Frequently Asked Questions About Thyroid Cancer and Thyroid Surgery

A new diagnosis of thyroid cancer can really be a shock. The most important first steps are to 1) remain calm 2) become informed and 3) seek evaluation and care by doctors who are experts in thyroid cancer. Your thyroid cancer team will include an endocrinologist, ultrasonographer and expert thyroid cancer surgeon. In this video, Dr. Clayman discusses how the diagnosis of thyroid cancer is very rarely an urgent call to action.

Thyroid Cancer can be very scary words when you first hear them. But it really shouldn’t be that way. Becoming informed about thyroid cancer, its diagnosis and treatment should be your goal and is the purpose of ThyroidCancer.com. First, take a deep breath and relax. Thyroid cancer is slow moving in almost all cases, so you have time to learn and time to find the best thyroid cancer doctors. Only the most rare types of thyroid cancers require urgent action. In fact, for almost all people, the new diagnosis of thyroid cancer is almost never an urgency. Watch this video, take a deep breath and relax. Identify the right thyroid cancer experts to evaluate and care for you. You need doctors who have expertise in thyroid cancer treatment, not just the “guy down the street”. You need a thyroid cancer expert in the doctors doing your evaluation (thyroid ultrasound), surgery (thyroid cancer surgeon), and endocrinologist. Everyone thinks thyroid surgery is easy because everyone does it. But everyone does not do it the same. The statistics are daunting. 11% of patients with known thyroid cancer that is readily curable, will still have disease (persistent disease) following their first operation. 50% of patients with thyroid cancer will not even know they have thyroid cancer until following their initial surgery. You only want to have one operation! Make sure that you are in the best of hands.

Thyroid cancer surgery doesn’t always need to include removal of the entire thyroid gland. Thyroid cancer can be cured in many people by removing only half of the thyroid gland, (called partial thyroidectomy or thyroid lobectomy). Removing only half of the thyroid for thyroid cancer has several advantages: 1) it is easier to maintain thyroid hormone levels, 2) many people have a better sense of wellbeing when some of the normal thyroid gland remains, 3) a decreased risk to the nerves to the voice box and the parathyroid glands during thyroid surgery. In a skilled thyroid cancer surgeon’s care, the complications are very low, however all thyroid surgery is dangerous within inexperienced thyroid surgeons. Choosing the right surgery, for the right cancer, for the right patient is the most important decision to arrive upon. Watch Dr. Clayman discuss the advantages of removing only part of the thyroid gland in surgery for thyroid cancer.

Thyroid cancer surgery has several options provided you have an expert thyroid surgeon who knows what is best for you. Partial removal of your thyroid gland may be the right surgery for you and still provides extremely high cure rates for your thyroid cancer. Many people do not need all of their thyroid removed in order to cure the thyroid cancer. This video shows several advantages to leaving some normal thyroid in your neck when operating to cure a thyroid cancer. Leaving normal thyroid tissue inside of you can make it much easier for your endocrinologist to control your thyroid hormone levels and allow you to feel the same way following your cancer surgery as you did before your thyroid operation.

Thyroid cancer requires you to choose the right operation for each patient depending on their specific cancer. This requires the thyroid surgeon you choose to be very knowledgeable regarding thyroid cancer. The disadvantages of partial removal of the thyroid for thyroid cancer (not taking the entire thyroid out) include the inability to treat with radioactive iodine postoperatively and the inability to look at blood for markers of thyroid cancer (thyroglobulin and calcitonin) postoperatively. In this video, Dr. Gary Clayman discusses the disadvantages of removal of part of the thyroid gland, called a thyroid lobectomy or partial thyroidectomy. If there is not a significant risk of the thyroid cancer recurring in the thyroid or the lymph nodes in the neck, then these disadvantages are not significant to the patient.

If your thyroid cancer has spread to the lymph nodes of the neck, any distant sites or grown outside of the thyroid gland itself, then total removal of the thyroid is the preferred treatment (a partial thyroid removal or thyroid lobectomy would not be the right operation). Personalized thyroid cancer care is what you should seek. Choose the right thyroid surgeon, to perform the correct operation for you and your thyroid cancer.

Thyroid Cancer is different in different people. In prior videos, Dr. Clayman discussed advantages and disadvantages of removal of part of the thyroid gland, called partial thyroidectomy or thyroid lobectomy. In this video, Dr. Clayman discusses the advantages of removal of all of the thyroid gland in thyroid cancer surgery. For the most common thyroid cancers, surgery of the thyroid which removes all of the thyroid gland called total thyroidectomy provides the ability to treat thyroid cancer with radioactive iodine and the ability to watch the blood of thyroid cancer patients for the most common blood markers for thyroid cancer, called thyroglobulin (for papillary, follicular and hurthle cell cancers) and calcitonin and CEA (for medullary thyroid cancer). Total thyroidectomy may be the best surgery for thyroid tumors or thyroid cancers if there are abnormalities in both sides (lobes) of the thyroid gland or if you have a thyroid cancer that has spread to lymph nodes in the neck or the thyroid cancer has broken out of the capsule (or covering) of the thyroid gland. Total removal of the thyroid should never be performed by an occasional thyroid surgeon. If your surgeon does not perform thyroid operations several times every day, then ask the right questions. In this video, Dr. Clayman will discuss that total thyroidectomy may be the preferred thyroid surgery for thyroid cancers which have spread to neck lymph nodes, grown outside of the thyroid, or have spread elsewhere in the body as well as when thyroid cancers involve both sides of the thyroid gland and no significant normal thyroid tissue could or should be left in the neck.

Thyroid nodules are very common especially in women. In this video, Dr. Clayman discusses the most important first step is to be evaluated by an expert with ultrasound and the potential for needle biopsy. Since thyroid nodules are very common and 85% or more are benign, you really need the highest quality ultrasound to examine your thyroid gland, the thyroid nodules, and the lymph nodes of your neck. The ultrasound will look at the nodule (lump) within your thyroid gland, where it is within your thyroid, and its appearance. Lymph nodes around the thyroid gland should also be examined. Sometimes lymph nodes may be more informative than the thyroid nodule, itself. If a biopsy of the thyroid nodule or lymph node is obtained, the doctor that looks at the cells under the microscope, called a cytopathologist, who needs to be equally an expert in thyroid as well. An expert endocrinologist should help guide you through your thyroid nodule evaluation and management.

Thyroid surgery has risks, but in skilled thyroid surgeon’s hands, thyroid surgery is not risky surgery. In this video, Dr. Gary Clayman, one of the most experienced thyroid surgeons (and thyroid cancer surgeons in the world) explains that the risks of thyroid surgery are much higher in inexperienced surgical hands. There are critical nerves to the voice box which lay underneath the thyroid gland, and the important parathyroid glands which control the bodies calcium levels that lay next to the thyroid gland. Keeping these critical structures from danger is the art of thyroid surgery and nothing is more important than the skill and experience of the surgeon. The other critical risk of thyroid surgery is incomplete surgery. A thyroid cancer may not be known until after the thyroid surgery is done and you have recovered for several days and the final pathology is available. You want to make sure that your first thyroid surgery is your final thyroid surgery and this is a very common problem we see—inexperienced thyroid surgeons who don’t take out all the cancer. Choosing the best thyroid surgeon is key in decreasing the risks of thyroid surgery.

Thyroid cancer surgery is highly specialized as discussed in this video. There are very few surgeons who perform only thyroid surgery. Thyroid surgery is performed by general surgeons and Otolaryngology/Head and Neck (ENT) surgeons. However, like all surgery and medicine, thyroid surgery and thyroid cancer surgery has become very specialized. Complications, risks, and cancer cure rates are directly related to the experience of the surgeon. Most general surgeons perform breast surgery, hernias, gallbladders, and numerous intestinal/abdominal operations. The typical general surgeon performs less than one thyroid operation per month. The results of this 'lack of experience' shows in multiple publications, with lesser experienced surgeons having much higher complication rates including paralysis of the vocal cord nerves and permanent damage to the parathyroid glands. Equally as severe is the unacceptable incidence incompletely removed thyroid cancer and recurrent cancer among inexperienced surgeons. Unfortunately, at the Clayman Thyroid Center, we operate on 2-3 patients every day who had a thyroid cancer operation performed by general surgeons or ENT surgeons and they are not cured. Many of them had a serious complication. You must choose your thyroid surgeon wisely! You should pick a surgeon that performs 100 or more thyroid cancer operations per year, otherwise your chance of a poor outcome or a serious complication is higher. And... if you see a surgeon that tells you he/she does 100 thyroid operations per year, do your homework! That is a minimum of two thyroid operations per week and very few surgeons do this much thyroid surgery. There is no question that the more thyroid operations a surgeon does, the less the complications and the better the cancer outcomes. We understand that we can't operate on every thyroid patient in the US... but please pick your surgeon wisely or you will have to come here for your second operation! If your doctor sent you to a surgeon who is not performing thyroid operations every week, without exception, then find a different surgeon. If you have to travel to another town to do so, then please do. Statistics don't lie, and experience is what really counts. Over 50% of our operations on patients with recurrent or persistent thyroid cancer had an inexperienced surgeon perform their thyroid cancer surgery and they still have cancer in their neck. IMPORTANT:  Just because your surgeon says they perform thyroid surgery does not mean they are an expert. What you want is a HIGHLY EXPERIENCED THYROID SURGEON WHO DOES HIGH VOLUME. The surgeons who do the most are almost always the best. Here is the sad part--surgeons will exaggerate their numbers and claim they do more than they do. However, as of April 2014, the US Government has begun releasing their Medicare data for all doctors. Now you can look up in the database to see how many thyroid operations (or any kind of operation) a doctor performs. Read this important article about surgeon volume according to 2012 Medicare data. You will see that there are very few surgeons in the world that do more than 200 thyroid operations per year, and most surgeons who are "endocrine surgeons" do not. Think about that, at 200 thyroid operations per year….that is only four thyroid operations per week. We do more than four in the morning every day! Ask hard questions. Make your surgeon look you in the eye. And, if your surgeon says they perform more than 250 thyroid operations per year, everyone should know them because those surgeons are very few and far between. The US government data shows there are very few high volume surgeons, except the Clayman Thyroid Center and very few others. Get the best surgeon you can. Ask good hard questions. Make sure you like and trust your surgeon.

Thyroid cancer follow up care is dependent on your relationship with your endocrinologist and the extent and stage of your thyroid cancer. In this video, Dr. Gary Clayman discusses what thyroid cancer follow up should be. Your endocrinologist will examine your neck, perform an ultrasound of your entire neck and monitor your blood for your thyroid hormone levels and the marker for your thyroid cancer, thyroglobulin (for papillary, follicular or hurthle cell thyroid cancers). What your thyroid cancer surgeon found during your operation and the final pathologic review are the most important factors determining whether or not to have radioactive iodine as a targeted treatment for your thyroid cancer. Your relationship with the endocrinologist is a long-term one so he/she should be experienced in thyroid cancer and you should be comfortable with them.

In this thyroid cancer video, Dr. Clayman discusses the importance of choosing your surgeon and ultrasonographer to ensure your thyroid cancer is cured with your first surgery – and does not reappear years later. The importance of an experienced, knowledgeable thyroid cancer surgeon is key to curing you. As discussed in earlier videos in this thyroid cancer series, the knowledge of how thyroid cancer behaves and the observations of the thyroid cancer surgeon during surgery are critical to properly removing not just the thyroid, but potential involved lymph nodes that could contain cancer. Recurrence of thyroid cancer in the neck is usually not recurrence at all. Instead it is cancer that was present during the first operation that was not removed by the first surgeon and over time it grows and is detected. It is also possible that this “recurrent” thyroid cancer was present prior to the first cancer operation but was not detected by ultrasound or other scans. It is important to have an expert thyroid cancer evaluation done, which involves a high definition ultrasound and a CAT scan to determine the extent of the thyroid cancer for its complete removal. If this did not happen with your first operation you want the most experienced, expert surgeon for your next surgery. Do not make the same decisions again which brought you to have recurrent or persistent thyroid cancer. We always tell patients seek your last thyroid operation!

In 99% of thyroid cancers, there is no urgency to rush into surgery. Take your time and make the best decisions. The most important thing to do when diagnosed with thyroid cancer is to not be in a hurry. In this video, Dr. Gary Clayman discusses that thyroid cancer is not an urgent or immediate matter. In almost all cases you have had thyroid cancer for years, but have only just become aware of it. Don’t panic and don’t hurry into thyroid cancer surgery. Take time to educate yourself and to find the best endocrinologist and the best thyroid surgeon to manage your thyroid cancer.

In this video, Dr. Clayman discusses that an increase in thyroglobulin is just a number but it requires further evaluation. Thyroglobulin is a protein made by thyroid cells and your thyroglobulin level may fluctuate over time. Different laboratories may also have different results for thyroglobulin so comparison of the numbers may not always be reliable. If not all of your thyroid was removed during your thyroid cancer surgery, or you were not treated with radioactive iodine after the operation, there may be a little bit of thyroid tissue that is producing the thyroglobulin. Thus, having some thyroglobulin in your blood doesn’t always mean the thyroid cancer has returned. However, if your thyroglobulin number was zero after your thyroid cancer operation and has now increased, then a high-definition ultrasound of the neck should be obtained. Any abnormalities found on ultrasound can undergo needle biopsy. A CAT scan of the neck with contrast and CAT scan of the chest can also be considered to evaluate other areas that thyroid cancer can be detected that would not be detected on the ultrasound study. Get the best and most experienced thyroid cancer surgeon-make sure your next thyroid cancer operation is your last one.

Radioactive iodine is a common treatment for thyroid cancer after the thyroid cancer surgery. Health care providers take advantage of the fact that the thyroid gland needs iodine to make thyroid hormone. In this video, Dr. Clayman discusses when to consider radioactive iodine in the treatment of thyroid cancer. Most of the common thyroid cancers will take up iodine just like normal thyroid cells. When you take a radioactive iodine pill, the radioactive iodine can go directly to thyroid tissue and thyroid cancer cells. The purpose of radioactive iodine is to kill any thyroid tissue and most importantly to kill any thyroid cancer cells that may still be in your neck. Radioactive iodine is not necessary for all thyroid cancers. In fact, radioactive iodine is now infrequently used to treat most patients with thyroid cancer. Radioactive iodine is typically used for thyroid cancer that has grown outside of the thyroid gland, for example into the muscle on top of the thyroid gland. This observation, however, relies upon the expertise of the surgeon. Radioactive iodine is also indicated when the thyroid cancer has spread to lymph nodes or to distant sites in the body.

Your thyroid surgeon’s experience and observations will play a critical role in determining whether you should have radioactive iodine therapy. Your endocrinologist or nuclear medicine specialist will manage the administration of the radioactive iodine. It will not make you sick, and will not make your hair fall out.

Thyroid cancer treatment has lots of things going on. In this video, Dr. Clayman discusses what to expect after thyroid surgery and how it changes depending on what kind of thyroid cancer operation you had. If half of your thyroid gland is removed (see our video on Thyroid Lobectomy for Thyroid Cancer), you should be released from the hospital the same day. If your entire thyroid gland is removed or your surgery requires removal of neck lymph nodes (neck dissection), then you will spend a night in the hospital. The incision is not very big if done by an expert thyroid cancer surgeon, so the discomfort of thyroid surgery may be relieved by taking ibuprofen (Motrin) or naproxen (Aleve). The day after surgery, Dr. Clayman recommends that you resume all normal activity, except for heavy lifting. Your incision will be covered with superglue which seals the incision allowing you to shower and exercise as you normally would. Just pat dry over the glue. Note, these are the expectations if your surgeon is Dr. Clayman. Your experience may not be similar with another surgeon.

Neck dissections are advanced operations for the removal of lymph nodes of the neck. If you have a thyroid cancer, there are two types of neck dissections that may or may not be indicated for you as discussed in this video by Dr Gary Clayman. Neck dissections are not necessary or indicated for all thyroid cancers. The two most common types of neck dissections for thyroid cancer are the 1) Central Neck Dissection and 2) Lateral Neck Dissection. The central neck dissection (also called paratracheal area, involves the area around your trachea, esophagus, and under the thyroid gland. The lateral neck dissection involves the lymph nodes of the side of the neck. The need for a lateral neck dissection for thyroid cancer must be determined prior to surgery via an expert high resolution ultrasound. This requires excellent equipment and an expert sonographer so that no cancer in the lymph nodes is missed. Lateral neck dissection does NOT involve a large slash along the neck – the incision is in the low collar area and cosmetically very acceptable. You can see testimonials on our website that show you how wonderfully the scar can be hidden

The purpose of a thyroid cancer neck dissection is to remove the lymph nodes that contain thyroid cancer and also those that are at risk of having thyroid cancer. Dissection of the central neck is dependent on the surgeon’s observation (during the operation) of the extent of the thyroid cancer. The surgeon should remove any lymph nodes under the thyroid that may be at risk for cancer spread. It is imperative for your surgeon to understand how thyroid cancer behaves to correctly assess the central (paratracheal) area to prevent leaving lymph nodes that already contain thyroid cancer. Ask your surgeon what their thyroid cancer surgery looks like, how often they perform neck dissection, and how often they perform thyroid surgery. Neck dissection for thyroid cancer is very different from the neck dissection for other conditions that ENT doctors frequently do for other head and neck cancers. Make sure your thyroid surgery is done by a thyroid cancer surgery expert.

You should not lose your voice after thyroid surgery. In this video, Dr. Clayman explains that a vocal cord nerve can become temporarily paralyzed uncommonly and you may experience hoarseness, but you should not lose your voice. If a person does lose their voice as a result of thyroid surgery, it may be temporary, or it may be due to inadvertent injury to a vocal cord nerve that is known or not known to the surgeon. You should ask your surgeon how frequently they perform thyroid surgery and how often a patient loses their voice. An excellent surgeon will tell you the risk is near zero, or way less than one percent. If the surgeon says 2% or more, then you may want to discuss this with another surgeon. The surgeons with the most experience have the lowest complications rate. Nerve monitoring does not prevent injury to a vocal cord nerve and in fact it gives a surgeon a false sense of security because they think they are protected, but what prevents damage to a vocal cord nerve is your surgeon seeing the nerve and preserving the entire nerve and all of its branches. A surgeon should be able to tell you that the risk of injury to your vocal cord nerves is less than one percent, if not, it’s not the right thyroid surgeon for you. If he/she says they are going to monitor your nerve in the operating room to help prevent a nerve injury, then know this is absolutely not true and often increases the risk of nerve injury. These tubes are used to protect the surgeon from lawsuits, not the patient from injury.

In this video, Dr. Clayman discusses how he designs the incision location for your thyroid cancer operation before you go to the operating room. He has the patient stand up and he looks for natural creases in the neck and where the sort of hollow of your neck is. He designs the incision which is only about an inch to inch and a half to remove part of the thyroid gland, or all of the thyroid gland, or even the lymph nodes under the thyroid gland. The incision is closed with stitches underneath the skin and covered with superglue. The incision heals so beautifully in most individuals that you won’t even see it in about six months.

Thyroid cancer occasionally occurs in pregnant women. This poses a specific challenge for the management of this thyroid cancer. OB/GYN doctors are very good at examining young women’s necks and frequently find lumps in the thyroid gland (thyroid nodules). They often diagnose of papillary thyroid cancer in their women patients and thus thyroid cancer can be diagnosed during a pregnancy. What is important is that these are young, healthy women and in the vast majority of cases have a very curable thyroid cancer. In Dr. Clayman’s practice, he has never performed thyroid surgery on a pregnant woman. The young woman will have an ultrasound when she is diagnosed and have strict measurements taken which will be monitored with ultrasound throughout the pregnancy. Dr. Clayman tells the pregnant young woman with thyroid cancer to enjoy her pregnancy, to eat well, and to breast feed. Once she has fulfilled her commitment to breastfeed her child, then they will proceed with surgery. For more information, see our video on “New Diagnosis of Thyroid Cancer” and you will see that the first rule is to relax. In almost every case you have time to research and make good decisions. Thyroid cancer in a pregnant woman is the same: relax, we almost always have time to cure the cancer after the pregnancy. Do not be in a hurry.

A goiter is a big thyroid. Most thyroid goiters are big because the thyroid has grown multiple nodules within it. A thyroid goiter is not dangerous, and in fact, in most circumstances it has no symptoms and most people with a goiter don’t know they have one. Goiters can become quite large and cause symptoms of pressure, make you feel uncomfortable in your breathing, and/or uncomfortable in your swallowing. All goiters do not need to be removed. Many goiters can be watched with an ultrasound every year or so. If a goiter continues to grow, it can push on the trachea and esophagus or push under the sternum. Removal of a goiter is straightforward surgery with an expert thyroid surgeon.

It is totally natural for patients to be concerned over the idea of having an incision for a thyroid surgery. In almost every circumstance, the thyroid incision can be designed so that it will heal beautifully in the shadow and hollow of your lower neck in the midline. Sometimes there may even be a natural crease in this area. It is important that the incision is designed and cared for appropriately during the operation and following the operation. Equally important is how the incision is meticulously cared for and closed during the thyroid operation. The incision is designed, which is only about an inch to inch and a half, to remove part of the thyroid gland, or all of the thyroid gland, or even the lymph nodes under the thyroid gland. The incision is closed with stitches underneath the skin and covered with superglue. The incision heals so beautifully in most individuals that you won’t even see it in about six months. Choosing the right surgeon, for the right surgery, for the right patient is the most important decision to arrive upon. Watch Dr. Roy discuss the design and care of your planned thyroid incision. Dr. Rashmi Roy is one of the world’s most experienced thyroid surgeons.

Thyroid nodules usually produce no symptoms. However, because of a thyroid nodule’s location in the neck and their size, thyroid nodules can produce symptoms effecting swallowing. Some common complaints, if symptoms exist, include a sense of something that needs to be swallowed, feeling like there is “something there”, as well as a sense that some foods may be more difficult to swallow than others. When these symptoms exist, it is usually caused by the thyroid nodule laying close to the swallowing tube/esophagus. These symptoms may exist when the thyroid nodule is benign or a thyroid cancer. The presence of swallowing symptoms does not mean that the nodule is a thyroid cancer. Choosing the right surgeon, for the right operation for your symptomatic thyroid nodule, for the right patient is the most important decision to arrive upon. Watch Dr. Roy discuss the Thyroid Nodule which is producing swallowing symptoms. Dr. Rashmi Roy is one of the world’s most experienced thyroid surgeons.

Thyroid nodules are very common especially in women. In this video, Dr. Roy discusses the thyroid nodule which has undergone a needle biopsy and is reported to be “suspicious for thyroid cancer”. This does not mean that you have a thyroid cancer. The actual risk of thyroid cancer may vary based upon how this diagnosis was made. If a genetic analysis of your thyroid nodule was used in order to arrive upon a diagnosis suspicious of thyroid cancer, then this information will be important to you as well as the expert thyroid cancer surgeon and endocrinologist who are caring for you. An expert ultrasound is critically important. Lymph nodes around the thyroid gland and in the sides of the neck should also be examined. Our thyroid nodule app can help you better understand your thyroid nodule which is suspicious for thyroid cancer and the next steps you should consider. You can access your free Thyroid Nodule and Cancer Guide app here: Free 3-D Thyroid Nodule and Cancer Guide app. In this video, watch Dr. Roy discuss the thyroid nodule which is suspicious for malignancy. Dr. Rashmi Roy is one of the world’s most experienced thyroid surgeons. This is not an urgent or immediate matter. In almost all cases you have had this thyroid nodule for years, but have only just become aware of it. Don’t panic and don’t hurry into a thyroid surgery. Take time to educate yourself and to find the best endocrinologist and the best surgeon to manage your thyroid cancer.

A thyroid nodule or thyroid cancer has been diagnosed and you are trying to determine whether a minimally invasive thyroid surgery can be done for you and is this the correct operation. In this video, Dr. Rashmi Roy (one of the world’s most experienced thyroid surgeons) at the Clayman Thyroid Center discusses who may be eligible for a minimally invasive thyroid surgery for either a thyroid nodule or a thyroid cancer.

If you are already accepting the concept of requiring a thyroid operation, this can be anxiety provoking. But it really shouldn’t be that way. Becoming informed about your thyroid nodule or thyroid cancer, it’s diagnosis and treatment should be your goal and is the purpose of ThyroidCancer.com. Use our Free Thyroid app to understand your thyroid cancer risk and the next steps you should consider at the following link: Free Thyroid Nodule and Cancer Guide app. Watch this video, take a deep breath and relax. Identify the right thyroid surgery experts to evaluate and care for you. You need doctors who have expertise in thyroid cancer treatment, not just the “guy down the street”. You may not know whether you have or do not have a thyroid cancer, but you still need a thyroid cancer expert doing your evaluation (thyroid ultrasound), surgery (thyroid cancer surgeon), and endocrinologist. Nearly one half of thyroid cancers are not able to be diagnosed until after your thyroid operation! Make sure that you are in the best of hands.