Thyroid Nodules and Surgery

This depends on the nature of the nodule, whether it is benign or malignant and also if it causes symptoms.

Cancer – Surgery is the treatment of choice. Depending on the size of the tumour, either half or the entire thyroid gland may need to be removed. Additional treatment like radio-iodine treatment or radiotherapy may be necessary.

Benign nodules – may be observed if not causing any symptoms. Follow-up of the nodules is usually by ultrasound.

The interval will be decided by your doctor.

Surgery is an option if symptoms are present, including difficulty swallowing or breathing, or even just to remove the unsightly lump.

Indeterminate – if the nature of the nodule is indeterminate on FNAC, your doctor will discuss with you the options of close observation versus surgery. The risk of your nodule being cancerous depends on the exact findings on ultrasound and FNAC.

How is thyroid surgery performed?

Thyroid surgery is performed under general anaesthesia. It may be:

• Hemithyroidectomy – removal of half the thyroid gland. For benign nodules or small cancers.
• Total Thyroidectomy – removal of the entire thyroid gland. For larger cancers, nodular goitre or toxic goitre including Graves disease.

Your surgeon will explain to you which operation you require and the reason for it.

What are the risks of thyroid surgery?

Other than the risks that apply to all surgery including general anaesthesia risk, risk of bleeding and infection, the risks specific to thyroidectomy are:

• Hoarseness – due to injury of one recurrent laryngeal nerve, which supplies the muscles controlling the vocal cord. Injury is rare and usually temporary, but may be permanent.
• Difficulty breathing – due to injury of both recurrent laryngeal nerves. Injury is very rare and usually temporary, but may be permanent. May require a tracheostomy to secure airway.
• Low calcium – due to disturbance of the parathyroid glands that control calcium levels in the body. Usually temporary, rarely permanent.

What is scarless or minimal access thyroid surgery?

In suitable patients, thyroid surgery can be performed without using a neck incision. The surgery may be endoscopic or robot-assisted. Skin incisions are located in the axilla or armpit and are less visible than a neck scar and easily hidden by clothing.