Thyroid cancer – cancer of the thyroid gland – is a cancer which has become more and more common over the last few decades.¹ 

The thyroid gland has an essential function in the body, secreting hormones to help regulate things such as metabolism, so thyroid cancer must be diagnosed and treated as soon as possible. 

Fortunately, the survival rate is very good thanks to the many treatment options available today. In this article, we will explore what thyroid cancer is and what types of surgical treatments exist. 

What is thyroid cancer? 

As the name suggests, the term ‘thyroid cancer’ refers to cancer in the thyroid gland, an ‘endocrine’ gland (a gland that produces hormones) which is found in the neck by the windpipe and voice box. 

It is a really important gland because the hormones it makes and secretes affect virtually all systems in the body, and are responsible for many vital functions such as regulating metabolism.²

The severity of thyroid cancer can differ depending on the cancer’s size, type and spread. 

According to the NHS, symptoms of thyroid cancer may include: 

• A lump/growth in the neck: It should be noted that only 5% of thyroid lumps turn out to be cancer and could be benign (not cancerous) lumps called ‘nodules’, so whilst you should see your GP immediately when you find one, it may not be a case for alarm
• The feeling of something pushing on the front of your neck, potentially painful
• Hoarseness in the voice lasting over 3 weeks.
• A sore throat and/or finding it hard to swallow for over 3 weeks

More unusual symptoms can include looser stools or diarrhoea, a red face and/or losing weight. 

Whilst relatively rare in the UK, there has been an increase in cases of thyroid cancer in England over the last forty years, particularly among under 49-year-olds. People assigned female at birth are two to three times more likely to have it.³ 

However, despite the rise in cases, the mortality rate (number of people who die from it) has not changed.¹ In fact, the survival rates are very good.⁴ This is, in part, down to the wide range of treatment options available.⁵

Diagnosing thyroid cancer

To diagnose thyroid cancer, a GP or specialist may prescribe various tests such as ultrasound scans, blood tests and a biopsy. 

If diagnosed, further tests will be carried out to establish how big the cancer is and if it has spread. This may be done through MRI scans, CT scans, PET scans or through passing a tube with a tiny camera through the nose to view the vocal cords.  

Staging thyroid cancer

With the data from these tests, a team of specialists will discuss and choose the appropriate treatment course – this is called a ‘multidisciplinary team’ (MDT), and will include specialists from many different medical departments such as surgery, radiology, oncology, etc.

They will make informed decisions on what treatment is best, often striving to avoid ‘overtreating’ the patient if they are not high-risk, as this could negatively affect their quality of life.⁴

To find the right level of treatment, they will ‘stage’ the cancer. This means they will assign the cancer a ‘stage’ according to its size and extent of spread. One of the most common systems to do this is the tumour-node metastasis (TNM) classification which can predict the risk of dying from the cancer.⁴

Another common system is the number staging system (i.e. stages 1 - 4). 

Thyroid cancer treatment: surgery options 

There are a variety of non-surgical treatment options for thyroid cancer that may be appropriate, depending on the stage of the cancer, such as: 

• Radioactive iodine therapy (radiotherapy)
• Targeted treatment with drugs such as tyrosine kinase inhibitors (TKIs)

Nevertheless, the main treatment option for thyroid cancer is surgery. For example, if a tumour measures between > 1 cm and 2 cm, a near-total or total thyroidectomy is recommended to manage the cancer.⁵

Total thyroidectomy 

In a total thyroidectomy, the surgeon will excise (remove) the entire thyroid gland by making an incision in your neck (at the front). The patient will be under general anaesthetic (i.e. put to sleep) during the surgery. 

Dissolvable stitches will be used to close the incision so no stitches will need to be removed at a later date. The surgery can often be performed as an outpatient surgery (meaning you don’t usually need to stay overnight). 

This is the most common option for thyroid cancer surgery. With advancements in technology, understanding of anatomy, and techniques, it is a very safe procedure, with a global mortality rate of less than 1%.⁶

Partial thyroidectomy 

Another surgery option is a partial thyroidectomy – also referred to as a ‘hemithyroidectomy’ or a ‘thyroid lobectomy’. This is regarded as a good option for certain cases of low-risk thyroid cancer.⁷

The thyroid gland is made up of two lobes. In this type of surgery, the surgeon will remove half of the thyroid gland (one lobe) and the tissue that connects the two lobes, the ‘isthmus’. This will also be done under general anaesthetic. 

As well as to treat low-risk (small) cancers in the thyroid, this surgery may also be used to affirmatively establish whether a lump is benign (not cancerous) or malignant (cancerous) in cases where the diagnosis before surgery was not certain. 

If the diagnosis and postoperative scans indicate that it is necessary, the patient may then need a second surgery to excise the other lobe – referred to as a completion thyroidectomy. 

Lymph node dissection 

Lymph nodes form part of your lymphatic system and are an important part of your immune system and it is possible for cancer to spread to them. 

If thyroid cancer cells have spread to the lymph nodes in the neck the surgeon may perform a neck dissection – whereby they remove the lymph nodes from the side and/or centre of the neck. 

A lymph node dissection from the middle of the neck is called a ‘prophylactic lymph node dissection’.

Potential complications of surgery 

• Infection (of the wound)
• Problems with breathing 
• Blood clots
• Bleeding 

Your doctor and team of specialists would be on hand to help avoid and/or treat any complications that may happen.

Life after thyroid surgery 

Stiffness 

It is possible to experience stiffness in your neck following a thyroid surgery due to the wound site and scarring. This should improve over time, but you may be advised by a physiotherapist to help with this recovery. 

Wound care 

Any surgery comes with a risk of infection to the surgical site afterwards, so proper care of the wound is essential – your doctor will advise you on how to change the dressings and clean the wound after the surgery. 

Eating

You may find yourself turning to softer foods for a few weeks following the surgery to avoid discomfort or pain when swallowing. 

Recovery time 

It is advised that you do not do any heavy lifting and do not return to work for at least 2 weeks following the surgery. You should, however, stay active with non-strenuous exercise each day if possible. 

Changes to your voice

Your voice may change after your surgery if the nerve connecting to your voice box is damaged during the surgery. This is rarely permanent, though.

Thyroid hormone replacement therapy

Following a total thyroidectomy, you will be given a lifelong prescription for hormone tablets. These tablets will substitute the hormones that your now-removed thyroid would make, and this is called thyroid hormone replacement therapy. 

The most common hormone to take is thyroxine. Taking tablets like these will ensure that your body continues to function as normal and will prevent you from experiencing things such as: 

• Fatigue
• Putting on weight
• Dryness of hair and skin
• Thinning of hair
• Constipation 
• Feeling cold
• Problems with concentration 

In some cases, you may need to undergo thyroid hormone replacement therapy even if you have only had a partial thyroidectomy. 

Summary

• Thyroid cancer is cancer in the thyroid gland which secretes important hormones
• Symptoms can include neck lumps/growths, voice hoarseness, and difficulty swallowing
• It is usually diagnosed using various scans (MRI, CT, etc.) and blood tests
• Whilst there are other treatment options like radiotherapy, surgery is the most common treatment
• A total thyroidectomy is where the entire thyroid gland is removed
• A partial thyroidectomy (a thyroid lobectomy/hemithyroidectomy) is where half of the thyroid gland (1 lobe) is removed as well as the connective tissue between the lobes (isthmus)
• Sometimes this may lead to a diagnosis and prompt a second surgery to remove the second lobe – called completion thyroidectomy
• After surgery, you should wait at least 2 weeks before returning to work/heavy lifting
• You may experience temporary voice changes
• You will need to undergo thyroid hormone replacement therapy in the form of tablets for the rest of your life
• The good news is the survival rate is very good