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Total Thyroidectomy

In this thyroid cancer surgery, the entire thyroid gland is removed. A small incision in the lower central neck is required which is about an inch in length unless the thyroid mass or the thyroid itself requires a longer length to allow them to be “delivered”. The length of a total thyroidectomy incision is no longer than an incision for a thyroid lobectomy. All of the critical structures on both sides of the thyroid are maintained including all four parathyroid glands and all four nerves that provide movement (recurrent laryngeal nerves) and sensation and tightening to the voice box (superior laryngeal nerves). The lymph nodes along the side and beneath the thyroid gland are also examined during this surgery to make sure that they are not cancerous as well. Often these lymph nodes need to be removed as well. Total removal of the thyroid should not be performed by "occasional" thyroid surgeons. Although thyroidectomy is thought to be a simple and easily performed operation by many, it is a very dangerous operation among inexperienced thyroid surgeons. Written by Gary L. Clayman, DMD, MD, FACS. Dr. Clayman has also written extensively about thyroid surgery on the EndocrineWeb site here and in multiple highly reviewed medical publications. See his publications here. Last updated May 1, 2020.
Potential reasons to consider removing the entire thyroid gland (total thyroidectomy):
  • The thyroid cancer is:
    • A large papillary thyroid cancer (more than 4 centimeters or 1.75 inches in greatest dimension)
    • A follicular thyroid cancer with or without distant spread
    • A hurthle cell cancer (carcinoma)
    • A medullary thyroid cancer (carcinoma)
    • A patient who is direct relative of a medullary thyroid cancer patient and has tested positive for a genetic mutation of the ret gene predisposing them to develop a hereditary medullar thyroid cancer (carcinoma)
  • The thyroid cancer appears to have extended outside of the surface of the thyroid gland (called its capsule or soft tissue extension)
  • The thyroid cancer has spread to the lymph nodes underneath the thyroid gland (called central compartment lymph nodes [also called Level VI or VII lymph nodes] of the neck)
  • The thyroid cancer has spread to lymph nodes along the side of the neck (called lateral neck lymph nodes)
  • The papillary, follicular or hurthle cell thyroid cancer has spread to distant sites outside of the neck (most commonly the lungs, bones, or liver)
  • The papillary thyroid cancer patient with a small thyroid cancer, does not accept the potential of another surgery to remove the remainder of the thyroid gland if a new thyroid cancer should develop within the remaining thyroid tissue.
  • The thyroid cancer developed in a radiation exposed thyroid gland

Extended or Complicated Thyroidectomy

Thyroid cancer may sometimes be more aggressive than ultrasound or CT imaging suggested before undergoing their undergoing thyroid cancer surgery. In these cases, an expert surgeon that recognizes those “more aggressive” intraoperative findings such as growth or extension of the cancer outside of the thyroid gland or invasion of the cancer into adjacent structures such as the nerve to the voice box (recurrent laryngeal nerve), breathing tube (trachea), voice box, or esophagus-must adapt the surgery to adequately address the complete removal of the cancer- at that time!!!! Unfortunately, occasional thyroid surgeons are commonly unprepared to perform the appropriate surgery and a subsequent surgery for persistent disease will be required .

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Founded by Dr Gary Clayman, the Clayman Thyroid Center is widely known as America’s leading thyroid surgery center performing nearly 2000 thyroid operations annually. Our reputation as the best thyroid surgeons means patients from all over the US and many foreign countries travel to Tampa for their thyroid surgery. With same-day evaluation and surgery scheduling, we make traveling for thyroid surgery convenient for every patient.

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