Thyroid Cancer Surgery

The thyroid is a butterfly-shaped gland sitting in front of the windpipe at the base of the neck. Surgery removes either one half of it or all of it, through a short transverse cut in a natural skin crease.

How much is removed depends on the size of the growth, whether it involves both halves, whether it has spread beyond the gland, and your age. Removing one half preserves enough gland for most people to make their own thyroid hormone; removing all of it means taking a replacement tablet daily for life. The lymph nodes in the central compartment directly around the thyroid are removed in the same operation where there is evidence they are involved, and the nodes at the sides of the neck are cleared where scans have shown disease there.

Two structures beside the gland dictate how this operation is done. The nerves to the voice box run immediately behind the thyroid on each side, and the four parathyroid glands, each the size of a grain of rice, sit on its back surface and control your blood calcium. Protecting both is the technical work of the operation, and it is the reason your voice is assessed beforehand.

You are admitted on the morning of surgery or the evening before. Your voice box is usually examined with a fine flexible camera through the nose beforehand, so that the movement of both vocal cords is documented before anything is done.

The operation is under a general anaesthetic and takes one and a half to three hours, longer where the neck nodes are being cleared. A cut of four to six centimetres is made in a skin crease low in the neck, which heals into a line most people find hard to see after a year. Many surgeons use a nerve monitor, a probe that confirms the voice nerve is conducting as they work around it.

A small drain is sometimes left overnight. You wake with a sore throat from the breathing tube and a tight, bruised feeling in the neck. Your blood calcium is checked the same evening and the next morning where the whole gland has been removed. Most people stay one or two nights.

The neck is uncomfortable for about a week, worse on turning and swallowing, and tablets manage it. A sore throat and a slightly hoarse voice for a few days are usual and settle.

Most people are back to desk work in one to two weeks and to full activity in three to four. Avoid heavy lifting and straining for two weeks. Keep the scar out of direct sun for six months and massage it once healed; it looks its worst at about six weeks and improves steadily for a year.

If the whole gland was removed you start thyroid hormone replacement immediately, and the dose is adjusted from blood tests at around six weeks and then periodically. Getting it right takes a few rounds. Calcium and vitamin D supplements are often given for the first weeks while the parathyroid glands recover from being handled. The laboratory report on the gland comes back in about a week and determines whether radioactive iodine treatment is recommended, which usually follows some weeks later.