What is Thyroid Surgery?

In the United States in 2016, over 62,000 new cases of thyroid cancer are expected to be diagnosed, with almost three out of four cases found in women. To treat it, thyroid surgery is often performed, but what is thyroid surgery?

Known as a thyroidectomy, thyroid surgery is a delicate procedure where part or all of the thyroid gland is removed. It’s used to treat suspicious thyroid nodules, large thyroid masses, thyroid cancer and hyperthyroidism.

Henry N. Ho, M.D., board certified otolaryngologist, specializing in head and neck cancer, president of The Ear, Nose, Throat and Plastic Surgery Associates and co-director of the Head and Neck Program at the Florida Hospital Cancer Institute, has been performing thyroid surgery and helping patients overcome thyroid cancer for more than 32 years.

Over the past 30 years, diagnosis of thyroid cancer has tripled, making it the most rapidly increasing cancer in the U.S. However, researchers attribute the rise in large part due to the advances in diagnostic testing and the increased usage of ultrasound to detect thyroid nodules in the earliest stages.

The good news is that nine out of ten thyroid nodules are benign. However, it is still important that your ear, nose and throat surgeon examine and evaluate any thyroid nodules, to rule out the possibility of cancer.

Testing the Thyroid for Cancer

Thyroid cancer quite often doesn’t produce any symptoms; and the first sign of the disease may be the emergence of a thyroid nodule. According to Dr. Ho, evaluating a thyroid nodule begins with a careful history and physical examination. If indicated, an ultrasound imaging study is then performed and, if necessary, a fine needle aspiration biopsy of the nodule is performed.

“If the nodule meets certain risk criteria which take into account size, appearance and medical history, then we want to further evaluate it with a needle biopsy to obtain cells for pathological analysis, and by so doing, inform the patient of the risk of malignancy,” says Dr. Ho.

Fine-needle biopsy is an effective tool for determining risk of malignancy of a thyroid nodule. During the roughly twenty minute procedure, a thin needle is inserted into the nodule and a sample of cells is removed. The sample is then sent to the pathologist for analysis.

Almost three out of four needle biopsy reports come back indicating a benign nodule. “If the needle biopsy comes back malignant, or significantly suspicious for malignancy, a surgical option may need to be offered to the patient,” says Dr. Ho.

Removing the Thyroid Gland with Thyroid Surgery

Thyroidectomy is a surgery that has both surgical and medical implications. It is often managed with the collaboration of an endocrinologist, a physician specializing in the hormone system.

“Peri-operative care for thyroidectomy is often done in collaboration with the endocrinologist,” says Dr. Ho. “Because it produces thyroid hormone, removal of the gland requires a plan for replacement of that hormone post operatively. That, and for other medical concerns, the involvement of the endocrinologist many times offers the best care.”

Preservation of normal voice is a major goal when thyroid surgery is performed.

“There are some peculiar specifics regarding thyroid surgery that we take into consideration and one is the voice,” says Dr. Ho. “The nerves that move the vocal cords are located behind the (thyroid) gland, between the gland and the windpipe. Among the surgeon’s many tasks is to find the nerves that serve to move the vocal cords and protect them throughout the operation, in order to preserve the voice.”

“The other peculiar thing about thyroid surgery is the very small parathyroid glands located under the thyroid gland” says Dr. Ho.

The parathyroid glands are four tiny glands, about the size of a grain of rice, located in the neck behind the thyroid. Parathyroid glands control the body’s calcium levels circulating in the the blood stream.

“We need to protect those (parathyroid glands) because if we injure or remove them, the patient suffers low calcium levels,” says Dr. Ho. “Which happens within hours following surgery, and results in muscle cramping, numbness and tingling, and needs to be corrected in a timely fashion.”

Radioactive Iodine Therapy

Following surgery for most thyroid cancers, your doctor may recommend radioactive iodine therapy to complete the treatment. It’s used to eradicate any potentially cancerous thyroid tissue that wasn’t removed by surgery.

“The recommendation for using radioactive iodine, after thyroidectomy, depends upon the pathologic analysis of the surgical specimen,” says Dr. Ho. “If it’s used, no further treatment is usually needed for most thyroid cancers.”

“Radioactive iodine is a pill that’s prescribed by the endocrinologist, radiation oncologist or even a nuclear medicine physician,” says Dr. Ho. “So it’s a collaborative effort on the part of the surgeon, the endocrinologist, and sometimes nuclear medicine or radiation oncology doctors.”

Results of Thyroid Surgery

By and large, thyroid cancer is very treatable; and most people do very well after surgery, returning home the day after surgery is completed.

“Most people have benign nodules and surgery is never needed. It’s a matter of just keeping track of them and having serial ultrasound studies to manage and follow them,” says Dr. Ho. “If they have thyroid cancer, the good news is that the vast majority of cancers behave in a benign fashion and have excellent outcomes with treatment.”

“Fortunately, 85% of people who get thyroid cancer are cured with current treatment methods and can expect to lead normal lives. So that’s a blessing,” Dr. Ho continues.

For Dr. Ho and the staff at the Ear, Nose, Throat & Plastic Surgery Associates, managing patients with thyroid nodules or thyroid cancer is a tremendously fulfilling part of their practice because, working with their multidisciplinary team including endocrinology, radiation oncology, nuclear medicine and medical oncology, the vast majority of patients enjoy a successful outcome.