Thyroid Surgery 101: What you need to know before you consent to have thyroid surgery.

Thyroid Surgery 101: What you need to know before you consent to have thyroid surgery.

Thyroid Surgery 101: What you need to know before you consent to have thyroid surgery.

Thyroid Surgery 101: What you need to know before you consent to have thyroid surgery

DR.Guttler’s comments on thyroid surgery


  1. You have a diagnosis of thyroid cancer.
  2. You have a nodule that has been properly evaluate and is high risk for cancer.
  3. You have a nodule or goiter that is causing local symptoms – compression of the trachea, difficulty swallowing or a visible or unsightly mass, and you have been informed about alternative non-invasive ethanol PEI and radiofrequency RFA ablation for benign symptomatic nodules.
  4. You have a nodule or goiter that is causing symptoms due to the production and release of excess thyroid hormone.
  5. The extent of your thyroid surgery should be discussed with your thyroid consultant before seeing the thyroid surgeon.
  6. Only consider high volume thyroid surgeons. >25 cases a year.
  7. However, the extent of surgery is both a complex medical decision as well as a complex personal decision and should be made in conjunction with your endocrinologist and surgeon.


8.The most common reason for thyroid surgery is to remove a thyroid nodule, which has been found to be suspicious through a fine needle aspiration biopsy with the help of molecular markers in the case of suspicious results.

9. Surgery may be recommended for cancer in some cases but alternative treatment for small micropapillary cancers by active follow up only.

10.Inconclusive biopsy is not be an indication for surgery.Get more opinions and a repeat biopsy with molecular marker testing.

11. Molecular marker testing of biopsy specimen which indicates a risk for malignancy.

12. Lobectomy to confirm a benign disease formerly call non-invasive follicular variant of papillary thyroid cancer that is now Non-invasive follicular tumor with papillary looking cells or NIFTP.

13.  Surgery is also good option for the treatment of hyperthyroidism to avoid the radioiodine therapy option usually recommended in the USA.

14.Surgery is definitely indicated to remove nodules suspicious for thyroid cancer.

15.In the absence of a possibility of thyroid cancer, there may be nonsurgical options for therapy depending on your diagnosis.

16. Go online and see all the information on ethanol PEI and radiofrequency ablation RFA.

17. A complete endocrine neck ultrasound evaluating neck lymph nodes is essential. In 30% they find cancer lymph nodes BEFORE the first surgery. Neck dissection will be added to the surgery and save the patient from second and third surgeries in the future.

18.Thyroid surgery is best performed by a surgeon who has received special training and who performs thyroid surgery on a regular basis.

19.The complication rate of thyroid operations is lower when the operation is done by a surgeon who does a large number of thyroid operations each year.

20.Patients should ask their referring physician where he or she would go to have a thyroid operation or where he or she would send a family member.

21.In experienced hands, thyroid surgery is generally very safe. Not so with a low volume surgeon do <25 a year. One study found 65% increased complication in some low volume surgeons.images

22.Complications are uncommon, but the most serious possible risks of thyroid surgery include:

23. Bleeding in the hours right after surgery that could lead to acute respiratory distress.

24. Injury to a recurrent laryngeal nerve that can cause temporary or permanent hoarseness.2bleftcordparalysisopen

25. Acute respiratory distress in the very rare event that both nerves are injured.

26.Damage to the parathyroid glands that control calcium levels in the blood, leading to temporary, or more rarely, permanent hypoparathyroidism and hypocalcemia.


27.The risk of any serious complication should be less than 2% with high volume surgeons.

28.What are the risk with this the particular surgeon you are considering for the surgery?

29. Prior to surgery, patients should  always get a second opinion and understand the reasons for the operation.

30 The alternative methods of treatment for some small tumors by active surveillance.dpwmpt-voaa9xys

31. Alternative non-cancer treatment for NIFTP with just diagnostic lobe removal to determine if the capsule was not invaded to call the even large nodule a benign adenoma.


32.For some patients with papillary cancer surgeons recommend total or near total thyroidectomy. The use of radioiodine after surgery has gone from knee jerk everyone get it to selective use in the higher risk cases only.

33. For patients with larger (>1.5 cm) or more invasive cancers or have positive ultrasound and lymph node biopsy for nodal metastatic disease and for patients with medullary thyroid cancer, local lymph node dissection may be necessary to remove possibly involved lymph node metastases.

34. Epidemic of poor quality pre-op ultrasounds of the neck  <2% adequate in one study or over 200 cases.Lymph node ultrasound requires you to seek an expert ECNU sonologist to do the study.


Call for a pre-op consultation. It is never an emergency to have thyroid surgery. It is elective. You have time to get opinions.

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