Thyroid cancer surgery: What to consider

Hearing you have a thyroid nodule can be scary, but it doesn’t always mean you have cancer. In fact, only about 10% of thyroid nodules are malignant.

But if you’ve been diagnosed with thyroid cancer, you may be feeling anxious about the next steps, which almost always include surgery.

Below, Mark Zafereo, M.D., shares what to consider before undergoing thyroid cancer surgery.

Get an accurate diagnosis

It’s important that you’re comfortable with the evaluation of your thyroid nodule before undergoing surgery. Since most nodules aren’t cancerous, many patients don’t need surgery at all.

There are four types of thyroid cancer. About 95% of thyroid cancers are either papillary thyroid cancer or follicular thyroid cancer. Patients with these cancers typically have a good prognosis.

The remaining 5% are medullary thyroid cancer and anaplastic thyroid cancer, which can be more aggressive and may require more extensive treatment.

There are different types of thyroid cancer surgery

The type of surgery your doctor recommends will be based on a risk assessment that includes the tumor pathology, size and location.

The simplest thyroid tumor surgery is a lobectomy. This procedure removes half the thyroid gland. When a thyroid tumor is more likely to spread, a total thyroidectomy (removal of the entire thyroid gland) may be performed.

If the cancer has spread beyond the thyroid gland to surrounding lymph nodes, a more extensive surgery removing these lymph nodes may be needed.

In rare cases, thyroid cancers may spread to other important structures of the neck, which may require more complex surgeries that are best performed by an expert thyroid and neck surgeon.

Ask the right questions

When you meet with your surgeon, make sure you have a clear understanding of your diagnosis, surgical plan and expected recovery. Here are some questions to ask:

• How many thyroid cancer surgeries do you perform each year? The most experienced thyroid cancer surgeons perform more than 100 thyroid/neck surgeries annually.
• What type of thyroid cancer surgery do I need? How much experience do you have performing this specific type of surgery? If the surgeon hasn’t performed many surgeries like yours, seek a second opinion from someone who has.
• How many of your newly diagnosed patients have to undergo a second thyroid/neck surgery within a year? This number should be less than 1%.
• How closely do you work with an endocrinologist, radiologist and pathologist? It’s important that your doctors collaborate and are all confident in the diagnosis and care plan. This minimizes surprises during and after surgery.
• Will the surgery affect my metabolism regulation? If part of your thyroid gland is removed, it may still produce enough of the hormone that regulates your metabolism. But if you have the whole gland removed, you’ll need to take a daily thyroid hormone pill for the rest of your life.
• What are the risks of this thyroid surgery?
• How much discomfort will I have after surgery?

Every patient’s recovery from thyroid cancer surgery is different

Every patient’s recovery is different. Most people take a week or two off work to recover, but can talk and eat a few hours after surgery. All patients will have a scar after surgery. With surgeries limited to the thyroid, the scar is usually about 2 inches long and will look like a natural crease in the neck over time. But ask your doctor what to expect after your particular surgery.

Don’t rush into surgery

With thyroid cancer, you’re not in a race to remove the tumor as soon as possible. Except for the most aggressive thyroid cancers (such as anaplastic thyroid cancer), these cancers are typically slow-growing. Even when the cancer has spread to the lymph nodes, there’s generally not an urgent need for surgery. So, take time to research your options, and find the right cancer center with the right surgeon to perform the right surgery the first time.

Since there’s more urgency with anaplastic thyroid cancer, we encourage these patients to seek proper care soon after diagnosis. At MD Anderson, our specialized clinic called Facilitating Anaplastic Specialized Treatments, or FAST, enables us to quickly finalize treatment plans for patients with suspected anaplastic thyroid cancer.

Specialized care has benefits

Receiving thyroid cancer care at a major cancer center like MD Anderson can make a significant difference in your outcome. At MD Anderson, we have care teams studying every aspect of thyroid cancer, which gives you access to the most cutting-edge care and clinical trials. In fact, MD Anderson has the most clinical trials in the world for medullary and anaplastic thyroid cancers. No matter what type of thyroid cancer you have, a specialized team can help ensure you have a well-thought-out care plan that reduces your chances of recurrence and the need for another surgery.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.