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The steps before and after surgery are explained by Stavros Tsirigotakis, director of Iasso's Thyroid Surgery department

Stavros Tsirigotakis
13 Apr, 2023

As soon as you are told that you have one or more thyroid nodules, do not panic that you may have cancer, because only about 10% of nodules are malignant. Even in the minority of cases, thyroid malignancy can be treated with surgery, which is the mainstay of treatment.

Stavros Tsirigotakis, director of Iasso's Thyroid Surgery department, speaks to Documento as a specialist in thyroid cancer surgery.


Basic types and accurate diagnosis

There are four main types of thyroid cancer. About 95% of the types are either papillary or follicular thyroid cancer, and patients diagnosed with these types usually have a good prognosis. These types may have a subtype that makes the disease more aggressive and requires extensive intervention. It is good to go to a specialized center, because it is possible that you will need a reoperation once you know the diagnosis of the histological examination a few days after the surgery.

The remaining 5% of thyroid malignancies are myeloid cancer and anaplastic cancer. The latter is the worst form of malignancy that can appear in man. It is much more aggressive and unfortunately surgery and treatment only have a palliative role.

The type of surgery will be based on a risk assessment that includes your history, tumor pathology, size and location. The simplest is a lobectomy, in which half of the thyroid gland is removed, but this is done very rarely.


In case a tumor is more likely to spread, a total thyroidectomy, i.e. removal of the entire thyroid gland, must be performed. If it has spread to the surrounding lymph nodes, more extensive surgery (lymph node cleansing) will definitely be needed. Possible spread there can only be seen if you undergo a specialized ultrasound (mapping). Unfortunately, there are not a few cases where a patient with a diagnosis of thyroid cancer is not checked for the possibility of the presence of infiltrated lymph nodes, with the result that after a while a repeat operation is needed.

In rare cases, thyroid cancers can spread to other important organs of the neck, thus potentially requiring more complex operations.


What the patient needs to know

When you talk to your surgeon it is good to know how many related surgeries he does each year. The most experienced perform more than 100 per year. Ask how many of his newly diagnosed patients need a second surgery within a year – the rate should be less than 1%. If a suspicious lymph node is present during the procedure, it should be sent for a rapid biopsy.

In addition, your surgeon must work closely with the endocrinologist, radiologist, cytologist, pathologist, and nuclear surgeon. This minimizes surprises during surgery and afterwards.

Every patient's recovery is different. It usually takes two to three days, a few may take a week. Everyone can talk immediately after the procedure and eat a few hours later. The incision for a normal-sized thyroid will be about 3cm and will look like a natural fold in the neck. However, it depends on the dimensions of the thyroid, as it differs in an overweight patient with a very short neck or in one who needs lymph node cleansing.

If half of your thyroid gland is removed (lobectomy), the remaining one can produce enough hormone to regulate your metabolism. If you have it completely removed, you will need to take a thyroid hormone pill every day for the rest of your life. Many times, however, patients with half a thyroid are also required to take a thyroid hormone replacement pill.


Surgery as a solution

Except for the most aggressive thyroid cancers, such as anaplastic, the rest usually grow slowly. Even when it has spread to the lymph nodes, there is generally no need for surgery on the same day. So take the time to find the right thyroid surgeon at the right thyroid surgery center for the right procedure the first time.

The thyroid cancer center must have teams that study every aspect of the disease, which gives the patient access to the most up-to-date and specialized tests, to excellent and personalized surgery and to the most modern care. Regardless of the type of thyroid cancer, only a specialized team can help the patient to ensure that they have an accurate diagnosis, a well-studied surgical plan, an excellent surgical procedure that reduces the chances of complications, the chances of recurrence and the need for additional surgery.


A not rare case

One month before coming to the Thyroid Surgery department of Iasso, this particular patient had undergone removal of half of the thyroid (lobectomy). In the control after the operation, a lymph node with cancer was seen, but in the specialized ultrasound, cancer was also seen in the remaining lobe. During the surgery we performed removal of the remaining thyroid and lymph node cleansing. This unfortunately does not happen rarely.


Photo sasint  / https://pixabay.com


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