How Invasive Is Thyroid Surgery?

The thyroid gland is shaped like a butterfly and sits just below Adam’s apple.

It is attached to the deeper neck structures (trachea and voice box) and elevates when we swallow.

Thyroid surgery is major surgery. The extent of invasive surgery you require depends on the abnormality of the thyroid gland you are diagnosed with. Your surgeon will make this decision depending on your age, illness, overall health condition, and the outlook of the procedure. Most doctors will consider minimally invasive surgery, which involves a smaller cut over the neck. A few conditions might need a complete resection of the thyroid and the surrounding structures.

Conventional open thyroidectomy is a standard procedure that includes a collar incision of a few centimeters depending on the indication. For thyroid tumors, which are smaller than 3 cm, a minimally invasive technique could be an option. The approach to the thyroid gland can be cervical (MIVAT or minimally invasive video-assisted thyroidectomy) or extra cervical (axillary approach, chest approach, or clavicular approach). Usually, these procedures need special imaging equipment and instruments.

Types of thyroid surgery include:

• Total thyroidectomy: It means complete removal of all thyroid tissue from both thyroid beds, including tracheal attachments. Total thyroidectomy is usually preferred in cases of thyroid cancers with multiple nodules.
• Subtotal thyroidectomy: The surgeon preserves a part of the thyroid gland at the area of the recurrent laryngeal nerve, thereby decreasing the risk of nerve injury. This procedure may leave a small portion of the thyroid gland that could have thyroid cancer within it. The subtotal thyroidectomy is generally not used for thyroid cancer treatment, but for the removal of an enlarged thyroid gland that does not have cancer within it.
• Hemithyroidectomy or thyroid lobectomy: This procedure does not remove one lobe or side of the thyroid that does not have any mass or tumor in it. It also spares the small tongue-shaped portion in the middle of the gland between the two sides of the thyroid. The advantage of hemithyroidectomy is that half of the thyroid gland remains; therefore, in most cases, the person will not need external thyroid hormones. Additionally, because the other side of the thyroid is untouched, there is no risk to the other recurrent laryngeal nerve or the other two parathyroid glands (we only need one functional parathyroid gland to survive). Hemithyroidectomy is mostly indicated for removing a large, one-sided, noncancerous mass or to confirm the nature of such mass under a microscope.
• Completion thyroidectomy: It is done when the cancer recurs in a patient who has previously undergone a hemithyroidectomy. The surgeon removes the rest of the thyroid gland to complete the thyroidectomy. This surgery may be particularly more challenging because of the dense scarring due to the first surgery (hemithyroidectomy).

A total or partial thyroidectomy can be a challenging procedure due to the complex anatomy of the gland, the limited space in the cervical area, and the surrounding structures, such as nerves (e.g., recurrent laryngeal nerve), blood vessels, and several muscle layers. There is a risk of intra- and post-operative bleeding or vocal-nerve damage. In particular, damage to the recurrent laryngeal nerve can result in paralysis of the vocal cords. Anatomical variations of the thyroid gland and the way it is attached to the surrounding tissue due to the disease could also present challenges during surgery.