What to Expect From Surgery: Thyroid Cancer

“We now understand and have moved much more on the opposite end of the spectrum, away from these more aggressive procedures to trying to do more limited procedures like partial thyroidectomy.”

How much of your thyroid is removed depends on the reason for the surgery, the size of the affected area, and the type of thyroid disease present.

There are two main categories:

Total (or Near-Total) Thyroidectomy

• What Is It?: In this procedure, the entire thyroid gland is removed. In a near-total thyroidectomy, only a tiny part of thyroid tissue is left behind, but this is less common.
• Who Needs It?: People with more advanced thyroid cancers, those who have large goiters, or people who have multiple areas of concern in their thyroid might need this.
• After-Effects: Since the entire gland is gone, your body will no longer produce its own thyroid hormone. You will need to take synthetic thyroid hormone pills (most commonly levothyroxine) every day to replace the hormones your thyroid once made.

Partial Thyroidectomy

• What Is It?: In this procedure, only a portion of the thyroid gland is removed. This could be a hemithyroidectomy (thyroid lobectomy), where the surgeon removes one lobe (half) of the gland, or a isthmusectomy, where only the thin piece of tissue (isthmus) that connects the two lobes is removed. This is less common, typically considered if a small tumor sits in that narrow band.
• Who Needs It?: People who have a nodule confined to one side or who have smaller growths that only affect a portion of the thyroid may be candidates.

“The benefits to partial thyroidectomy over total thyroidectomy are that many patients maintain normal thyroid function and don’t have to be on lifelong thyroid hormone medication after a partial thyroidectomy, whereas with a total thyroidectomy, you need the lifelong medication,” Dr. Otto explains.

“Additionally, it’s shorter surgery and less invasive, so we do prefer partial thyroidectomy. There are some patients who are well suited to that, and then there are others who are not, and we can go over those details.”

Dr. Otto explains that tumors that are small and on one side of the gland are well-suited for a partial thyroidectomy.

“We really need a small tumor that is isolated to one lobe and doesn’t cross over the midline in order to be appropriate for that procedure. Most guidelines, NCCN and the American Thyroid Association suggests that patients with tumors under four centimeters are appropriate candidates for partial thyroidectomy,” she adds.

What Happens During Thyroid Surgery

A thyroidectomy can last anywhere from about 1 to 3 hours, depending on the complexity (for instance, if there’s a large goiter, multiple nodules, or the need to remove additional tissues). More extensive cases, such as an invasive cancer, may take longer. The surgery will involve the following steps.

Anesthesia and Positioning

Once in the operating room, you’ll receive general anesthesia through an IV or by inhaling medication through a mask. A breathing tube is gently placed in your trachea (windpipe) to protect your airway. You might be positioned with your head slightly tilted back to give the surgical team better access to your neck.

The Incision

• Conventional (Open) Thyroidectomy: The surgeon makes a small cut (incision) across the front of your neck, typically along a natural skin crease to minimize visible scarring. This opening allows direct access to the thyroid gland.
• Minimally Invasive or Robotic Approach: In some cases, smaller incisions or specialized techniques may be used. There’s even a method of accessing the thyroid through the mouth (transoral thyroidectomy) that leaves no neck scar. However, not everyone is a candidate for these techniques.

“The minimally invasive thyroid surgery means a lot of different things to a lot of different people. So many of us consider our procedures minimally invasive because we make very small incisions and the recovery time is very quick,” Dr. Otto explains.

“There’s a whole world of minimally invasive surgery in the abdominal surgery realm, because we know that doing a laparoscopic or a robotic procedure in the abdomen is far, far easier recovery and far faster time to mobilization and out of the hospital than the old style open large abdominal incision. But we don’t see the same issues in the neck.”

She adds that many people find the small thyroid incision heals in a very subtle way.

Locating and Removing Thyroid Gland

• Protecting Critical Structures: The surgeon identifies and avoids important nerves (especially the recurrent laryngeal nerves, which controls your vocal cords) and the parathyroid glands (tiny glands behind the thyroid that regulate calcium).
• Removing the Thyroid: Depending on your case, the surgeon removes either one lobe or both lobes of your thyroid. If the entire gland is taken out (total thyroidectomy), any diseased lymph nodes may also be removed.
• Intraoperative Neuromonitoring: Often used to help detect and preserve the recurrent laryngeal nerve by monitoring nerve signals in real-time. This can lower the risk of nerve damage that could affect your voice.

Recovery After Thyroidectomy

After you wake up in the hospital, you’ll go to a recovery area where nurses watch your breathing, vital signs, and incision site.

Soreness at the incision site and in the throat (due to the breathing tube) is common but typically mild. Over-the-counter medications or prescribed pain relievers help manage discomfort.

In some cases, a small tube may be placed in your neck to drain fluid. This is usually removed in a day or two.

Many people leave the hospital the same day, especially if it’s a lobectomy. Others might stay overnight.

“After partial thyroidectomy, most patients can go home from the hospital same day. They actually don’t have to stay overnight. The distinction with a total thyroidectomy, we do watch patients overnight, and the main reason is actually because we have to monitor calcium levels after total thyroidectomy,” Dr. Otto explains.

Patients can usually resume light activities the next day, but avoid strenuous exercise or heavy lifting for about two weeks to let your incision heal.

“The typical recovery time after thyroid surgery is usually two weeks. Two weeks to where patients are feeling back to normal regaining complete mobility of the neck. Things are pretty well healed at that point. We usually let patients go back to all normal activities after two weeks,” Dr. Otto says.

Hoarseness or voice fatigue may occur but often improves over several days or weeks.

Possible Complications & How They’re Managed

Thyroidectomy is generally considered safe, especially when performed by a skilled and experienced surgical team. Even so, every operation carries some risk.

“There’s always risks with anesthesia and risk of infection, but risk specific to thyroid surgery are risk to the nerve that controls the vocal cords,” Stephanie Giparas, a physician assistant at the Endocrine and Head and Neck Department at Moffitt Cancer Center, tells SurvivorNet.

Risks associated with thyroid cancer surgery include the following:

Nerve Injury

The recurrent laryngeal nerve controls your vocal cords. Damage may cause a hoarse or weak voice, and in very rare situations with both sides affected, it can lead to breathing issues.

The superior laryngeal nerve helps control pitch. Damage may be less obvious but can affect singing or speaking at higher pitches. Because voice changes can be subtle, they sometimes go unnoticed. Any persistent issues can be evaluated by a specialist.

Intraoperative neuromonitoring reduces this risk by guiding the surgeon around the nerve. Most injuries are temporary; persistent hoarseness may need therapy or, in rare cases, a procedure called “vocal cord medialization.”

“The risk is usually quite low, but they could have a vocal cord injury,” Giparas explains.

“If it’s just one side, then they might have some weakness of their voice that could recover over a period of time. But if that nerve injury is permanent, they can have a permanent change in their voice quality and strength. Again, quite rare. But what they might expect in that surgical appointment is a scope to visualize the vocal cords to make sure that they’re working normally and appropriately before surgery.”

Hemorrhage (Bleeding)

Bleeding in the surgical area can happen in the hours after surgery, and while rare, it can be serious if it causes pressure on the airway.

If severe bleeding occurs, surgeons may need to reopen the incision (even at bedside if necessary) to quickly relieve the pressure. In some cases, an emergency tracheostomy is required to secure the airway.

Hypoparathyroidism (Low Parathyroid Hormone)

“The other risk that’s specific to thyroid surgery is the surgeons operating near the parathyroid glands, which help regulate our calcium levels. Sometimes patients undergoing thyroid surgery will have to be on some calcium supplementation while those parathyroids recover, and that’s usually for a couple of weeks. There are some cases where patients need to be on long-term calcium,” Giparas explains.

Up to one-third of people who have a total thyroidectomy can experience temporarily low calcium levels right after surgery. This happens if the parathyroid glands, which regulate calcium in your body, are “stunned” or have reduced blood flow.

Nurses and doctors closely watch your calcium levels, and they may give oral or intravenous calcium. Most cases are temporary, resolving within weeks. About 1% to 2% of people may need lifelong calcium and vitamin D if the parathyroid glands never recover.

Infection

It is uncommon but possible for thyroidectomy patients to develop an infection at the incision site.

Typically treated with antibiotics. Good surgical technique and proper wound care lower the risk.

Esophageal or Tracheal Injury

Though rare injury to these structures can happen if the thyroid growth is stuck to or pressing on them.

If recognized quickly, surgeons can repair the injury. Delayed recognition can lead to complications like infection in the chest, so careful postoperative monitoring is important.

Difficulty Swallowing

Dysphagia is a temporary swallowing issues that can result from normal swelling and scarring.

Most people improve gradually. Persistent swallowing problems may need further evaluation or speech therapy.

Although these complications can be alarming to read about, it’s important to remember that they are either rare or usually manageable. Experienced surgeons and careful postoperative monitoring help catch problems early so they can be treated promptly.

Looking Ahead: Life After Thyroidectomy

Life after thyroid surgery is generally active and healthy for most patients. Thyroid cancer is often very treatable, and removing the gland (in combination with other treatments if needed) can be curative or significantly reduce disease progression. Here are some key points about the future:

• Monitoring: You’ll continue seeing your doctor for routine checkups. If you’ve had cancer, you may occasionally need imaging tests or blood work to ensure it hasn’t come back.
• Medication Adjustments: If you’re on levothyroxine, expect some dose adjustments in the first months as your doctor finds the ideal balance for you. Once stable, you’ll generally only need occasional updates if symptoms or hormone levels change or if pregnancy is planned or occurs.
• Lifestyle: Most people go on to lead normal, full lives after recovering from thyroid surgery. Some incorporate gentle exercise and a balanced diet to support their overall well-being.
• Outlook: The long-term outlook depends on factors like the type of thyroid cancer or disease, stage of any cancer, and overall health. For the most common types of thyroid cancer, such as papillary or follicular, survival rates are very high.

Questions To Ask Your Doctor

• Will I need to take thyroid hormone medication long-term?
• How should I prepare for surgery?
• How painful is the recovery?
• Can I still talk normally after surgery?
• How soon can I return to work or regular activities?

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