When is Thyroid Surgery Necessary

Many thyroid problems can be effectively treated without the necessity of having to undertake a surgical procedure but there are instances where a doctor might decide that thyroid surgery is the best possible course of action – or perhaps even the only course open.

If a patient has a thyroid nodule and it has continued to grow despite possible fluid removal or the prescribing of thyroxine, a doctor might conclude that surgery is necessary. Similarly, if the nodule is causing the patient pain or undue anxiety. Many doctors consider that once a nodule has a diameter in excess of 4 centimetres it should be operated upon. The Hot nodules (those stimulating the production of the thyroid hormone) are generally treated by either radio-iodine or surgery, and some patients will opt for the surgical procedure because of their concerns
over radio-iodine therapy.

Indications are that the risk of developing hypothyroidism as a result of having a nodule surgically removed for this reason is very low. Likewise, most multinodular goitres can be treated without recourse to surgery. Again, though, there are times when surgery becomes necessary. For example, surgery is indicated if the goitre continues to grow despite treatment; if the goitre has become toxic; if a patient has developed an unsightly looking lump and wants it removed for predominantly cosmetic reasons; if the goitre is substernal – in other words situated in
the lower part of the isthmus of the thyroid gland and difficult to locate and observe – and is considered to be most suitable for surgical removal; and finally if the goitre has resulted in compression of the trachea, which can lead to respiratory problems or infection, or has culminated in arterial compression, which can cause cerebral hypoperfusion and perhaps induce a stroke.

The most common reason for thyroid surgery to be carried out, however, remains thyroid cancer. Although on these occasions it is possible to have a partial thyroidectomy, in general doctors prefer to remove the complete thyroid in a total thyroidectomy, which will be more likely to prevent the cancer’s return at a later date. A partial thyroidectomy is likely to be carried out only for a papillary or follicular cancer that is less than a centimetre in width – and technically still in T1 stage. For those cancers that have been diagnosed as being medullary or anaplastic thyroid cancers (as well as larger papillary and follicular tumours) it is more common to remove the whole of the thyroid. Complete removal of the thyroid will result in the patient then needing to take thyroid hormone replacement tablets on a daily basis.

As with all surgical operations, there is an element of risk involved in thyroid surgery, albeit a very small one. Reactions to anaesthetics, infections or excess bleeding remain potentially harmful but, generally, thyroid surgery is considered a relatively safe and predictable procedure. The most likely possible complications specific to thyroid surgery are damage to the laryngeal nerve, which might result in hoarseness for a little while or, in extreme cases, permanent damage and hypothyroidism, which would then be medically treated.