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Thyroid Cancer

Source: www.uchsc.edu
Topic: Thyroid
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Sort Desciption: I was just told that my thyroid nodule biopsy was positive for cancer, what happens now? What can I expect from thyroid surgery? Are there any special risks with thyroid surgery? ...

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I was just told that my thyroid nodule biopsy was positive for cancer, what happens now?
There are four types of thyroid cancer divided into two categories: differentiated (papillary and follicular) and undifferentiated (medullary and anaplastic). 90-95% of all thyroid cancer is differentiated and most is papillary. The main treatment for differentiated thyroid cancer is surgery (removing most of the thyroid gland and any involved lymph nodes), radioactive iodine (discussed below) and thyroid hormone therapy (life-long). Cancer treatments like chemotherapy and external beam irradiation are almost never used.

What can I expect from thyroid surgery?
One of the most important parts of thyroid cancer therapy is the surgery. You need this to be done by a very experienced surgeon. Ask your potential surgeon how many thyroid surgeries they do each year (preferably more than 20) and what is the expected rate of complications. Thyroid surgery is done under general anesthesia and usually takes about two hours. You will be in the hospital for about 2 days and should plan on missing work for about a week to recover. Since most of the thyroid gland is removed, you will need to take thyroid hormone for the rest of your life.

Are there any special risks with thyroid surgery?
Two complications that can occur are damage to the recurrent laryngeal nerve and damage to the parathyroid glands. The recurrent laryngeal nerve runs behind the thyroid gland and makes the vocal cords work. Damage to one nerve can lead to a permanent hoarse voice, while damage to both nerves can lead to breathing problems. The risk of damage to one nerve is about 1-2% in the hands of an experienced surgeon and can be as high as 10- 20% for a less experienced surgeon. The risk of damage to both nerves is practically zero in the hands of a good surgeon. The parathyroid glands (most of us have four) are located just behind the thyroid and can be accidentally removed or damaged during surgery. If one functioning gland remains, it will work just fine. If all glands are removed or damaged, you won't have any parathyroid hormone (PTH), which helps to maintain blood levels of calcium. Low calcium can lead to numbness and muscle cramps which can be quite severe; this can be treated with vitamin D and calcium, but can be difficult to regulate. The risk of permanent damage to your parathyroid glands is about 1-2% in the hands of a good surgeon.

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