Surgery For Thyroid Nodules & Cancers
Most noncancerous, or benign, thyroid nodules do not need treatment unless they are a cosmetic concern or cause symptoms including problems with swallowing, breathing, or speaking and neck discomfort. In these situations, NYU Langone doctors may recommend surgery or a minimally invasive procedure called radiofrequency ablation.
Your NYU Langone endocrinologist and endocrine surgeon determine the most effective and least invasive treatment or type of surgery based on diagnostic test results.
Planning: Mdt For Malignant And Potentially Malignant Cases
Thyroid cancer should be managed by an appropriately trained multidisciplinary team . The thyroid surgeon must have access and regularly contribute to the MDT meeting, both to discuss cases as well as supporting colleagues from other disciplines. In the UK, it is a requirement that potential or proven malignant cases are discussed and treatment strategies agreed. The focus of the MDT meeting may vary due to region with thyroid cases being discussed typically at either head and neck or endocrine MDT. The MDT meeting provides a platform for cementing relationships between professionals. Furthermore, it provides a point from which prospective data can be collected and audited locally, improving patient outcomes in malignant disease .
Risks Of Thyroid Surgery
In the hands of an experienced thyroid surgeon, thyroid surgery is a safe procedure with few complications. The following possible complications are directly related to the operative experience of the surgeon, and these statistics are based on our own results here at Columbia:
Bleeding in the neck:
As with any operation, there is always a chance of bleeding. The average blood loss for this operation is less than a tablespoon and the chance of needing a blood transfusion is extremely rare. However, bleeding in the neck is potentially life-threatening because as the blood pools, it can push on the windpipe or trachea causing difficulty breathing. Fortunately, in the hands of Columbia Thyroid Center surgeons, the risk of bleeding is less than 1%. Due to this rare risk of bleeding, patients are observed for 4 hours by our highly trained recovery room staff. If there is no sign of bleeding and the patient feels well, he or she may go home. Once at home, patients and their friends/family should watch for signs such as difficulty breathing, a high squeaky voice, swelling in the neck that continues to get bigger, and a feeling that something bad is happening. If any of these symptoms happen, the patient should call 911 first and then their surgeon.
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What Questions Should I Ask My Doctor
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What Genetic Tests Are Used For Thyroid Biopsies Of Nodules
Within the past few years, several molecular tests have become available to help determine whether some nodules are cancerous or benign. These tests look at many genes within the thyroid nodules genetic information. They are being used when a nodule biopsy comes back with a diagnosis of indeterminate. Sometimes, the person doing the biopsy will perform an additional pass of the needle to obtain material for such a test. This may be done on the first biopsy or at the time of a repeat biopsy.
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Determine Your Insurance Benefit
Your insurance coverage is a practical matter. To receive the most insurance benefits and pay the least out-of-pocket for your surgery, you need to choose a surgeon that participates in your plan. But keep in mind, just because a doctor participates in your insurance plan doesnt mean he or she is a high-quality doctor. You still need to consider the doctors experience and expertise.
What Type Of Doctor Does A Thyroidectomy
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Recuperation Time And Restrictions
Most people are advised to take roughly two weeks off from work to recuperate, depending on their occupation. You should not drive as long as you continue to need pain medications, and some surgeons recommend abstaining from driving for the first week after surgery altogether.
You should also avoid any heavy lifting or strenuous activities for a few weeks. The excess activity could increase your chance of developing a hematoma or keep your wound from healing properly. Light housekeeping and walking are usually fine once you arrive home.
Thyroid Surgery Recovery Side Effects And Complications
If you are having thyroid surgery, known as a thyroidectomy, it’s important to know what to expect as you recover. Side effects of surgery are common and include neck pain, a sore throat, difficulty swallowing, hoarseness, and temporary hypoparathyroidism.
Complications are much less common and can include bleeding , permanent hypoparathyroidism , and damage to nerves that can lead to long-term hoarseness and vocal changes.
Taking time to learn about post-thyroidectomy recovery can prepare you to cope with any symptoms and to be alert to any problems.
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When To Call Your Healthcare Provider
- You have a fever of 100.5 °F or higher.
- You have drainage from your incision.
- You have trouble breathing.
- The skin around your incision is warmer than usual.
- You have more discomfort in the area around your incision than usual.
- The area around your incision is more red than usual.
- You have new or increased swelling around your incision.
- You have numbness, twitching, or tingling around your mouth, fingertips, or toes.
- You have any questions or concerns.
How Is A Thyroid Fna Performed
The neck will first be cleaned with an antiseptic. A local or topical anesthetic may be applied. For the biopsy, your doctor will use a very thin needle to withdraw cells from the thyroid nodule. The needle used is smaller in diameter than those used in most blood draws. Your doctor will insert the needle through the skin and into the thyroid nodule. After the sampling, which only takes several seconds, the needle will be removed. New needles are used for additional samples. Several samples of cells will be obtained, by sticking a fine needle in various parts of the nodule usually between two and six times . This assures a better chance to find cancerous cells if they are present. If there is fluid in the nodule, a syringe may be used to drain it.
Once the biopsy is completed, pressure will be applied to the neck. The procedure usually lasts less than 30 minutes.
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How Much Of My Thyroid Will Be Removed
It depends on the reason for your surgery. If your thyroid is overactive , or the whole gland is enlarged and causing symptomssuch as a feeling of pressure or difficulty talking, breathing or swallowingthe whole thyroid should be removed in a procedure called total thyroidectomy, said former Duke endocrine surgeon Dr. Julie Sosa, MD. If only half your thyroid is enlarged and causing symptoms, but the other half is normal, then half should be removed, said Sosa.
For the most common type of thyroid cancer, which is generally low-risk, your doctor may recommend removing all or half your thyroid, depending on your circumstances. If you have intermediate- or high-risk cancermeaning it has spread outside the thyroidwe recommend total thyroidectomy, said Sosa.
Sophisticated imaging called neck mapping can help your surgeon determine ahead of time how much of your thyroid and which lymph nodes, if any, need to be removed. While not in use everywhere, neck mapping is routine at Duke. The best chance for a cure for thyroid cancer is making sure we remove all of the disease, said former Duke endocrine surgeon Dr. Sanziana Roman, MD. We dont want to overtreat, but we also dont want to undertreat. So knowing exactly how much surgery a patient needs is very important.
How Does The Surgeon Know How Much Thyroid Tissue To Remove During A Thyroidectomy
The amount of thyroid tissue that needs to be removed is determined prior to the surgical procedure. The surgeon works closely with an endocrinologist to determine what areas of the thyroid gland are not functioning normally. Usually thyroid function tests and thyroid scanning are involved to aid in this decision. For cases in which thyroid cancer is suspected, a fine needle aspiration biopsy may also be performed. Using this information the endocrinologist and surgeon determine how much of the thyroid gland is removed.
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Thyroid Vs Parathyroid: Whats The Difference
The names sound the same, but the thyroid and parathyroid glands are actually completely separate organs, with completely different functions in the body.
The thyroid gland plays a large role in regulating your metabolism. It affects things like body temperature, appetite and energy levels.
The parathyroid glands are actually a set of four glands, and their job is to control the amount of calcium in your blood. Having the proper calcium levels is important for maintaining proper bone density and nerve conduction.
So what do they have in common?
Well, since they both secrete hormones into the bloodstream, theyre both considered part of the bodys endocrine system, a broad term used to cover all of the bodys glands, including others like the adrenal glands and the pituitary gland too. Problems with glands usually manifest in one of two ways: they make too much of their hormones or too little. Like other parts of the body, glands are also vulnerable to cancer.
Theyre also both located within the neck. Typically, the parathyroid glands can be found just behind the thyroid, with both sitting in front of the wind pipe . Procedures to treat either one require a thorough understanding of the delicate anatomy of this area, which is why surgeons need special training to take care of thyroid and parathyroid disease.
Risks And Side Effects Of Thyroid Surgery
Complications are less likely to happen when your operation is done by an experienced thyroid surgeon. Patients who have thyroid surgery are often ready to leave the hospital within a day after the operation. Potential complications of thyroid surgery include:
- Temporary or permanent hoarseness or loss of voice. This can happen if the larynx or windpipe is irritated by the breathing tube that was used during surgery. It may also occur if the nerves to the larynx are damaged during surgery. The doctor should examine your vocal cords before surgery to see if they move normally.
- Damage to the parathyroid glands . This can lead to low blood calcium levels, causing muscle spasms and feelings of numbness and tingling.
- Excessive bleeding or formation of a major blood clot in the neck
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Highlights Of Our Center
More Care, Fewer Visits
Coming back and forth to the doctors office for multiple appointments is a burden, which is why we work with you to coordinate efficient and effective visits. See multiple specialists, get blood work completed and even have a procedure all in a single appointment. For added convenience, we have both a Manhattan and a Westchester location, and we offer video visits which can be done from the comfort of your own home. Need to be seen soon? We also do same-day consultations. Just call to be seen by the next available doctor on our team.
Dedicated Patient Navigator
Our on-site patient navigator is here to help make sure your experience with us goes as smoothly as possible. Theyll help you prepare for your appointment, coordinate appointments with other specialists, clarify any insurance and billing concerns, and will always be available to make sure your questions are answered.
More Surgical Experience and Better Results
Comprehensive Thyroid Cancer Care
Our surgeons and endocrinologists work closely with oncologists, radiologists and other specialists to create personalized treatment plans for all forms of thyroid cancer, at any stage. We are proud to be part of Columbias Herbert Irving Comprehensive Cancer Center, one of only a few programs in the country to earn the National Cancer Institutes official comprehensive cancer center designation.
Finding An Endocrine Surgeon: What Should You Look For
As with most types of surgery, the chance of having a successful and safe operation increases with the experience of the surgeon. In particular, endocrine surgery is a highly specialized field which requires significant experience to master.
When visiting a surgeon for thyroid, parathyroid, or other endocrine diseases, keep in mind that the specific title of the surgeon is not necessarily relevant to their experience. For example, a head and neck surgeon may not necessarily be an expert in parathyroid surgery. It is therefore important that you inquire about the surgeon’s specific experience.
Do not be afraid to ask how many parathyroid and thyroid operations a surgeon performs each year and what their personal complication rate is. An expert will expect to be asked these questions and should not get offended by them. Research has shown that an endocrine surgeon should do more than 50 parathyroid and thyroid operations a year to be considered an expert. Use the chart below to determine the experience of your surgeon.
- Total No. of Thyroid or Parathyroid Operations: < 200Experience Level: Inexperienced
Stories & Perspectives
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Will I Be Able To Lead A Normal Life After Surgery
Yes. Once you have recovered from the effects of thyroid surgery, you will usually be able to do anything that you could do prior to surgery. Some patients become hypothyroid following thyroid surgery, requiring treatment with thyroid hormone . This is especially true if you had your whole thyroid gland removed. Generally, you will be started on thyroid hormone the day after surgery, even if there are plans for treatment with radioactive iodine.
Surgery For Eyelid Retraction
TED can cause muscles and fatty tissue behind your eye to swell. This can push your eye out of position.
In some cases, your eyelid is no longer able to cover the whole eye. When your eyelid cant close all the way, the exposed part of your eye becomes very irritated.
This surgery adjusts the position of your eyelid.
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When Is Thyroid Surgery Needed
To decide on the best course of treatment, each patient is carefully evaluated. If surgery is recommended, your surgeon will discuss the appropriate surgical options with you. Surgical options range from removing only the side of the thyroid gland that contains the nodule to removing the entire thyroid gland . For patients with nodules that need to be removed, some of these surgeries can be performed as a minimally invasive procedure. Depending on the situation and the procedure performed, some patients may be sent home the same day while others remain in the hospital overnight and are sent home the next morning.
Who Needs Thyroid Surgery
Your doctor may recommend thyroid surgery to treat numerous conditions.
- Thyroid nodules or goiters are usually benign, but they may become cancerous. Your doctor will do a thorough workup possibly including a needle biopsy before recommending surgery.
- An enlarged thyroid can cause bothersome or even dangerous symptoms, such as difficulty swallowing or breathing and changes to the voice. Surgery eliminates these problems.
- Hyperthyroidism, or an overactive thyroid, can be treated in multiple ways. If conservative treatments dont work, surgery may be recommended. This is uncommon however.
- Graves disease, an autoimmune condition, can cause hyperthyroidism. Other approaches may be successful at treating Graves disease, but surgery is still necessary in some cases.
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Day Before Your Surgery
Note the time of your surgery
A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, theyll call you on the Friday before. If you dont get a call by 7:00 pm, call .
The staff member will tell you what time to arrive at the hospital for your surgery. Theyll also remind you where to go.
This will be one of the following locations:
- Josie Robertson Surgery Center
Instructions for eating before your surgery
Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
What Are The Risks Of Thyroid Surgery
All surgery brings risk for complications like bleeding and infection. Thyroid surgery can also involve risks for damage to vocal cord nerves, which could cause hoarseness, and damage to your parathyroid glands, which are located behind and very close to your thyroid and regulate your bodys calcium levels.
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Neck Pain And Stiffness
The neck is put in an extended position during surgery, and many people avoid moving their necks afterward. This can lead to neck pain and stiffness. Using pain medication after surgery may reduce discomfort, making it easier for you to keep moving your neck so that you have less stiffness later on. Applying a warm compress may also help.
Many surgeons recommend doing gentle stretching and range-of-motion exercises, such as the following, to reduce stiffness. Before doing these, however, make sure to ask your surgeon about their appropriateness for you, any additional exercises she believes might be helpful, how often you should perform them, and whether there are any exercises you should avoid.
- Gently turn your head to the right, then roll your head so that you are looking at the floor, then gently roll your head to the left.
- Gently tilt your head to the right and then to the left.
- Rotate both shoulders forward in a circular motion.
- Slowly raise your arms overhead, and then slowly lower them back down against your body.
Suggested frequency: 10 repetitions, three times day
Most often, neck stiffness lasts for only a few days to a few weeks after surgery. If yours does not, talk to your surgeon about seeing a specialist in physical medicine and rehabilitation or a physical therapist who can work with you to improve the flexibility of your neck and design an exercise program to restore your neck mobility to normal.