It depends on the reason for your surgery. If your thyroid is overactive (hyperthyroid from Graves’ disease or a what’s called a toxic multinodular goiter), or the whole gland is enlarged and causing symptoms—such as a feeling of pressure or difficulty talking, breathing, or swallowing—the whole thyroid should be removed in a procedure called a total thyroidectomy, said Duke endocrine surgeon Michael Stang, MD. “If only half your thyroid is enlarged and causing symptoms, but the other half is normal, then only half of the gland may be removed,” said Stang.
If your thyroid cancer is considered low-risk, your doctor may recommend removing half or all your thyroid, depending on your circumstances. “If you have an intermediate or high risk of cancer recurrence — meaning it has spread outside the thyroid—we recommend removing the whole thyroid gland,” Stang said.
Sophisticated imaging, called ultrasound neck mapping, can help your surgeon determine ahead of time how much of your thyroid and which lymph nodes, if any, need to be removed. While not in use everywhere, neck mapping is routine at Duke. “The best chance for a cure for thyroid cancer is making sure we remove all of the disease in your initial surgery,” said Hadiza S Kazaure, MD. “We don’t want to overtreat, but we also don’t want to undertreat. Knowing exactly how much surgery a patient needs is very important.”