Thyroid cancer is very curable in the vast majority of cases. But, to have any chance of cure, you need to find the best surgeon you can, and your surgeon needs to do the best operation for the type of thyroid cancer you have. As a surgeon who has dedicated my entire career to thyroid surgery, I get to see several patients per week who need a second or third operation to cure their thyroid cancer.  This is usually because they, unfortunately, did not get the right kind of operation the first time from another surgeon.

Because surgeons can remove the thyroid several different ways, it follows that there are good choices and bad choices that the surgeon can make. Let’s take a look at the different types of operations for thyroid cancer, and see which ones are best for different situations. In order to cure your thyroid cancer, you need to find an expert thyroid surgeon who will perform the best thyroid operation for your thyroid cancer.

The 3 Best Thyroid Operations for Thyroid Cancer

First type of Operation for Thyroid Cancer – Lobectomy and Central Lymph Node Dissection

This is the best operation for thyroid cancer in specific patients who have a thyroid cancer on one side of their thyroid gland and the other side does not have any suspicious thyroid nodules. For these types of patients, a thyroid lobectomy and central lymph node dissection on the side of the cancer is their best operation.   This operation has a very high chance of curing the cancer, and yet it will preserve the normal thyroid gland on the other side. 

Since a thyroid lobectomy is only a one-sided operation,  the other side of the thyroid gland is saved and thus the patient has some of their own thyroid hormone being produced by the normal thyroid left behind.  One side of the thyroid is removed, and the lymph nodes behind only that side of the thyroid gland are removed with it.  As long as the lymph nodes are not concerning, the operation stays as a one-sided operation, and the other side of the thyroid can be saved.

If natural thyroid tissue can be saved during thyroid surgery, while still obtaining a cure, then this is usually the best operation for unilateral thyroid cancers. A lobectomy with central lymph node dissection is the best because the majority of patients will not need any thyroid hormone replacement—the one half of the thyroid left behind can usually make enough hormone so the person doesn’t need to take thyroid hormone pills every day.  If thyroid hormone replacement is needed, it will be a small supplement as opposed to being completely dependent on thyroid hormone. Another benefit of doing a thyroid lobectomy for thyroid cancer is that it is less surgery—there is less dissection in the neck.  It is always beneficial to get a cure for thyroid cancer with a smaller operation.  The time in the operating room is less, the time under anesthesia is less, the risk of complications is less, and patients can leave the hospital the same day.

Second type of Operation for Thyroid Cancer – Total Thyroidectomy and Bilateral Central Lymph Node Dissection

There are several reasons and scenarios where a total thyroidectomy and bilateral central lymph node dissection is the best operation for thyroid cancer.  A total thyroidectomy with bilateral central neck dissection means removal of the whole thyroid gland and the lymph nodes behind both the right and left sides of the thyroid gland.

If a patient has malignant or suspicious nodules on both sides of the thyroid gland, then it is not reasonable to save any portion of the thyroid gland.  There are times when we do not know definitively if a patient has thyroid cancer until after the surgery is completed and the pathologist can study the removed gland.  Therefore, a “cancer appropriate” operation to cure any potential thyroid cancer needs to be performed. 

In order to provide a cure for the person with cancer in both sides of the thyroid, the best operation would be a total thyroidectomy and bilateral central lymph node dissection.  The lymph nodes on both sides of the neck need to be removed because if a patient has thyroid cancer on both sides of the thyroid lobe, the lymph nodes underneath both sides of the thyroid gland in the central portion of the neck are at significant risk for harboring cancer.  These lymph nodes need to be removed in order to decrease the recurrence rate to <0.1%, which therefore makes it their best operation for thyroid cancer.  

The best operation for thyroid cancer in a patient with known cancer spread to lymph nodes in the center of the neck is also a total thyroidectomy with bilateral central lymph node dissection. There are 2 ways that we could obtain this information about the central neck lymph nodes in order to choose the best operation for that person’s cancer. During our preoperative evaluation, a very thorough neck ultrasound is performed, where all of the lymph nodes are evaluated.  If we find suspicious appearing central neck lymph nodes, we will obtain a biopsy preoperatively to prove that they are malignant.  If the biopsy proves to be cancer in the central neck lymph nodes, this will change the type and extent of the operation—a lobectomy is not a choice for this person.  Instead, the best operation for this person’s thyroid cancer would be a total thyroidectomy and bilateral central neck dissection. 

The second way that we can determine if central neck lymph nodes are malignant is during intraoperative evaluation/pathology—that is, during the operation itself.  If cancerous lymph nodes are found during the operation, the best operation for thyroid cancer would again be a total thyroidectomy and bilateral central neck dissection.

Lastly, a total thyroidectomy and bilateral central neck dissection is the best operation for thyroid cancer in the setting of co-existing thyroid disease.  Two of these specific scenarios would be in a patient with thyroid cancer in the setting of Graves’ disease or very symptomatic Hashimoto’s thyroiditis.  In order to cure Graves’ disease or Hashimoto’s thyroiditis that has failed medical management, the whole thyroid needs to be removed during their thyroid surgery.  The central neck lymph nodes need to be removed during this thyroid surgery to cure the co-existing thyroid cancer and prevent recurrence, which would therefore be their best operation for thyroid cancer.

Third type of operation for thyroid cancer – Total thyroidectomy and Modified Neck Dissection

A total thyroidectomy and modified neck dissection is the best operation for thyroid cancer when the cancer has spread outside of the thyroid and central neck lymph nodes into the lymph nodes in the side of the neck.  A modified neck dissection is a type of operation where all of the lymph nodes on the side of your neck have been removed from essentially below your ear to your collar bone and in towards your windpipe, while sparing all important blood vessels, nerves, and muscles. 

A patient will sometimes ask me why all of the lymph nodes need to be removed if only a couple of them are able to be felt or if only a couple of them have been biopsied to have cancer.  The reason that I need to remove all of these lymph nodes is because they can harbor microscopic cancer cells.  If some lymph nodes were left behind in the neck during their thyroid surgery, I would be setting the patient up for a second operation, which is unacceptable.  Therefore, the best operation for thyroid cancer that has spread to the lymph nodes in the side of the neck is a total thyroidectomy and modified neck dissection to remove all lymph nodes at risk.

BONUS!  Best Type of Operation for Thyroid Cancer – Robotic Scarless Thyroid Surgery

Within the past 4-5 years, a new approach to thyroid surgery has become the robotic thyroid operation.  Using brand new techniques, thyroid surgery can be performed using various hidden-scar or scarless techniques. The scarless robotic thyroidectomy uses a state-of-the-art robotic technology for treating thyroid nodules and thyroid cancers.

If you have a small thyroid cancer and would prefer to not have an incision on your neck, then robotic thyroid surgery could be your best operation for thyroid cancer.  Scarless thyroid surgery allows for thyroid gland dissection and removal by placing the scars in far away locations (like the skin in front of the arm-pit). Therefore, there is no scar at all on the neck.

The goal of the robotic scarless thyroid surgery technique are to provide the same successful outcome as the traditional surgery while providing the highest cosmetic satisfaction and confidentiality benefits for the patients. This approach may prove to be your best operation for thyroid cancer if you are good surgical candidate for this approach.

Who can have Robotic Thyroid Surgery?

Additional resources:

Become our patient here.

Browse patient testimonials here.

Head back to the thyroid cancer blog.