According to the Society of Radiologists in Ultrasound: a thyroid nodule should be biopsied if it is 1 cm or larger with microcalfications, 1.5cm in diameter or larger that is solid or with coarse calcifications, or if it is 2cm or larger and has mixed solid and cystic components, or if a nodule had grown significantly or is associated with enlarged lymph nodes in the neck. The nodule is typically biopsied under ultrasound guidance and the tissue is recovered using a needle. The technique of “Fine Needle Aspiration,” or FNA is used to get as much information about the thyroid nodule as possible to avoid unnecessary surgery and to make a diagnosis without removing a part of the gland at the outset. Genetic testing, including Affirma testing, can then be done on the cells of the biopsy to get even more information. Biopsied cells are viewed under a microscope by a pathologist to determine if they are atypical or normal.

Thyroid cancers are treated with removal of part of the thyroid (thyroid lobectomy), all of the gland (total thyroidectomy), and possible removal of lymph nodes in the neck, depending on their involvement by a thyroid cancer. If a thyroid lobectomy is performed for thyroid cancer, a pathologist will give a full report about the cancer in the thyroid lobe. A second surgery may be done for complete removal of the gland if needed. A total thyroidectomy is done in one surgery for some patients depending on their diagnosis and biopsy findings. After the thyroid is removed for thyroid cancer, some patients will go on to receive radioactive iodine therapy to further treat any remaining thyroid cells in the body. Dr. Magill practices thyroid surgery and surgical treatment of thyroid cancer in accordance to regularly updated guidelines by the American Thyroid Association.

The thyroid is removed under general anesthesia and patients are asleep with a breathing tube. A special nerve monitor on the endotracheal tube is often used during thyroid surgery to ensure safety of surrounding structures during thyroid surgery. An incision is made horizontally in the neck, several finger breadths above the top of the sternum. If a part of the thyroid is removed (thyroid lobectomy), surgery may take 1-2 hours. If a total thyroidectomy is being performed, surgical time can range from 2.5-4 hours, depending on the size of the thyroid and if cancer is present. Dr. Magill is board certified in Otolaryngology-Head and Neck Surgery and performs thyroid surgery regularly in her practice.

If the entire thyroid gland is removal, synthetic thyroid hormone will need to be taken for the rest of a patient’s life. If only a portion of the thyroid is removed with a thyroid lobectomy, the remaining lobe can provide thyroid hormone for the whole body. Oral thyroid hormone replacement is often unnecessary after thyroid lobectomy unless a secondary condition exists in the remaining gland. After a total thyroidectomy, transient or permanent hypocalcemia may occur, requiring patients to take replacement oral calcium and replacements until parathyroid glad function returns.

The risks of thyroid surgery are bleeding, infection, and the need for further surgery. Risks specific to thyroid surgery include a temporary or permanent injury to the recurrent laryngeal nerve, which controls muscles in the larynx and voice production. The recurrent laryngeal nerve is in proximity to the thyroid gland. Other risks include transient or permanent hypocalcemia from loss of function of the parathyroid glands. In choosing a thyroid surgeon, it is important to discuss risks, rate of postoperative complications, and to choose a surgeon who regularly operates on the thyroid in their practice. Dr. Magill is board certified in Otolaryngology-Head and Neck Surgery and performs thyroid surgery regularly in her practice.

Initial recovery after thyroid surgery is 1 week. Dr. Magill recommends waiting until three weeks after surgery before resuming regular activities and physical exercise.