10 Top Questions You Can Ask Before Thyroid Cancer Surgery

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What is the thyroid gland, and what is its function? If I need my thyroid gland, how can it be removed safely?

The thyroid gland is part of the endocrine system. This system relies on internal checks and balances to keep hormone levels within a healthy range. The thyroid gland produces thyroid hormones. Do you know what happens when half of the thyroid gland is removed? The other half can adjust to produce the amount of hormone the body needs. However, if the whole gland is removed, patients must take thyroid hormone replacement  in the form of a daily pill. 

The cancer is only a small part of the gland. Why do we need to remove an entire lobe or both lobes?

Even though the cancer itself may only be a small part of the thyroid gland, your doctor may recommend removing half or all of the gland. Your health care providers want to keep you safe and prevent cancer from growing or spreading. Clinicians typically evaluate other features of the tumor and surrounding neck lymph nodes to guide their care.

I heard about two nerves that are very close to the thyroid gland. What are those nerves and why are they important?

The recurrent laryngeal nerve runs along the back side of the gland. It controls the vocal cords’ ability to open and close, which allows us to breathe and speak. The other nerve runs along the upper edge of the thyroid gland. It is known as the external branch of the superior laryngeal nerve. This nerve also affects the vocal cords, allowing us to change the pitch and volume of our voice. 

Most thyroidectomies are relatively safe procedures, but surgeons must be careful to protect these vital structures.  Doctors may use an advanced form of nerve monitoring during surgery. This helps ensure that the nerves are not stretched or damaged.

Do I need general anesthesia? Will I feel the tube that goes into my mouth to help me breathe?

All thyroid surgeries are done under general anesthesia. This requires intubation, or the placement of a breathing tube. Most people do not feel or remember the tube, since it is inserted after they are asleep and removed by the time they wake up.

When they remove my thyroid, how long does the surgery take?

The surgery typically takes less than one hour. However, patients usually need to arrive at the hospital a few hours before the procedure begins. For cases with more extensive disease, the operation may take up to three hours.

What happens after the surgery? Will I have a scar?

After the surgery, most patients can go home the next day. They may have a sore throat, feel tired, or experience side effects from anesthesia. However, most patients recover within a few days. It’s important to stay active after surgery to speed recovery. Patients should avoid lifting heavy objects, but should otherwise keep moving. Most patients will have a scar about one inch wide at the base of the neck. Immediately after surgery, the incision site may be more apparent, but it will fade with time. It is important to wear sunblock over the scar. 

How soon can I return to work after surgery?

Many people can return to work after a few days of rest following surgery. But each person’s recovery is slightly different. Some patients take 1 to 2 weeks off depending on their job. Work that involves strenuous activity or heavy lifting should be avoided for at least 2 weeks. 

I learned about a pill that I will have to take every day if I have my whole thyroid gland removed. What is that pill and why do I need it?

After total thyroidectomy surgery, patients take thyroid replacement hormone in the form of a daily pill. This substitutes the hormone that the thyroid gland used to produce naturally. If you undergo a hemithyroidectomy, there is still a chance you will need some replacement hormone. Patients who undergo surgery will meet with an endocrinologist to find the dose of thyroid replacement hormone that is right for them. This may be adjusted over time. 

If I have cancer, does that mean I need chemotherapy and radiation?

Each person’s health and biology are unique. That means there is no uniform treatment plan for all thyroid cancer patients. However, most papillary thyroid cancer patients do not need chemotherapy or immunotherapy. Depending upon your case and the extent of disease, your doctor may recommend radioactive iodine (RAI) therapy after surgery. This is a unique form of radiation therapy that involves ingesting radioactive iodine and self-isolating for a few days. It is typically painless. Occasionally, patients with more advanced disease may need external beam radiation therapy.

Why do I have thyroid cancer? What caused the cancer to develop?

Cancer develops in the body due to genetic changes to cells. These mutations allow the cells to grow uncontrollably. Patients may undergo molecular testing to identify their specific genetic changes. However, the definitive cause of papillary thyroid cancer is still unknown. Prior radiation exposure, a family history of thyroid cancer, certain inherited conditions, and gender are all considered risk factors for papillary thyroid cancer. Women are more likely than men to develop papillary thyroid cancer.