• Surgical Procedures for Thyroid Cancer

    Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues.

    Thyroidectomy

    A thyroidectomy is an operation to remove all or part of the thyroid gland. There are four main types of thyroidectomy:
    • Lobectomy and isthmusectomy—One of the two lobes and the central isthmus are removed.
    • Bilateral subtotal thyroidectomy—Both lobes and the isthmus are removed, with only a small bit of thyroid tissue from the back of the gland left behind. This thyroid tissue is left behind in order to avoid injury to nearby parathyroid glands and nerves.
    • Near total thyroidectomy—All of one lobe and the isthmus are removed; most of the other lobe is removed, with only a small bit of thyroid tissue left behind.
    • Total thyroidectomy—Both thyroid lobes and the isthmus are totally removed.
    For the treatment of follicular, papillary, or medullary thyroid cancer, near total or total thyroidectomy is usually recommended. These types of surgery provide the best chance for a cure. Lymph nodes in the area can be examined and removed during the course of the procedure.
    Description of the Procedure
    You will receive a general anesthetic prior to your thyroidectomy. You’ll be placed on the operating table. A roll will be positioned under your shoulders and the base of your neck, so that your head is flexed back and your neck exposed. A curved incision will be made in your lower neck, and the tissue will be pulled back to expose the thyroid gland and surrounding lymph nodes. The thyroid gland, lymph nodes, and any tissues that appear to have been invaded by the cancer will be removed. Your surgeon will be very careful during the operation to try to avoid nicking or injuring all of the parathyroid glands and nearby blood vessels and nerves.
    If you are making a good recovery, you may be able to go home from the hospital within a day or two of a thyroidectomy. You may be able to return to work within about a week.
    Effectiveness
    Thyroidectomy is extremely effective for early stage thyroid cancer, providing a nearly 100% chance of cure.
    Possible Complications
    Possible complications of a thyroidectomy include the following:
    • Bleeding into the surrounding tissues around the trachea causing problem with breathing
    • Injury to the parathyroid glands or their blood vessels, resulting in hypoparathyroidism (which is preventable with transplanting the parathyroid glands at the time of the surgical procedure)
    • Injury to nerves in the neck, which can cause a persistently hoarse voice or, in rare cases, airway obstruction that requires breathing assistance ( tracheotomy )
    • Infection
    Postoperative Care
    Your vital signs will be monitored regularly after surgery (heart rate, breathing, blood pressure, temperature), and you will be given intravenous fluids. You’ll be allowed to drink liquids and perhaps advance to a soft diet some hours after surgery. Additionally, your doctor will monitor blood calcium levels by giving you tests and by tapping on your cheek to see if your facial nerve is twitchy (a sign of low blood calcium).
    You will most likely:
    • Have a sore throat for a day or two
    • Feel nauseated for the first 12 hours or so after your operation
    • Require pain medication and/or antinausea medication
    • Take thyroid medication for the rest of your life
    • Take vitamin D and calcium supplements (if your parathyroid glands have been injured during surgery)

    References

    Baudin E, Schlumberger M. New therapeutic approaches for metastatic thyroid carcinoma. Lancet Oncol. 2007;8:148-156.

    Cooper DS, Doherty GM, Haugen BR, et al. The American Thyroid Association Guidelines Taskforce: management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16:1-33.

    Conn’s Current Therapy. 54th ed. Philadelphia,PA: WB Saunders; 2002: 652-657.

    Cornett WR, Sharma AK, Day TA, et al. Anaplastic thyroid carcinoma: an overview. Curr Oncol Rep. 2007;9:152-158.

    Rachmiel M, Charron M, Gupta A, et al. Evidence-based review of treatment and follow up of pediatric patients with differentiated thyroid carcinoma. J Pediatr Endocrinol Metab. 2006;19:1377-1393.

    Sosa JA, Udelsman R. Total thyroidectomy for differentiated thyroid cancer. J Surg Oncol. 2006;94:701-7

    Thyroid carcinoma. In: Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: WB Saunders; 2000: 1247-1250.

    What is thyroid cancer? American Cancer Society website. Available at http://www.cancer.org/docroot/CRI/CRI%5F2%5F3x.asp?dt=43 . Accessed December 10, 2002.

    What you need to know about cancer of the thyroid. National Cancer Institute website. Available at http://cancer.gov/ . Accessed December 10, 2002.

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