There are a variety of thyroid disorders including both malignant and benign (cancerous and non-cancerous) nodules, overactive thyroid glands and large thyroid glands (goiters) for which thyroid surgery is performed. The types of surgery performed include:

1. hemithyroidectomy – removing half of the thyroid gland
2. total thyroidectomy- all identifiable thyroid tissue is removed.
3. excisional biopsy – removing a small part of the thyroid gland (usually used for diagnostic purposes)
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The decision for surgery is guided by a fine needle aspiration biopsy (FNAC), imaging (usually an ultrasound of the neck) and a clinical evaluation by your doctor. Surgery may be recommended for the following biopsy results:

1. cancer
2. possible cancer (follicular neoplasm or atypical findings); or
3. inconclusive biopsy
4. molecular marker testing of biopsy specimen which indicates a risk for malignancy

Surgery may also be recommended for benign nodules if the nodule is large, is increasing in size, is extending into the chest or if it is causing symptoms (pain, difficulty in swallowing). Surgery is also performed for overactive thyroid glands (hyperthyroidism caused by Grave’s disease or toxic nodules) and glands with multiple nodules.

Patients considering thyroid surgery should be evaluated preoperatively with a thorough and comprehensive medical history and physical exam including cardiopulmonary (heart) evaluation. An electrocardiogram and a chest x-ray prior to surgery are often recommended for patients who are over 45 years of age or who are symptomatic from cardiac disease. Blood tests may be performed to determine if a bleeding disorder is present.
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Any patients who have had a change in voice or who have had a previous neck operation (thyroid surgery, parathyroid surgery, spine surgery, carotid artery surgery, etc.) and/or who have suspected invasive thyroid disease should have their vocal cord function evaluated preoperatively. This is necessary to determine whether the recurrent laryngeal nerve that controls the vocal cord muscles is functioning normally and is becoming a norm of practice. Finally, if medullary thyroid cancer is suspected, patients should be evaluated for coexisting adrenal tumours (pheochromocytomas) and for hypercalcemia and hyperparathyroidism.

The most serious possible risks of thyroid surgery include:

1. bleeding which can cause respiratory distress
2. injury to the recurrent laryngeal nerve that can cause permanent hoarseness, and breathing problems with possible tracheotomy in rare cases if there is nerve injury on both sides
3. damage to the parathyroid glands that control calcium levels in the body, causing hypoparathyroidism and hypocalcemia

These complications may occur more frequently in patients with invasive tumors, extensive lymph node involvement, re-operative thyroid surgeries (thyroids which have already been operated upon, and in patients with large goiters that extend below the sternum (bone in the centre of the chest). The risk of any serious complications is less than 2%.

Yes. You will usually be able to doing anything that you could do before surgery. Some patients require long-term treatment with thyroid hormone following surgery, usually when the whole gland is removed. Thyroid hormone replacement therapy might be delayed for several weeks if you are to receive radioactive iodine (RAI) therapy unless there is a plan for you to receive TSH injection prior to RAI.

Endoscopic surgery is a form of minimally invasive surgery that uses scopes going through small incisions or natural body openings. The advantage in thyroid surgery is that it avoids scars in the neck (or at least avoids large scars in some techniques). This is commonly through the breast and axilla (armpit), from behind the ear or more recently, through the mouth (trans oral thyroidectomy). In some cases, endoscopic and open surgery can be combined (MIVAT).