1. Surgical treatment of differentiated thyroid cancer (papillary and follicular carcinoma)
Before surgery, both the American Thyroid Society and European Thyroid Society guidelines recommend neck ultrasound to carefully examine the central and lateral lymph nodes of the neck for the presence of metastases. This is required for both adult patients and pediatric patients. Some physicians may also use other imaging modalities, such as CT.
Treatment of non-microscopic thyroid cancer often requires total or near-total thyroidectomy. For microscopic papillary thyroid cancer or thyroid nodules of suspected malignancy, lobectomy on the side of the cancer may be sufficient. Yin Zhiqiang, Thyroid Disease Clinic, Shanghai Tenth People’s Hospital
In addition, the surgeon will usually check the lymph nodes for enlargement during surgery.
Depending on the size of the tumor and the presence of thyroid metastases and/or nearby neck tissue invasion, the surgeon may change the scope of the surgery. Tumors in the soft tissues of the neck can often be removed without damaging the neck muscles or the recurrent laryngeal nerve (which governs the movement of the vocal cords).
Surgeons will remove lymph nodes that look abnormal or that are biopsy-proven to have metastasized. Both the American Thyroid Association and the European Thyroid Association recommend that if lymph node metastases are found, all lymph nodes in the area should be removed.
For patients with more aggressive tumors, some surgeons will prophylactically remove all lymph nodes in the central region.
2.Surgical treatment of medullary thyroid cancer
Surgical removal of the thyroid gland is the treatment option for medullary thyroid cancer.
Surgeons will remove the lymph nodes in the neck of almost all patients who are preoperatively diagnosed with medullary thyroid cancer.
However, once the medullary thyroid cancer has metastasized to the lymph nodes, reoperation is usually not curative.
Risks of surgery
The more experience a surgeon has in thyroid surgery, the lower the risk of surgical complications. However, surgical complications can occur even with the most experienced surgeons.
Some risks.
Temporary or permanent hoarseness or loss of voice: caused by damage to the recurrent laryngeal nerve. The recurrent laryngeal nerve is a nerve immediately adjacent to the thyroid gland.
The change in voice quality is often temporary. In rare cases, the changes are permanent.
If the nerve is damaged, some corrective measures may be taken.
If the nerve is damaged bilaterally, some patients may have difficulty breathing and require a tracheotomy. This is very rare.
Low blood calcium: caused by damage to the parathyroid glands.
There are four parathyroid glands on the back of the thyroid. During thyroidectomy, the surgeon will carefully determine the location of the parathyroid glands and try not to damage or remove them. Symptoms of hypocalcemia include muscle twitching and numbness, especially in the hands and feet. Injury to the parathyroid glands results in “hypoparathyroidism”.
Hypoparathyroidism can be treated with calcium supplements and special forms of vitamin D.
Hypocalcemia is usually temporary, and treatment with calcium and vitamin D supplementation usually lasts only 2-4 weeks.
However, a small percentage of patients may develop permanent postoperative hypoparathyroidism and require lifelong calcium and vitamin D supplementation.
Infection: A rare complication. Treat with antibiotics.
Bleeding: A rare complication. Manage intraoperative or postoperative hemostasis. It is best to find a surgeon who is experienced in thyroid surgery to help reduce the risk and ensure the outcome.
[Postoperative recovery].
Most thyroid surgeries have a short hospital stay.
The surgeon will instruct the patient on how to care for the wound, tell the patient how to move around after surgery, and when to return to normal activities.
The surgeon will instruct the patient when follow-up appointments are needed. Before discharge, patients should know the date and time of their post-operative follow-up appointments.
Choose comfortable pillows during hospitalization, on the way back home and at home.
Rest, attention to nutrition, drinking enough water, and not being overly active will help with post-operative recovery.
Patients should avoid smoking, alcohol and stimulating foods, avoid overwork, get enough sleep, and exercise appropriately to strengthen resistance and prevent pharyngeal congestion and discomfort caused by colds.
After cervical lymph node dissection, patients should start functional exercises for shoulder joint and neck after incision healing to prevent scar contraction, and generally avoid strenuous activities of neck for 2 – 3 months after surgery.
Patients with total thyroidectomy should take thyroid preparations as replacement therapy as prescribed by the doctor. If discomfort such as panic attacks or fear of heat occurs during the medication period, the patient should be promptly checked at the hospital.
Patients should be reviewed at 3 months, 6 months, and 1 year after surgery, and followed up once a year for 5 years thereafter, and may be followed up every 2 – 3 years thereafter.