diagnosis and create personalized treatment plans tailored to each patient’s needs.
Across locations, our Divisions of Endocrine Surgery employ state-of-the-art treatments and minimally invasive techniques to reduce discomfort and recovery time. We also strive to make care more simple when possible with options such as same-day biopsies.
What happens during surgery?
What happens during surgeryThyroid surgery may be performed with local, regional, or general anesthesia, depending on the procedure and the patient. If you receive general anesthesia, you will receive a temporary breathing tube during surgery. After the procedure, your surgeon may place a small tube, called a drain, in your neck to remove fluid. The drain is typically removed before you go home.
In most cases, surgeons access the thyroid through a small incision in the front of the neck. Our surgeons take great care to protect nearby structures, including the nerves that control the vocal cords. During surgery, patients under general anesthesia may have a device called a nerve monitor that helps identify and protect these nerves. Patients under local or regional anesthesia may be asked to speak during the procedure, a technique known as voice monitoring.
Thyroid tissue or lymph nodes removed during surgery may be sent to a pathologist for evaluation. This analysis helps determine the subtype of thyroid cancer and guides next steps in care.
Minimally invasive/scar-minimizing options
Minimally invasive/scar-minimizing optionsNewYork-Presbyterian offers minimally invasive and scar-minimizing surgeries for eligible patients. These procedures are not an option for everyone but may be suitable for those with a history of bad scarring or concerns about having a visible neck scar. Speak with your surgeon to determine if this is an option for you. Your surgeon will consider tumor size, cancer type, your weight, and your overall health when determining what treatments are appropriate.
Transoral (TOETVA)
Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) allows the surgeon to access the thyroid through three small incisions inside the lower lip. One incision is for an endoscope and the other two are for surgical instruments. These incisions create a direct path to the thyroid. Since TOETVA avoids an external neck incision, it reduces visible scarring.
TOETVA is not suitable for everyone and is generally considered for patients with small, less aggressive tumors.
Robotic / Remote-Access
During robotic or remote-access thyroid surgery, your surgeon accesses your thyroid by inserting robotic instruments into an incision in your armpit. These instruments act like robotic hands controlled by the surgeon.
In addition to reducing visible scarring, robotic surgery can lessen postoperative pain, reduce the length of your hospital stay, and lower the rate of postsurgical complications. Eligibility depends on several factors, including the size of the thyroid, the size of the tumor, and the patient’s weight.
What are the risks and side effects of thyroid surgery?
Risks and side effectsThyroid surgery is generally very safe, with low complication rates and a smooth recovery for most patients. As with any major surgery, there are risks to be aware of. Your care team will review common side effects and postoperative symptoms so that you know what to expect and when to seek medical attention.
Patients may be at greater risk of complications if they have previously undergone thyroid surgery, if the cancer has spread to their lymph nodes, or if they have a goiter.
Common Side Effects of Thyroid Surgery Include:
- Pain, discomfort, or stiffness in the neck and at the incision site
- A hoarse or weak voice
- Temporary difficulty swallowing
- A raw or sore throat due to the breathing tube inserted during surgery
These side effects are usually temporary. As the nerves heal, the voice typically returns to normal, and pain in the neck and throat dissipates.
While less common, hypocalcemia (low calcium levels) can cause temporary numbness and tingling in the hands, soles of the feet, or around the lips, usually 24 to 48 hours after surgery. This occurs when the parathyroid glands, which are located near the thyroid and help regulate calcium levels in the blood, are temporarily affected or, in rare cases, damaged or removed during surgery. To help reduce this risk, your doctor may instruct you to take calcium supplements before and after surgery.
Potential Complications (Less Common)
- Bleeding from the incision site
- Infection, often marked by fever or increased drainage, pain, redness, or swelling at the wound
- A permanent hoarse or weak voice caused by damage to the nerves that control the vocal cords
When to seek medical care
- You experience swelling, bleeding, worsening pain, or pus from the incision site
- You have difficulty breathing or feel like you are choking
- You have a fever of 101°F (38.3°C) or higher
- You experience numbness or tingling in your face, hands, or lips
Recovery
RecoveryMost patients recover well after thyroid surgery. Many return home the same day, while some stay in the hospital overnight, depending on the extent of the procedure and individual needs. Your surgeon will discuss the recovery timeline and what to expect after surgery. It is important to ask questions and seek guidance as needed.
24 - 48 hours post-surgery:
In most cases, patients experience mild to moderate discomfort rather than severe pain and are able to eat, drink, and move around the same day. In the first couple of days, it is common to feel tired and to experience neck discomfort, a slight cough, and a sore throat, especially when swallowing. To help minimize symptoms, your doctor will often instruct you to take acetaminophen, naproxen, or ibuprofen for a few days. In rare cases, your doctor will prescribe a narcotic painkiller.
Your doctor may also instruct you to take calcium supplements, which help support your parathyroid glands and reduce the chance of hypocalcemia. Hypocalcemia usually shows up 24-48 hours after surgery as a tingling or numbness in the hands, feet, and lips. It is usually temporary, but you should contact your doctor if your symptoms worsen or persist.
You are able to eat and drink after surgery once the anesthesia has worn off. Many people prefer to stick to softer foods in the first days of recovery. While you are encouraged to move around, it is crucial to avoid heavy lifting, strenuous activity, swimming, or soaking in baths for at least a week. When showering, try to avoid saturating the incision, even though it will be covered with a water-resistant plastic coating.
First week post-surgery:
Most patients are able to return to work after one week, although you must still avoid heavy lifting, strenuous activity, swimming, and soaking in baths. You are able to drive as soon as you have full mobility in your neck. In most cases, the sore throat, pain when swallowing, and cough will have subsided, although residual neck discomfort is still common. Mild bruising, swelling, and tightness around the incision is common and normal. The water-resistant plastic coating covering your incision will also peel off within a week.
You will receive specific instructions from your care team that address how to care for your incision, physical restrictions during recovery, and guidelines for seeking emergency medical care in the rare case of complications.
2 - 6 weeks post-surgery:
By this point, many patients are feeling much better and are able to return to normal routines. Symptoms such as neck tightness and tenderness, as well as a hoarse or weak voice, usually continue to improve and subside. You will visit your surgeon for a follow-up appointment three weeks after surgery. At this appointment, you will discuss any remaining symptoms, ongoing wound care, and medication adjustments.
Post-surgery activity:
Most patients can walk and do light activity soon after surgery, if not the same day, but should wait to resume strenuous exercise and heavy lifting until cleared by their surgeon. A return to work is often possible within one week, especially for non-physical jobs, though recovery may take longer after more extensive surgery. While many physical symptoms improve within the first few weeks, it is normal for energy levels to take longer to fully return to baseline.
Post-surgery diet:
Most patients can eat and drink shortly after surgery, typically with soft foods. A sore throat or some difficulty swallowing is common and usually improves during the first several days. If these symptoms worsen or if swallowing becomes more difficult, you should contact your care team.
Post-surgery calcium:
Patients who undergo a total thyroidectomy are more likely to experience low calcium levels due to disturbance of the parathyroid glands during surgery. Some patients need temporary calcium supplements, and some may also need calcitriol, an active form of vitamin D, if calcium levels drop or symptoms develop. In most cases, this is temporary.
In cases of medullary thyroid cancer, which make up about 5% of all thyroid cancer cases, calcitonin and CEA are key tumor markers used to monitor for growth or recurrence. For these patients, calcitonin and CEA levels will be checked to determine a baseline level shortly after surgery. After that, bi-annual or annual tests will be used to check calcitonin and CEA levels, as an increase often indicates the cancer has returned or is growing.
Thyroid hormone replacement:
After a thyroidectomy, lifelong thyroid hormone replacement is necessary. If you had a lobectomy, thyroid hormone may not be necessary, though some patients still need it depending on postoperative thyroid function tests. These levels are monitored with blood work, and the dose can be adjusted over time. Dosage varies based on weight and other patient factors.
FAQs
Get Care at NewYork-Presbyterian
Get CareAt NewYork-Presbyterian, multidisciplinary clinics and tumor boards bring together specialists across treatment modalities to coordinate care and tailor thyroid cancer treatment to each patient. Depending on your diagnosis and individual needs, you will be treated by endocrine surgeons, endocrinologists, radiologists, pathologists, and other specialists. Our teams at Columbia University Irving Medical Center and Weill Cornell Medicine offer advanced surgical care, including minimally invasive and scar-minimizing approaches for eligible patients
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