Do you need thyroid surgery?

There are several reasons to remove all or part of a person’s thyroid. The most common reasons are:

Thyroid cancer. The most accepted treatment for thyroid cancer is thyroidectomy.  Usually this requires a total thyroidectomy, but in a few low risk cases a hemithyroidectomy can be considered.This should be discussed with your surgeon.

Follicular lesion of undetermined significance. This is a group of diagnoses classified by the pathologist  after a fine needle aspiration biopsy.  The cells from the thyroid biopsy show changes consistent with a tumor (neoplasm), but it cannot be characterized as malignant or benign.  The only way to definitively tell the difference is to look at the architecture of the nodule—that can on ly be done with removal of the nodule with a hemithyroidectomy.If cancer is found, then a completion thyroidectomy will likely need to be done for treatment.

Nodules or a goiter causing compressive symptoms. These symptoms are problems swallowing or tightness in the neck with lying back or with neck motion.

Nodules larger than 4 cm. Some feel that larger nodules have a higher chance of harboring a cancer.

Visible nodules seen on the front of the neck.

Hyperthyroidism. If the person has failed medical therapy, cannot tolerate medical therapy, and/or is not a candidate for radioactive iodine therapy

There are other less common indication. Substernal goiter (thyroid growing into the upper chest) is uncommon but should be removed.  Some multinodular goiters are so filled with nodules that follow-up is difficult.  Serial measurements are hard if you cannot easily determine where specific borders are.

The indications for your surgery should be thoroughly discussed by your surgeon.  Never be afraid to ask questions.