Thyroidectomy

A thyroidectomy is a surgical procedure in which part or virtually all of the thyroid gland is removed. The extent of the surgery depends on the diagnosis and determines subsequent factors such as hormonal function, calcium control and follow-up care.

What is a thyroidectomy?

The thyroid is a gland situated at the front of the neck, in front of the windpipe. It produces hormones that play a role in metabolism and numerous bodily functions.

Surgery allows the thyroid tissue affected by a lesion, a functional disorder or an enlargement causing symptoms to be removed. The aim is not necessarily to remove the entire gland, but to carry out the appropriate procedure to treat the specific problem.

When one of the two thyroid lobes is removed, this is referred to as a lobectomy or hemithyroidectomy. When virtually the entire gland is removed, a total thyroidectomy is performed.

This distinction has significant clinical implications. It affects the likelihood of preserving the patient’s own thyroid function, the risk of disrupting parathyroid function, and the type of follow-up care required after the operation.

In which situations might thyroid surgery be indicated?

Thyroidectomy may form part of the treatment for certain types of thyroid cancer, nodules with suspicious characteristics, symptomatic goitres and some forms of hyperthyroidism. The indication for and extent of the surgery depend on the specific condition.

In the case of thyroid cancer, the decision takes into account the type and size of the tumour, its location, whether it affects one or both lobes, the presence of lymph node involvement and the estimated risk. Certain localised, well-differentiated cancers can be treated by lobectomy, whilst other situations require more extensive surgery.

When a nodule exhibits ultrasound or cytological features suggestive of malignancy, surgery can provide a definitive diagnosis and treat the lesion. An indeterminate cytology result, however, does not automatically mean cancer and may require further assessment before a decision on treatment is made.

Benign nodules and goitres may also require surgery when they reach a significant size, cause pressure on the neck, make breathing or swallowing difficult, or extend into the chest.

In certain forms of hyperthyroidism, such as Graves’ disease, toxic multinodular goitre or some autonomous nodules, surgery may be one of the various treatment options. The choice depends on the clinical situation, the size of the gland, the symptoms and the available alternatives.

How is the amount of thyroid tissue to be removed decided?

The choice between a lobectomy and a total thyroidectomy is based on the diagnosis, the extent of the disease and the expected benefit of each option.

A lobectomy may be sufficient when the problem is confined to one side of the gland and the clinical characteristics allow the other lobe to be preserved. Preserving functional thyroid tissue may obviate the need for lifelong hormone replacement therapy in some people.

A total thyroidectomy may be appropriate where there is bilateral disease, certain types of diffuse goitre, some forms of hyperthyroidism, or tumours that require more extensive surgery.

In certain cancers, it may be necessary to perform a lymph node dissection, that is, to remove lymph nodes from specific areas of the neck. This procedure is not automatically part of every thyroid cancer operation and affects both the complexity and the potential risks, as well as the subsequent follow-up.

Pre-operative assessment and planning

The assessment begins with a medical history, a physical examination and a detailed ultrasound scan of the thyroid and neck. The ultrasound scan allows us to examine the size of the gland, the characteristics of any nodules and the possible presence of abnormal lymph nodes.

When a nodule meets certain criteria, a fine-needle aspiration may be carried out to obtain cells for examination. The result helps to assess the nature of the lesion and to decide whether it requires follow-up, further tests or surgical assessment.

Laboratory tests usually include thyroid function tests and, depending on the diagnosis, may also assess antibodies, calcium levels and other parameters. For certain nodules with indeterminate results, additional tests may be used to reduce diagnostic uncertainty.

Where hoarseness is present, or where there is a history of previous neck surgery, advanced disease or suspected nerve involvement, it may be necessary to assess vocal cord mobility prior to surgery.

If the indication is related to hyperthyroidism, prior control of the excess hormones forms part of the preparation to minimise cardiovascular and metabolic complications during the procedure.

Associated conditions, allergies and regular medication are also reviewed. Anticoagulants and antiplatelet agents must not be discontinued or adjusted without medical advice.

How a thyroidectomy is performed

The procedure is carried out under general anaesthesia. The conventional approach involves a horizontal incision at the base of the neck, which is made, where possible, along one of the neck’s natural creases.

Through this incision, the surgeon carefully identifies and dissects the gland from the surrounding structures. These include the trachea, blood vessels, parathyroid glands and the nerves involved in voice production.

The parathyroid glands are small glands usually situated next to the back of the thyroid. They regulate calcium levels, and during the operation, every effort is made to preserve both the glands and their blood supply.

The recurrent laryngeal nerve is involved in the movement of the vocal cords. Another nerve branch, the external branch of the superior laryngeal nerve, is particularly important for the strength and high-pitched tones of the voice.

In certain procedures, nerve monitoring may be used, which provides functional information about these nerves during surgery. It is used as a complementary tool and does not replace careful anatomical identification.

The duration of the procedure depends on the extent of the operation, the size of the gland, the possible extension of the goitre into the thorax, the need to treat lymph nodes, and whether it is a primary operation or a revision procedure.

Recovery after surgery

Following a thyroidectomy, you may experience pain or a feeling of tightness in the neck, difficulty swallowing, throat irritation related to intubation, and temporary changes to your voice.

During the first few hours, the surgical wound and neck swelling are closely monitored. The appearance of a haematoma that increases rapidly in size requires immediate assessment as it may compress the airway structures.

The length of observation or hospital stay depends on the extent of the surgery, how the wound is healing, calcium levels and any associated medical conditions.

Activity is resumed gradually. It is not usually necessary to keep the neck immobilised, although some movements may be uncomfortable during the first few days.

The scar also changes over time. Initially, it may be red or slightly raised, and subsequently become less visible, although its progression depends on individual scar-healing characteristics.

Thyroid hormones following a thyroidectomy

Following a total thyroidectomy, it is necessary to take levothyroxine to replace the hormones that the gland can no longer produce. The dose is adjusted based on blood tests and may need to be modified until the correct target level is reached.

Following a lobectomy, the remaining lobe may produce a sufficient amount of thyroid hormone. Some people, however, go on to develop hypothyroidism and also require treatment.

For this reason, thyroid function is monitored as part of follow-up care even when part of the gland has been preserved.

Calcium and the function of the parathyroid glands

Monitoring calcium levels is particularly important following a total thyroidectomy or other operations involving both sides of the neck.

The parathyroid glands may experience a temporary reduction in function after surgery due to manipulation or changes in their blood supply. When this occurs, hypocalcaemia – that is, a drop in blood calcium levels – may develop.

Symptoms may include a tingling sensation around the mouth, numbness in the hands or feet, and muscle cramps. Some people may need calcium and vitamin D supplements for a while.

The impact on the parathyroid glands varies depending on the type of operation. A lobectomy and a total thyroidectomy accompanied by lymph node surgery are different procedures, and the associated risk must be assessed according to the specific operation actually performed.

Voice and function of the laryngeal nerves

Changes in the voice are a common concern following surgery, but post-operative hoarseness does not necessarily indicate nerve damage. Intubation, inflammation and tension in the cervical tissues can cause temporary changes.

When the recurrent laryngeal nerve is affected, the mobility of a vocal cord may be impaired, leading to dysphonia, fatigue when speaking or difficulty projecting the voice.

Damage to the external branch of the superior laryngeal nerve can particularly affect vocal power and high-pitched tones. This may be of particular relevance to people who use their voice professionally.

Where changes persist or the nature of the case warrants it, it may be necessary to assess the function of the larynx and the vocal cords.

Risks and possible complications depending on the extent of the surgery

A thyroidectomy is a surgical procedure and may be associated with complications. The type and likelihood of these occurring depend on the extent of the operation, the diagnosis, the need to treat lymph nodes, previous operations and the clinical characteristics of each individual.

Complications specifically related to this surgery include voice changes due to nerve damage and changes in parathyroid function and calcium levels. The significance of these risks varies considerably between a procedure limited to a single lobe and more extensive bilateral surgery.

A cervical haematoma may also develop. Due to the limited space in the neck, a haematoma that grows rapidly in size can compress the trachea and requires immediate attention.

Other possible complications include infection, fluid accumulation, healing problems and anaesthesia-related effects.

Revision surgery may present a different level of complexity because scarring alters the anatomical planes. For this reason, risk assessment must be tailored to the specific procedure and cannot be summarised by a single estimate applicable to all thyroidectomies.

Pathology results and follow-up

The tissue removed during surgery is examined by the Pathology Department. This analysis confirms the nature of the nodules or tumours and provides information that may influence subsequent treatment.

When a lobectomy is performed for a lesion whose diagnosis was not entirely clear, the results may confirm that the condition is benign, thereby making further surgery unnecessary. If cancer is identified, its characteristics help to assess whether the surgery performed is sufficient or whether other measures should be considered.

In some cases, a second operation may subsequently be recommended to remove the remaining thyroid tissue. In others, the initial lobectomy constitutes the necessary surgical treatment.

Follow-up is tailored to both the diagnosis and the extent of the operation. Following a lobectomy, the function of the preserved tissue is monitored; following a total thyroidectomy, levothyroxine dosage is adjusted and calcium levels and parameters related to the treated condition are monitored.

Alternatives to thyroidectomy

Surgery is one of the possible strategies for treating certain thyroid conditions, but other options are available depending on the diagnosis.

Low-risk nodules can be monitored using ultrasound. Certain very small, carefully selected papillary tumours may be managed using active surveillance where the appropriate criteria are met.

Some benign nodules that cause symptoms can be treated using ablation techniques in selected cases, provided their nature has been properly established.

In hyperthyroidism, there are also alternatives such as antithyroid drugs or radioactive iodine. The choice depends on the cause, the size of the gland, the symptoms and the individual’s specific circumstances.

These strategies are not equivalent to one another. The decision is made by comparing the aim of each treatment, its potential consequences and the patient’s clinical situation.

Situations requiring a specific assessment

Previous thyroid surgery

Revision surgery may be technically more complex because scarring alters the anatomical planes and the relationship between the structures of the neck.

Previous voice disorders

Hoarseness, a history of cervical surgery or possible nerve damage may make it necessary to assess vocal cord mobility prior to the operation.

Hyperthyroidism

Where there is a significant excess of thyroid hormones, bringing these under control before surgery forms part of the preparation to minimise cardiovascular and metabolic effects during the procedure.

Intrathoracic goitre

When part of the gland descends into the chest, the anatomy and surgical approach may differ and require specific planning.

Anticoagulant or antiplatelet therapy

These medicines may alter the risk of bleeding. Their management must be tailored to the individual, taking into account the indication for treatment and the planned surgery.

Signs requiring medical assessment

Following the procedure, you should contact the healthcare team if you experience a fever, progressively worsening pain, redness or discharge from the wound, increasing difficulty swallowing, or changes in your voice that do not improve as expected.

Tingling around the mouth, cramps or numbness in the hands and feet may be linked to low calcium levels and require assessment.

Difficulty breathing, rapid swelling of the neck, significant bleeding or a severe feeling of tightness in the neck require urgent medical attention.

Specialists involved

The clinical pathway for a patient who may require a thyroidectomy begins with identifying the thyroid problem, assessing thyroid function and determining whether there is an indication for surgery and what the appropriate extent of the procedure might be.

At the Publio Cordón Memorial Hospital, the Thyroid Unit is involved in the diagnosis and monitoring of thyroid function disorders and nodular pathology. The unit carries out hormone testing, thyroid ultrasound and fine-needle aspiration where indicated, and coordinates referral to Endocrine Surgery when surgery is deemed necessary.

The Endocrine Surgery Unit is the specialist surgical unit for this treatment. It specialises specifically in thyroid and parathyroid surgery and forms part of the Department of General and Digestive Surgery. The unit assesses the indication, the extent of resection and the surgical strategy for thyroid conditions requiring surgery.

The Endocrine Surgery Unit itself works in coordination with Endocrinology, Interventional Radiology, Nuclear Medicine, Pathology and, where necessary, Otorhinolaryngology.

Diagnostic Imaging comprises Radiology and Nuclear Medicine and may be involved at different stages of the investigation depending on the diagnosis and the treatment required.

Where it is necessary to assess the voice, the mobility of the vocal cords or laryngeal function, Otorhinolaryngology – and specifically the areas of Rhinology, Laryngology and Voice – may be involved in the care pathway.

Pathology completes the diagnosis by examining the excised tissue and may influence subsequent decisions. Where the diagnosis or surgical outcome requires it, Nuclear Medicine, Oncology and other specialists may be involved.

Not everyone requires the involvement of all these departments. The care pathway is tailored to the diagnosis, the extent of the surgery, the pathological findings and any subsequent hormonal, functional or oncological needs.

Preguntas frecuentes

Is a lobectomy the same as a total thyroidectomy?

No. In a lobectomy or hemithyroidectomy, one of the lobes of the gland is removed, whereas in a total thyroidectomy, virtually all of the thyroid tissue is removed. This difference affects subsequent hormonal function, certain surgical risks and the necessary follow-up care.

Will I need to take levothyroxine for the rest of my life?

Following a total thyroidectomy, it is necessary to take thyroid hormone replacement therapy on a permanent basis, usually in the form of levothyroxine. The dose is adjusted on the basis of blood test results. Following a lobectomy, the remaining tissue may continue to produce sufficient hormones, although some people develop hypothyroidism and also require treatment.

Do all suspicious thyroid nodules require surgery?

Not necessarily. The decision depends on the ultrasound findings, the cytology results, the size of the lesion, the patient’s medical history and other clinical factors. Depending on the level of risk, options may include monitoring, repeating or completing the investigation, performing a diagnostic lobectomy or adopting another approach.

Does nerve monitoring prevent changes to the voice?

No. Nerve monitoring provides information on the function of specific nerves during the operation and can help guide surgical decisions, but it does not completely eliminate the risk of injury nor does it replace careful anatomical identification. Changes in the voice may also occur temporarily as a result of intubation, swelling or neck tissues.

What does it mean to experience a tingling sensation after a thyroidectomy?

A tingling sensation around the mouth or in the hands and feet, as well as muscle cramps or spasms, may indicate low blood calcium levels. This condition is associated with a temporary or, less commonly, persistent reduction in parathyroid function and is more common following bilateral surgery. These symptoms should be reported to the healthcare team so that calcium levels can be assessed and a decision made as to whether treatment is required.

Does the scar from a thyroidectomy fade?

The scar usually changes and becomes less visible over the following months, but it does not necessarily disappear completely. Its final appearance depends on the individual’s healing process, the type of incision and other factors. There are surgical approaches that avoid a visible cervical scar in selected patients, but these have their own specific indications and characteristics.

Might a second operation be necessary following a lobectomy?

Yes. When a lobectomy is performed for a lesion whose diagnosis was not entirely clear, the final pathology report may provide information suggesting that the remaining thyroid tissue should be removed at a later date. In other cases, the result confirms that the initial surgery was sufficient and that it is not necessary to complete the thyroidectomy.

When should you seek urgent medical attention following a thyroidectomy?

Difficulty breathing, rapid swelling of the neck, significant bleeding or a severe sensation of tightness in the neck require urgent medical attention. Severe muscle spasms or severe symptoms consistent with low calcium levels also need to be assessed without delay.

Medical information for general guidance

This information sheet aims to help you understand what a thyroidectomy involves, why it may be necessary to remove a lobe or virtually the entire gland, how the operation is carried out, and what effects it may have on thyroid hormones, calcium levels, your voice and follow-up care.

At the Publio Cordón Memorial Hospital, we believe it is important for medical information to be accurate, understandable and useful in guiding each person through their care journey. Our specialists devote part of their work to explaining conditions, tests and treatment options in an accessible way, helping patients and their families to better understand each stage and participate with greater confidence in decisions about their health. This commitment to knowledge and public education is also part of our commitment to .

The information contained in this factsheet describes the general principles of thyroidectomy. The indication for and extent of the surgery must be determined on a case-by-case basis, taking into account the diagnosis, the extent of the disease, thyroid function, clinical characteristics and the available alternatives.