Thyroid Surgery: Breaking Down the Different Types

Not all thyroid surgeries are the same. Thyroid surgery can range from the removal of a piece of the gland to the entire gland. The type of thyroidectomy you need will depend on the thyroid condition you have. Knowing the differences of each procedure can help you know what to expect from your thyroidectomy. 

What is thyroid removal surgery?

A thyroidectomy is a surgery that removes part or all of the thyroid gland. Your thyroid is a gland in your neck that sits in front of your trachea (windpipe). A piece of tissue (isthmus) connects the two lobes of the thyroid gland. The thyroid gland produces thyroid hormone, which helps your body systems to work properly.

Thyroid surgery is a common and generally safe procedure. In fact, there are nearly 100,000 thyroid surgeries done in the U.S. every year. It’s one of the most common surgeries worldwide.

When is thyroid surgery needed?

Not every thyroid condition requires surgery. Medications can treat many conditions, such as hypothyroidism (underactive thyroid gland). But sometimes surgery might be the best option to treat your thyroid.

Your healthcare provider might recommend thyroid surgery for several reasons, including:

• Large thyroid nodule (a growth in the thyroid) or possible cancer

• Goiter (a swelling of the thyroid) causing cough, trouble breathing, or difficulty swallowing

• Retrosternal goiter (a large goiter that extends into the chest)

• Thyroid cancer

• Hyperthyroidism (overactive thyroid gland) due to a nodule, goiter, or Graves’ disease

What are the different types of thyroid surgery?

There are several different types of thyroid surgery. The surgery that is best for you will depend on your medical history and the size of your thyroid gland. The types of thyroid surgery are:

• Partial thyroid lobectomy: This is the removal of a piece of one of the lobes of the thyroid. It’s the least common thyroid surgery.

• Thyroid lobectomy: This is the removal of either the entire left or right lobe of the thyroid.

• Thyroid lobectomy and isthmus removal: This is the removal of an entire lobe and the isthmus.

• Subtotal thyroidectomy: This is the removal of an entire lobe, the isthmus, and part of the other lobe. A piece of one lobe of the thyroid will remain.

• Total thyroidectomy: This is the removal of both lobes and the isthmus. There’s no thyroid tissue left to produce thyroid hormone.

What happens during thyroid surgery?

You may have your thyroid surgery in the hospital or at an outpatient facility. No matter where you have your surgery, the procedure and results will be similar. Your care team will place a breathing tube in your airway to prepare you for general anesthesia. This allows you to breathe safely while you’re asleep during the surgery. With rare exceptions, the breathing tube comes out at the end of surgery.

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During thyroid surgery, your surgeon will make a 4 cm incision in your skin and separate the neck muscles. This allows for a better view of the thyroid gland. They’ll locate the parathyroid glands and nerves in the area to avoid damaging them. The surgeon will then cut out the necessary amount of thyroid tissue to treat your condition.

If necessary, they’ll also remove any lymph nodes that look suspicious or enlarged. Sometimes the surgeon will send sections of tissue to the lab during the surgery. A pathologist will look under a microscope to check for any signs of cancer. Your surgeon will then make sure to remove all the cancerous tissue present. Finally, they’ll close your wound and apply bandages.

What are the most common side effects of thyroid surgery?

Although thyroid surgery is very safe, you may experience some side effects. Finding an experienced surgeon who has performed many thyroidectomies will reduce these risks. 

Common side effects may include:

• Hoarseness: Damage to one of the nerves that goes to the voice box (larynx) can cause a hoarse voice. It usually goes away in a few weeks, but it can be permanent.

• Pain: Pain is often mild and treated with over-the-counter pain relievers. When pain is more severe, your provider may prescribe a stronger pain medication. 

• Hematoma: Hematomas are usually small collections of blood underneath the skin. But they can cause problems if they’re large or located in sensitive areas.

• Difficulty breathing: You may have trouble breathing due to bleeding near your airway, swelling, or nerve damage. 

• Loss of thyroid function: If most of your thyroid is removed, you’ll need to take thyroid hormone. Medications like levothyroxine are often used.

• Low calcium: The parathyroid glands control your calcium levels. They’re on the back of your thyroid gland. Sometimes thyroid surgery affects them.

What is the recovery process like after thyroid surgery?

Most people recover from thyroid surgery quickly. Your surgeon will advise you to take it easy for 1 to 2 days to minimize the chance of bleeding. Even though you can do light activities the day after surgery, it can take up to 2 weeks to resume regular activities. If you need to have a larger incision or lymph nodes removed, your recovery may take longer.

The thyroid hormone your thyroid gland makes does important work for your body. So your provider will recommend that you have your levels checked after surgery. If you have a low thyroid hormone level (hypothyroidism), you'll need medication to replace it. Many people develop hypothyroidism after surgery. This is especially true after the removal of a large piece of the thyroid.

What factors determine which type of thyroid surgery you can have?

Your surgeon will use your medical history and the size of your thyroid to decide which thyroid surgery you need. You’ll also likely need lab tests, imaging, or a biopsy.

Before surgery, care teams often do a fine-needle aspiration biopsy of a nodule or lump in your thyroid. This is where your provider inserts a small needle in your neck to take a sample of your thyroid. This helps to identify any abnormal tissue in your thyroid or cancer.

Thyroid cancer almost always needs a total or subtotal thyroidectomy. Rarely, your surgeon may recommend a less extensive operation for your type of cancer. 

Large nodules or goiters will often need a subtotal thyroidectomy. But small, noncancerous nodules may leave more thyroid tissue intact.

What is the safest and most effective type of thyroid surgery?

The most effective type of thyroid surgery will vary from person to person. You’ll have the surgery that gives you the best chance of cure with the least risk of side effects. It’s often preferable to go with a less extensive option to treat your condition, if available. That’s because the risk of complications is higher when you have more thyroid tissue removed. But sometimes even a small cancer may need a total thyroidectomy.

In the hands of a skilled surgeon, all types of thyroid surgery are considered safe. You’ll have a thorough preoperative evaluation to decrease the risk of surgery. This will include having your thyroid hormone levels checked. Your surgeon will want to make sure they’re as close to normal as possible before surgery. And they’ll check that your thyroid gland isn’t affecting your airway, heart, or lungs.

Your healthcare provider will determine the best and safest procedure for you.

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Written by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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