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You will be asleep for the operation. The incision is made in a curve in the skin low in the neck. The operation will usually last 2-3 hours. A cosmetic, plastic surgical closure is performed.

 

  • The extent of operation depends on your particular case:
  • There can be removal of only one lobe of the thyroid. This is call a lobectomy (also known as a hemithyroidectomy).
  • Removal of one lobe plus the majority of the opposite lobe is called a subtotal thyroidectomy and is done for hyperthyroidism.
  • near total thyroidectomy is functionally the same as a total thyroidectomy and is performed for cancer.
  • The parathyroid glands are preserved and not purposely removed. On occasion it is necessary to autotransplant a parathyroid gland into a neck muscle. These glands function well after a few weeks of recovery.

Some of the following tests may be done depending on your particular case.

  • Thyroid Function Tests: A blood test to see how your thyroid functions. Your level of thyroid stimulating hormone (TSH) is checked.
  • Ultrasound: Harmless sound waves are aimed at the thyroid gland. This is a painless and convenient way to get a picture of the thyroid. It is often used to guide a biopsy.
  • Biopsy: The best way to determine if a nodule is cancer is to do a fine needle aspiration biopsy (FNA) of the nodule. The skin is prepared and numbed and a needle is inserted into the nodule. Cells from the nodule are removed and examined.
  • Cytology: The FNA biopsy specimen is read by the cytopathologist. Thyroid cytology is classified into one of six categories according to the risk of cancer.
    • After review of the microscopic slides, thyroid nodules can be classified into one of six different categories according to the Bethesda Classification:
      • A benign (noncancerous) result is found in 60-70% of biopsies. 
      • A definite cancer is found in about 5% of biopsies. 
      • Ten percent of nodules may be suspicious for cancer. The final risk of cancer in the group is approximately 75%, but 25% of these nodules will prove to be benign. Thyroid removal is necessary to make a definitive diagnosis. 
      • About 20% of nodules are classified as suspicious for a follicular neoplasm. These neoplasms can be benign (75%) or they can be malignant in approximately 25% of cases. These nodules may be reevaluated with a second fine-needle aspiration (FNA) biopsy for molecular testing or may need to be removed by surgery to make a definitive diagnosis. 
      • Atypical cells of undetermined significance or follicular cells of undetermined significance is the result in 10-15% of cases. This category is associated with a 5-30% risk of cancer. As with follicular neoplasms, these nodules may be reevaluated by molecular testing, repeat FNA biopsy in 3-4 months, or surgical removal for definitive diagnosis. 
      • Inadequate biopsies, from which no diagnosis can be made, are rare. These nodules need repeat biopsy.
  • Molecular Testing: At the University of Colorado Hospital, doctors in our Thyroid Tumor Program have developed two types of molecular tests to reduce unnecessary operations and decrease the chance that a patient with thyroid cancer will need a second operation.
    • The best way to determine if a thyroid nodule is cancerous is to do a fine needle aspiration biopsy (FNA) of the nodule. The FNA biopsy specimen is read by the cytopathologist.
    • The results of the biopsy are classified int. Two of these categories, in particular, can be problematic:
      • About 20% of nodules are classified as suspicious for a follicular neoplasm (SFN). These neoplasms can be either benign (75% of cases) or malignant (25% of cases).
      • About 10-15% of nodules are classified as atypical cells of undetermined significance (ACUS) or follicular lesion of undetermined significance (FLUS). This category is associated with a 5-30% risk of cancer.
    • Until 2011, patients with these indeterminate results from thyroid nodule biopsies either had to undergo diagnostic surgery to make a definitive diagnosis or were monitored closely. With an average risk of cancer at about 20%, many patients underwent unnecessary diagnostic operations. On the other hand, the rate of cancer in these indeterminate nodules was unacceptably high to simply monitor in most patients. Many doctors and patients felt stuck.
    • At the University of Colorado Hospital, doctors in our Thyroid Tumor Program have been working hard to develop and bring two types of molecular tests into clinical use to reduce unnecessary operations and decrease the chance that a patient with thyroid cancer in an indeterminate thyroid nodule will need a second operation.
  • Genomic Test
    • The first test is a ‘genomic’ test called the Afirma® Gene Expression classifier (Veracyte, Inc.).  This test uses a pattern of RNA expression from a needle biopsy to distinguish benign nodules which do not need surgery from suspicious nodules that need surgery. 
    • We typically use this test on patients with indeterminate biopsies in the atypical (AUS/FLUS) or neoplasm (FN/SFN) categories.
    • A benign Afirma result has a 95% accuracy rate and allows us to safely avoid a diagnostic operation. These nodules are monitored for growth or other changes.
    • A suspicious result is associated with a 40-50% risk of thyroid malignancy, which means a thyroidectomy will be necessary.
    • Since implementing use of this test, we have reduced the number of unnecessary thyroid surgeries by 50%.
  • Genetic Test
    • The second test is a ‘genetic’ test that looks for mutations in several genes know to be altered in thyroid cancer.  This test is marketed by different laboratories, with the most commonly used test being miRInform® (Asuragen Corp).  If the test is positive, we can be fairly certain that a patent with an indeterminate biopsy has a thyroid cancer.
    • We generally use this test for patients who have indeterminate nodules and are likely to opt for diagnostic surgery for various reasons (e.g., suspicious features on ultrasound, large nodules, or patient preference). The test results help guide the type of surgery. If the mutation test is negative, it may be worth considering removing only half of the thyroid, preserving the other half. If the mutation test is positive, we recommend removing the entire thyroid
  • Thyroid Uptake and Scan: A small amount of radioactive iodine solution is ingested. The radioactive material is taken up by the thyroid, allowing a scanner to take pictures of the thyroid. This test also determines if the thyroid is overactive, normal, or underactive. It is most commonly used in evaluation of patients with hyperthyroidism.

This information is provided by the Department of Surgery at the University of Colorado School of Medicine. It is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.