Thyroidectomy

June 15, 2024 
This page was reviewed under our medical and editorial policy by Sasan Fazeli, M.D., Natalie Johnson, M.D., Ellie Maghami, M.D., Karen Tsai, M.D., and John Yim, M.D., City of Hope^® Cancer Center Duarte.

A thyroidectomy is a surgical procedure to remove all or part of the thyroid, and it is a common thyroid cancer treatment.

The butterfly-shaped thyroid gland is found on the front of the neck, just below the Adam’s apple. It produces vital hormones that regulate heart rate, blood pressure, the process to turn food into energy (metabolism) and body temperature.

Depending on the extent of a thyroidectomy, the patient may need to take daily thyroid hormone replacement medications to replace the hormones that the thyroid typically makes.

Types of Thyroidectomies

There are two main types of thyroidectomy: total thyroidectomy and partial thyroidectomy.

Each patient’s thyroid cancer type and stage determines the choice of surgery recommended.

Total Thyroidectomy

A total thyroidectomy removes the entire thyroid gland. If the thyroid cancer has spread, surrounding tissue, which may include the lymph nodes, may also be removed. Patients will need to take thyroid hormone replacement medication after this surgery to help maintain normal metabolism.

A total thyroidectomy is performed for medullary thyroid cancer, even in the early stages. It may be one of the surgical options for patients with Stage 1, 2, 3 or 4 papillary and follicular thyroid cancers, too. It is the main choice if these cancers have spread (metastasized). With anaplastic thyroid cancer, surgery to remove the entire thyroid gland and nearby lymph nodes helps to relieve symptoms, but because this cancer often develops quickly, other treatments are typically needed, as well.

Partial Thyroidectomy

A partial thyroidectomy, which is also called a thyroid lobectomy or hemithyroidectomy, removes only the part (lobe) of the thyroid that contains cancer. Thyroid hormone replacement medication may not be needed after this procedure if the remaining thyroid tissue produces enough hormone.

This surgery may treat small follicular or papillary thyroid cancers that have not spread beyond the thyroid. In more aggressive variants or if more aggressive pathology is detected after the initial lobectomy for follicular or papillary thyroid cancer, the care team may recommend doing a second surgery called a completion thyroidectomy to remove the remaining thyroid tissue.

Partial thyroidectomy may also be the initial surgery if follicular or oncocytic (Hürthle cell cancer) is suspected, followed by a second surgery (completion thyroidectomy) to remove the remaining thyroid if it is confirmed. If there is a high level of suspicion for either of these cancers and the patient only wants one surgery, a total thyroidectomy may be recommended upfront.

How Long Does a Thyroidectomy Take?

The length of the surgery will depend on the type of thyroidectomy and the surgical approach. Typically, the procedure takes two to three hours, not including preparation (pre-op) or recovery (post-op).

Thyroidectomy Recovery

Recovery time differs for each patient, depending on how complex the surgery is, the patient’s general health before surgery and how his or her body recovers. Some people heal quickly, while others take longer.

Some patients may go home the same day, while others stay in the hospital for a few days. Other considerations are listed below.

Most surgeons will advise patients to limit strenuous activities for two weeks to avoid pulling on the stitches or causing a blood clot to form. Normal activities may resume after discharge.

While diet is not restricted after surgery, liquids and soft foods may be preferred in the first few days, as swallowing may be uncomfortable.

Some patients may go home with a bulb drain (a soft tube inserted into the incision and attached to a squeeze bulb that stops fluids from building up at the surgery site). It is usually removed after a few days. A member of the health care team will instruct the patient before discharge on how to care for it.

Patients may experience some pain for the first few days. Narcotic pain medications may be prescribed for a short period. The doctor may also tell the patient whether and when they may switch to over-the-counter pain medication, such as acetaminophen or ibuprofen. It is important to follow the doctor’s instructions, including not driving and avoiding alcohol while taking narcotic pain relievers.

Placing a cold pack on the neck for 15-minute intervals also helps relieve pain and swelling. Patients should not put ice directly on the skin.

Most patients will need thyroid hormone replacement medication for the rest of their lives. Their doctor will regularly monitor levels of thyroid-stimulating hormone (TSH) in their blood and adjust the medication based on the results.

Thyroidectomy Complications

Risks are associated with any procedure, and even though precautions are taken to minimize them, complications may occur.

Some complications may be related to anesthesia, while others may be directly associated with the surgery. Patients may experience any of the complications listed below.

Infection: It is important to keep the wound site clean and dry. Watch for signs of infection, such as increased pain, redness or drainage from the incision, or fever.

Temporary hoarseness or loss of voice: This may be caused by irritation from the breathing tube and usually resolves after a few days. It may also occur when nerves that control the vocal cords or voice box (larynx) are damaged during surgery. In some cases, this may be permanent.

If the patient has had a voice change or previous neck surgery, the surgeon will check that the vocal cords are moving normally before surgery by looking down the throat with special mirrors or a thin tube with a light (laryngoscope). The doctor will use a special probe to help protect the nerve from any damage during surgery.

Damage to the parathyroid glands: These glands lie just behind the thyroid and regulate calcium levels. Some patients may experience low calcium levels after total thyroidectomy, which may cause muscle spasms, twitching, numbness and tingling. Some patients may need calcium and vitamin D supplements.

Bleeding: Excessive bleeding or a blood clot is possible. The thyroid gland has a rich blood supply, so the surgeon will pay careful attention to monitor for bleeding vessels during surgery. Postoperative bleeding may be significant and cause breathing difficulty requiring an urgent return to the operating room for control.

Difficulty breathing: Breathing issues are an extremely rare complication associated with thyroid surgery and are most often due to postoperative bleeding requiring an urgent return to surgery to control. Bilateral laryngeal nerve injury may create an emergency airway situation requiring reintubation, but this is very rare.