Why It Is Done

Surgery is used to treat thyroid problems if:

• Thyroid cancer is present or is suspected.
• A noncancerous (benign) nodule is large enough to cause problems with breathing or swallowing.
• A fluid-filled (cystic) nodule returns after being drained once or twice.
• Hyperthyroidism cannot be treated with medicines or radioactive iodine.

Surgery is rarely used to treat hyperthyroidism. It may be used if the thyroid gland is so big that it makes swallowing or breathing difficult or thyroid cancer has been diagnosed or is suspected. Surgery also may be done if you are pregnant or cannot tolerate antithyroid medicines.

You may have all or part of your thyroid gland removed, depending on the reason for the surgery.

• Total thyroidectomy. Your surgeon will remove the entire gland and the lymph nodes surrounding the gland. Both sections (lobes) of the thyroid gland are usually removed. Additional treatments with thyroid-stimulating hormone (TSH) suppression and radioactive iodine work best when as much of the thyroid is removed as possible.
• Thyroid lobectomy with or without an isthmectomy. If your thyroid nodules are located in one lobe, your surgeon will remove only that lobe (lobectomy). With an isthmectomy, the narrow band of tissue (isthmus) that connects the two lobes also is removed. After the surgery, your nodule will be examined under a microscope to see whether there are any cancer cells. If there are cancer cells, your surgeon will perform a completion thyroidectomy.
• Subtotal (near-total) thyroidectomy. Your surgeon will remove one complete lobe, the isthmus, and part of the other lobe. This is used for hyperthyroidism caused by Graves' disease.

Some surgeons are now doing endoscopic thyroidectomies using several small incisions through which a tiny camera and instruments are passed.